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      Effects of Galvanic Vestibular Stimulation on Upper and Lower Extremities Motor Symptoms in Parkinson’s Disease

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          Abstract

          As a neurodegenerative movement disorder, Parkinson’s disease (PD) is commonly characterized by motor symptoms such as resting tremor, rigidity, bradykinesia, and balance and postural impairments. While the main cause of PD is still not clear, it is shown that the basal ganglia loop, which has a role in adjusting a planned movement execution through fine motor control, is altered during this disease and contributes toward the manifested motor symptoms. Galvanic vestibular stimulation (GVS) is a non-invasive technique to influence the vestibular system and stimulate the motor system. This study explores how the motor symptoms of upper and lower extremities in PD are instantly affected by vestibular stimulation. In this regard, direct current GVS was applied to 11 individuals with PD on medication while they were performing two sets of experiments: (1) Instrumented Timed Up and Go (iTUG) test and (2) finger tapping task. The performance of participants was recorded with accelerometers and cameras for offline processing of data. Several outcome measures including coefficient of variation of the step duration, gait phase, phase coordination index, tapping score, and the number and duration of manual motor blocks (MMBs) were considered for objective quantifying of performance. Results showed that almost all of considered outcome measures were improved with the application of GVS and that the improvement in the coefficient of variation of the step duration, the tapping score, and the number of MMBs was statistically significant ( p-value < 0.05). The results of this study suggest that GVS can be used to alleviate some of the common motor symptoms of PD. Further research is required to fully characterize the effects of GVS and determine its efficacy in the long term.

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          Most cited references28

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          Dual tasking, gait rhythmicity, and Parkinson's disease: which aspects of gait are attention demanding?

          Cognitive function and the performance of a secondary, dual task may affect certain aspects of gait, but the relationships between cognitive function and gait are not well understood. To better understand the motor control of gait and the relationship between cognitive function and gait, we studied cognitive function and the effects of different types of dual tasking on the gait of patients with Parkinson's disease (PD) and controls, contrasting measures of gait automaticity and rhythmicity with other features. Patients with idiopathic PD (n=30; mean age 71.8 year) with moderate disease severity (Hoehn and Yahr Stage 2--3) were compared to age and gender-matched healthy controls (n=28). Memory and executive function were also assessed. In both groups, gait speed decreased in response to dual tasking, in a parallel fashion. For the PD group only, gait variability increased compared to usual walking. Executive function was significantly worse in the PD group, while memory was not different in the two groups. Executive function measures were significantly correlated with gait variability during dual tasking, but not during usual walking. These findings demonstrate that regulation of gait variability and rhythmicity is apparently an automatic process that does not demand attention in healthy adults. In patients with PD, however, this ability becomes attention-demanding and worsens when subjects perform secondary tasks. Moreover, the associations between executive function and gait variability suggest that a decline in executive function in PD may exacerbate the effects of dual tasking on gait, potentially increasing fall risk.
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            Ambulatory monitoring of freezing of gait in Parkinson's disease.

            Freezing of gait (FOG) is common in advanced Parkinson's disease (PD), is resistant to treatment and negatively impacts quality of life. In this study an ambulatory FOG monitor was validated in 11 PD patients. The vertical linear acceleration of the left shank was acquired using an ankle-mounted sensor array that transmitted data wirelessly to a pocket PC at a rate of 100 Hz. Power analysis showed high-frequency components of leg movement during FOG in the 3-8 Hz band that were not apparent during volitional standing, and power in this 'freeze' band was higher (p=0.00003) during FOG preceded by walking (turning or obstacles) than FOG preceded by rest (gait initiation). A freeze index (FI) was defined as the power in the 'freeze' band divided by the power in the 'locomotor' band (0.5-3 Hz) and a threshold chosen such that FI values above this limit were designated as FOG. A global threshold detected 78% of FOG events and 20% of stand events were incorrectly labeled as FOG. Individual calibration of the freeze threshold improved accuracy and sensitivity of the device to 89% for detection of FOG with 10% false positives. Ambulatory monitoring may significantly improve clinical management of FOG.
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              A new measure for quantifying the bilateral coordination of human gait: effects of aging and Parkinson's disease.

              The bilateral coordination of locomotion has been described in detail in animal studies and to some degree in man; however, the mechanisms that contribute to the bilateral coordination of gait in humans are not fully understood. The objective of the present study was to develop a measure for quantifying the bilateral coordination of gait and to evaluate the effects of aging and Parkinson's disease (PD) on this new metric. To this end, we compared the gait of healthy older adults to that of healthy young adults and patients with PD. Specifically, we defined the stride duration of one foot as a gait cycle or 360 degrees , determined the relative timing of contra-lateral heel-strikes, and defined this as the phase, varphi (ideally, varphi = 180 degrees for every step). The sum of the coefficient of variation of varphi and the mean absolute difference between varphi and 180 degrees was defined as the phase coordination index (PCI), representing variability and inaccuracy, respectively, in phase generation. PCI values were higher (poorer bilateral coordination) in patients with PD in comparison to the healthy older adults (P < 0.006). Although gait speed and stride time variability were similar in the healthy young and older adults, PCI values were significantly higher among the healthy elderly subjects compared to the young adults (P < 0.001). Regression analysis suggests that only about 40% of the variance in the values of PCI can be explained by the combination of gait asymmetry (as defined by the differences in each leg's swing times), gait speed and stride time variability, pointing to the independent nature of this new metric. This study demonstrates that bilateral coordination of gait deteriorates with aging, further deteriorates in PD, and is not strongly associated with other spatio-temporal features of gait.
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                Author and article information

                Contributors
                Journal
                Front Neurosci
                Front Neurosci
                Front. Neurosci.
                Frontiers in Neuroscience
                Frontiers Media S.A.
                1662-4548
                1662-453X
                11 September 2018
                2018
                : 12
                : 633
                Affiliations
                [1] 1Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University , Burnaby, BC, Canada
                [2] 2ETH Zürich , Zurich, witzerland
                Author notes

                Edited by: Antonio Oliviero, Fundación del Hospital Nacional de Parapléjicos, Spain

                Reviewed by: Michele Dileone, Centro Integral en Neurociencias A.C. HM, Spain; Hiroshi Kataoka, Nara Medical University, Japan

                *Correspondence: Carlo Menon, cmenon@ 123456sfu.ca

                This article was submitted to Neurodegeneration, a section of the journal Frontiers in Neuroscience

                Article
                10.3389/fnins.2018.00633
                6141687
                f3b82e43-46c9-4e4a-9b7a-1d5ffafca7fb
                Copyright © 2018 Khoshnam, Häner, Kuatsjah, Zhang and Menon.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 03 May 2018
                : 23 August 2018
                Page count
                Figures: 4, Tables: 6, Equations: 0, References: 32, Pages: 10, Words: 0
                Categories
                Neuroscience
                Original Research

                Neurosciences
                parkinson’s disease,galvanic vestibular stimulation,itug test,gait analysis,finger tapping task

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