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      Validation of 24-hour ambulatory gait assessment in Parkinson's disease with simultaneous video observation

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          Abstract

          Background

          Parkinson's disease (PD) is a neurodegenerative disorder resulting in motor disturbances that can impact normal gait. Although PD initially responds well to pharmacological treatment, as the disease progresses efficacy often fluctuates over the course of the day, and clinical management would benefit from long-term objective measures of gait. We have previously described a small device worn on the shank that uses acceleration and angular velocity sensors to calculate stride length and identify freezing of gait in PD patients. In this study we extend validation of the gait monitor to 24-h using simultaneous video observation of PD patients.

          Methods

          A sleep laboratory was adapted to perform 24-hr video monitoring of patients while wearing the device. Continuous video monitoring of a sleep lab, hallway, kitchen and conference room was performed using a 4-camera security system and recorded to hard disk. Subjects (3) wore the gait monitor on the left shank (just above the ankle) for a 24-h period beginning around 5 pm in the evening. Accuracy of stride length measures were assessed at the beginning and end of the 24-h epoch. Two independent observers rated the video logs to identify when subjects were walking or lying down.

          Results

          The mean error in stride length at the start of recording was 0.05 m (SD 0) and at the conclusion of the 24 h epoch was 0.06 m (SD 0.026). There was full agreement between observer coding of the video logs and the output from the gait monitor software; that is, for every video observation of the subject walking there was a corresponding pulse in the monitor data that indicated gait.

          Conclusions

          The accuracy of ambulatory stride length measurement was maintained over the 24-h period, and there was 100% agreement between the autonomous detection of locomotion by the gait monitor and video observation.

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          Most cited references 19

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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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            Marching to the beat of the same drummer: the spontaneous tempo of human locomotion.

            Laboratory studies have suggested that the preferred cadence of walking is approximately 120 steps/min, and the vertical acceleration of the head exhibits a dominant peak at this step frequency (2 Hz). These studies have been limited to short periods of walking along a predetermined path or on a treadmill, and whether such a highly tuned frequency of movement can be generalized to all forms of locomotion in a natural setting is unknown. The aim of this study was to determine whether humans exhibit a preferred cadence during extended periods of uninhibited locomotor activity and whether this step frequency is consistent with that observed in laboratory studies. Head linear acceleration was measured over a 10-h period in 20 subjects during the course of a day, which encompassed a broad range of locomotor (walking, running, cycling) and nonlocomotor (working at a desk, driving a car, riding a bus or subway) activities. Here we show a highly tuned resonant frequency of human locomotion at 2 Hz (SD 0.13) with no evidence of correlation with gender, age, height, weight, or body mass index. This frequency did not differ significantly from the preferred step frequency observed in the seminal laboratory study of Murray et al. (Murray MP, Drought AB, and Kory RC. J Bone Joint Surg 46A: 335-360, 1964). [1.95 Hz (SD 0.19)]. On the basis of the frequency characteristics of otolith-spinal reflexes, which drive lower body movement via the lateral vestibulospinal tract, and otolith-mediated collic and ocular reflexes that maintain gaze when walking, we speculate that this spontaneous tempo of locomotion represents some form of central "resonant frequency" of human movement.
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              Levodopa in the treatment of Parkinson’s disease: an old drug still going strong

              After more than 40 years of clinical use, levodopa (LD) remains the gold standard of symptomatic efficacy in the drug treatment of Parkinson’s disease (PD). Compared with other available dopaminergic therapies, dopamine replacement with LD is associated with the greatest improvement in motor function. Long-term treatment with LD is, however, often complicated by the development of various types of motor response oscillations over the day, as well as drug-induced dyskinesias. Motor fluctuations can be improved by the addition of drugs such as entacapone or monoamine oxidase inhibitors, which extend the half-life of levodopa or dopamine, respectively. However, dyskinesia control still represents a major challenge. As a result, many neurologists have become cautious when prescribing therapy with LD. This review summarizes the available evidence regarding the use of LD to treat PD and will also address the issue of LD delivery as a critical factor for the drug’s propensity to induce motor complications.
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                Author and article information

                Journal
                Biomed Eng Online
                BioMedical Engineering OnLine
                BioMed Central
                1475-925X
                2011
                21 September 2011
                : 10
                : 82
                Affiliations
                [1 ]Human Aerospace Laboratory, Department of Neurology, Mount Sinai School of Medicine, New York NY 10029, USA
                [2 ]Robert and John M. Bendheim Parkinson and Movement Disorders Center, Department of Neurology, Mount Sinai School of Medicine, New York NY 10029, USA
                [3 ]School of Psychology, University of Sydney, Sydney, Australia
                Article
                1475-925X-10-82
                10.1186/1475-925X-10-82
                3184280
                21936884
                Copyright ©2011 Moore et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research

                Biomedical engineering

                accelerometry, stride length, levodopa, motor fluctuations, parkinsonian

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