Variability of Anticipatory Postural Adjustments During Gait Initiation in Individuals With Parkinson Disease

Lin, Ching‐Heng; Creath, Robert A.; Rogers, Mark W.

doi:10.1097/npt.0000000000000112

Cited by 32 publications

(31 citation statements)

References 42 publications

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“…To our knowledge, there are few studies where the regularity of APAs were found to be modified. Lin et al 51 found an increased variability of APAs in patients with Parkinson'’s disease during gait initiation, which may affect their posture-locomotion coupling and lead to start hesitation and even falls. Also, the variability of APA onset times was decreased in people with chronic low back pain at acute and chronic stage 52 53 and this was unrelated with the participants’ reported levels of pain or disability.…”

Section: Discussionmentioning

confidence: 99%

Inconsistent anticipatory postural adjustments (APAs) in rugby players: a source of injuries?

Wang

Mahé

Fang

et al. 2018

BMJ Open Sport Exerc Med

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BackgroundWe are developing since 2010 with Thales and the Fédération Française de Rugby (FFR) M-Rex, a new kind of rugby scrum simulator. The study questioned whether it could improve safety and protect players from injury by using it as a tool for training/coaching the packs.AimTo explore the anticipatory postural adjustments (APAs) during the engagement of the ruck, because these predictive neck and back muscles contractions protect the spinal cord at the time of impacts, which is crucial to prevent injuries.MethodsWe quantified the kinematics and the EMG activities in high-level front row players during their initial engagement, when scrummaging with M-Rex. All studies were performed with one player interacting with the robot, at first, and then with the three players acting together.ResultsFor most of the tested high-level players, the APA latencies were highly variable from trial to trial even though the engagement resulted in similar impacts. At time, the onset of the electromyography activity in the neck and back muscles showed latencies inferior to 50 ms or even close to zero prior to the impact, which rendered muscle contractions inefficient as APAs. We were also unable to identify clear muscular synergies underlying the APAs because of their great variability on a trial-to-trial basis. Finally, the APAs were not related to the amplitude of the ensuing impact and were asymmetric in most trials. All these characteristics held true, whether the player was playing alone or with two other frontline players.ConclusionOur result suggest that APAs should be systematically tested in high-level rugby players as well as in any high-level sport men at risk of neck and back injuries. Because APAs can be efficiently trained, our study paves the way to design individual position-specific injury prevention programme.

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Section: Discussionmentioning

confidence: 99%

Inconsistent anticipatory postural adjustments (APAs) in rugby players: a source of injuries?

Wang

Mahé

Fang

et al. 2018

BMJ Open Sport Exerc Med

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“…This result is consistent with the idea that PD leads to a reduced ability to release inhibition of the step when the APA has been initiated ( Boulinguez et al, 2009 ; Cohen et al, 2014 ). The resulting decoupling between the APA and the step could lead to start hesitation ( Jacobs et al, 2009 ; Delval et al, 2014a ; Lin et al, 2016 ). This line of thinking is supported by recent neuroimaging evidence that freezing episodes are associated with functional decoupling between the cognitive control network and the basal ganglia network ( Shine et al, 2013 ) and is in general agreement with a recent review suggesting that freezing of gait is likely due to a combination of cognitive and decoupling factors ( Nieuwboer and Giladi, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

Recovery from Multiple APAs Delays Gait Initiation in Parkinson’s Disease

Cohen

Nutt

Horak

2017

Front. Hum. Neurosci.

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Background: Freezing of gait in Parkinson’s disease (PD) has been linked with deficits in inhibitory control, but causal mechanisms are not established. Freezing at gait initiation (start hesitation) is often accompanied by multiple anticipatory postural adjustments (APAs). If inhibition deficits contribute to freezing by interfering with ability to inhibit initial weight shifts in the wrong direction, then PD subjects should experience more episodes of multiple APAs than healthy controls (HCs) do. If inhibition deficits contribute to freezing by interfering with ability to release a previously inhibited step following multiple APAs, then step onset following multiple APAs should be delayed more in people with PD than in HCs.Methods: Older adults with PD and HC subjects rapidly initiated stepping in response to a light cue in blocks of simple (SRT) and choice (CRT) conditions. We recorded kinematics and ground reaction forces, and we administered the Stroop task to assess inhibitory control.Results: Multiple APAs were more common in CRT than SRT conditions but were equally common in HC and PD subjects. Step onsets were delayed in both conditions and further delayed in trials with multiple APAs, except for HC subjects in SRT trials. Poor Stroop performance correlated with many multiple APAs, late step onset, and rearward position of center of mass (COM) at cue presentation. Forward motion of the COM during the APA was higher in trials with multiple APAs than in trials with single APAs, especially in CRT trials and in PD subjects without self-reported freezing.Conclusion: Start hesitation is not caused by multiple APAs per se, but may be associated with difficulty recovering from multiple APAs, due to difficulty releasing a previously inhibited step.

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“…The specific mechanisms through which dance may improve balance have yet to be elucidated. In 2016, McKay et al conducted the first study to evaluate automatic postural responses using kinematic and electromyographic outcome measures before and after an adapted tango program, which showed a reduction of forward center of mass displacement and delayed antagonist onset time and duration (measured using EMG) after three weeks of a high volume tango intervention (450 minutes/week) [6]. This uncontrolled study demonstrated that further research investigating the effects of dance on postural control using kinematic and electromyographic outcome measures is warranted and feasible.…”

Section: Motor Symptomsmentioning

confidence: 99%

The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis

2020

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Dance may help individuals living with Parkinson's disease (PD) improve motor and nonmotor symptoms that impact quality of life (QOL). The primary aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy of dance in improving motor and non-motor symptoms of PD and QOL. The secondary aims of this review were to evaluate the methodological quality of included studies by assessing risk of bias across nine categories and to inform the direction of future research. Peer-reviewed RCTs that included people living with PD at all disease stages and ages and measured the effects of a dance intervention longer than one day were included. Sixteen RCTs involving 636 participants with mild to moderate PD were eligible for inclusion in the qualitative synthesis and nine in the meta-analysis. Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.

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Variability of Anticipatory Postural Adjustments During Gait Initiation in Individuals With Parkinson Disease

Cited by 32 publications

References 42 publications

Inconsistent anticipatory postural adjustments (APAs) in rugby players: a source of injuries?

Inconsistent anticipatory postural adjustments (APAs) in rugby players: a source of injuries?

Recovery from Multiple APAs Delays Gait Initiation in Parkinson’s Disease

The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis

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