Parkinson's Disease

Metrics of multi-muscle synergies in Parkinson’s disease: Analysis of variance and motor equivalence

Over the past years, we have developed a test for postural stability based on the theory of synergies stabilizing salient performance variables. In this study, effects of Parkinson's disease (PD) and dopamine-replacement therapy on multi-muscle synergies stabilizing the center of pressure (COP) coordinate were explored between: (1) a cohort of 11 patients without clinically identifiable postural problems (Hoehn-Yahr stage II) and 11 age-matched controls, and (2) a cohort of 10 patients tested off- and on-medication, with and without postural problems (stage II and III, n = 5 per stage). Participants stood on a force platform and performed cyclical body sway at 0.5 Hz along the anterior-posterior direction. Electromyographic signals from 13 leg and trunk muscles were used to compute: (1) the amount of inter-cycle variance that did not affect (VUCM) and affected (VORT) COP coordinate, and (2) the magnitude of the cycle-to-cycle motion that did not change (motor equivalent: ME) and changed (non-motor equivalent: nME) the COP coordinate. We hypothesized that both methods would produce indices sensitive to PD and dopaminergic medications. Compared to controls, patients showed significantly smaller inter-cycle VUCM and ME components suggesting a less flexible, and hence less stable, behavior. Moreover, inter-cycle variance within/orthogonal to the UCM correlated with ME/nME displacements. Results suggest clinical utility of variance and motor equivalence analyses of postural instability in early stages of PD and quantifying the effects of dopamine-replacement drugs. The analysis of motor equivalence is particularly attractive because it requires only a handful of trials (observations).
Listed In: Neuroscience

Dance May Improve Quality of Life But Not Gait in Individuals with Parkinson’s Disease

Purpose: Research supports the use of ballroom dance to improve balance in individuals with Parkinson’s disease (PD). This study used the Mark Morris Dance for PD program as a template for dance classes to examine the effects of dance on gait, balance, and quality of life in individuals with PD. Subjects : Eleven individuals with mild to moderate PD participated in the study. Methods : A trained instructor led dance classes for subjects once a week for 12 weeks. Participants were encouraged to use the Mark Morris Dance for PD At Home DVD twice a week for 45 minutes. Classes included a 20 min. seated warm up; a 20 min. supported standing portion focused on balance and strength; and 30 min. partnered movements for swing, shag, or tango. Data collected before and after the intervention included gait parameters (Protokinetics Zeno walkway), sway area (AMTI force platform) during mCTSIB, Mini-BESTest, Falls Efficacy Scale, Apathy Scale and PDQ-39. A paired-samples t-test was performed. Results : Participants had significant decrease in apathy following the intervention (P = 0.018). A significant decrease in the percentage of the double support phase of gait indicated individuals spent less time with both feet in contact with the ground (P = 0.019). Conclusions : An instructor-led dance class based on the Dance for PD program once per week for 12 weeks improved certain aspects of quality of life, but not necessarily gait and balance. Further research with increased frequency of supervised dance classes is indicated.
Listed In: Gait, Neuroscience, Physical Therapy

Auditory Cues on Postural Control in Parkinson's Disease: A Pilot Study

Objective: To evaluate the effect of auditory cues toward postural control in patients with Parkinson's disease (PD). Background: Auditory cues have been proved to be one of rehabilitation strategies for PD [1]. Most of Parkinson's Disease patients present postural instabilities regarding the severity of the disease [2, 3]. Rhythmic Auditory Stimulation (RAS) has been justified to be a standardized neurological motor therapy (NMTs) in PD, which cue-ing benefits may be associated with the activation of cerebellum-thalamic-cortical circuitry [4]. A potential method to stimulate the putamen that might help regulate PD brain's circuits could be providing music as a rhythmical cue [4]. A distinct manifestation in PD is also the arm swing reduction [5] which limits the capability of maintaining balance. It is rare to explore the static standing balance in Parkinson's Disease. Methods: 5 idiopathic PD patients (5 female) aged 72.6 ± 2.51 years, duration of the disease 15 ± 1.22 years (mean ± SD), H&Y 2.5-3 participated in this study. They were recruited from Yawata Medical Center, Ishikawa, Japan in June and November, 2014. The subjects were instructed to stand on the balance platform (Nintendo Wii Fit) and swing arm; Alternation (Alt) and Synchronization (Syn) in 3 scenarios; with no auditory cues (AC), with AC 5% increased and with AC 5 % decreased. The data were analyzed by Wilcoxon Signed Ranks Test and the dimensional clustering method [6] on MATLAB. Results: Tempo at 95% improved area, RMS and Min ML in Alternation, and decreased the path length in rest 2. Tempo at 105% decreased area and RMS in rest 2 statistically significant. A case with H&Y stage 3 showed poorer postural control in both Antero-Posterior (AP) and Medio-Lateral (ML) directions. Most cases presented the higher Center of Pressure (CoP) displacement in ML direction. AC with arm swing regulated the pattern of CoP trajectories. Conclusions: Auditory cues with arm swing - Alternation improved postural control in the PD patients. This concept might be considered clinically to be a rehabilitation program for Parkinson's disease (PD) to improve standing balance. It is a need to enlarge the sample size and develop more rehabilitation programs for improving balance in PD.
Listed In: Physical Therapy, Posturography