'Le regard des autres': the experience of walking in social environments as a person with Parkinson's disease.

OBJECTIVE: To examine the experience of people with Parkinson's disease when walking in different social situations, and improve understanding of how this affects participation in meaningful activity. METHODS: A convenience sample of fourteen people with Parkinson's disease and a history of gait dysfunction was recruited. In-depth interviews and direct observations were conducted in the participants' home environments. Specific examples from community mobility were reviewed using first person interviewing techniques with the support of video footage. Interview transcripts were analyzed using an interpretive phenomenological approach to derive key themes. RESULTS: The feeling of 'being looked at' (le regard des autres) was the central theme in participant discourse. This sentiment was inextricably linked to the given norms of the social setting, and the relationships between participants and others within that environment. Participants sought to manage how they were perceived by others through modification of posture/gait patterns; disclosure of their neurological disease; and avoidance/withdrawal from social situations. CONCLUSION: Further to the functional aspects of mobility, gait is important for maintaining self-image in people with Parkinson's disease. Affective gaze interactions have significant consequences upon participation restriction. These findings underscore the interest of activities which strengthen self-image and validate movement diversity in PD rehabilitation.

Patterns of bidirectional communication between cortex and basal ganglia during movement in patients with Parkinson disease.

Cortico-basal ganglia networks are considered to comprise several parallel and mostly segregated loops, where segregation is achieved in space through topographic connectivity. Recently, it has been suggested that functional segregation may also be achieved in the frequency domain, by selective coupling of related activities at different frequencies. So far, however, any coupling across frequency in the human has only been modeled in terms of unidirectional influences, a misplaced assumption given the looped architecture of the basal ganglia, and has been considered in static terms. Here, we investigate the pattern of bidirectional coupling between mesial and lateral cortical areas and the subthalamic nucleus (STN) at rest and during movement, with and without pharmacological dopaminergic input, in patients with Parkinson's disease. We simultaneously recorded scalp electroencephalographic activity and local field potentials from depth electrodes and deduced patterns of directed coherence between cortical and STN levels across three frequency bands [sub-beta (3-13 Hz), beta (14-35 Hz), gamma (65-90 Hz)] in the different states. Our results show (1) asymmetric bidirectional coupling between STN and both mesial and lateral cortical areas with greater drives from cortex to STN at frequencies <35 Hz, (2) a drop of beta band coupling driven from mesial cortex to STN during movement, and (3) an increase in symmetrical bidirectional drives between STN and mesial cortex and in lateral cortical drive to STN in the gamma band after dopaminergic therapy. The results confirm a bidirectional pattern of cortico-basal ganglia communication that is differentially patterned across frequency bands and changes with movement and dopaminergic input.

"The whole perimeter is difficult": Parkinson's disease and the conscious experience of walking in everyday environments.

Purpose: This study sought to characterize the way patients with Parkinson's disease consciously perceive and respond to their surroundings while walking in everyday situations.Method: A qualitative research program designed around an ecological data collection protocol was employed. A convenience sample of 14 patients with a diagnosis of Parkinson's disease and a history of gait difficulties were recruited. Details regarding patients' subjective experience of walking in everyday environments were obtained using first person interviewing techniques with the support of video footage from their daily-life activity. Interview transcripts were analyzed using an interpretive phenomenological approach in order to derive key themes.Results: The sense of proximity and the way in which an individual perceived themselves with respect to their surroundings appeared central to the way patients organized their locomotor behavior. Further to this, the patient relationship to different features and obstacles appeared conditioned by prior experiences in those circumstances. Patients described managing gait difficulties by consciously regulating their walking trajectory and gaze with respect to their environment.Conclusion: Perceptual challenges, visual flow and the dynamic valence of features in the patient's surroundings may have important effects upon the gait stability of patients with Parkinson's disease and warrant further attention in planning rehabilitation interventions.Implications for rehabilitationWalking abilities of patients with Parkinson's disease should be conceptualized in terms of perceptuomotor coupling to a given environment.The functional significance of a patient's environment is dynamic and might be seen to vary in accordance with their physical capacities.Valency, or the subjective relationship between a patient and their surrounds, appears to be an important component of the "fit" between a person and their environment.Novel rehabilitation strategies for the management of parkinsonian gait disturbances might seek to integrate psychological, sensorimotor and environmental elements in order to have individually tailored, ecologically valid home assessment and community rehabilitation programs.

Existing motor state is favored at the expense of new movement during 13-35 Hz oscillatory synchrony in the human corticospinal system.

Oscillations in local field potentials in the beta-frequency band (13-35 Hz) are a pervasive feature of human and nonhuman primate motor cortical areas. However, the function of such synchronous activity across populations of neurons remains unknown. Here, we test the hypothesis that beta activity may promote existing motor set and posture while compromising processing related to new movements. Three experiments were performed. First, healthy subjects were instructed to make reaction time movements of the outstretched index finger in response to imperative cues triggered by transient increases in corticospinal synchrony, as evidenced by phasic elevations of beta-frequency band microtremor and intermuscular synchrony. Second, healthy subjects were instructed to resist a stretch to the index finger triggered in the same way. Finger acceleration in the reaction time task and transcortical components of the stretch reflex were measured and compared with those elicited by random cue or stretch presentation. Finally, we sought a correlation between finger acceleration in the reaction time task and cortical synchrony directly measured from the electrocorticogram in two patients undergoing functional neurosurgery. We demonstrate that movements are slowed and transcortical responses to stretch are potentiated during periods of elevated beta-band cortical synchrony. The results suggest that physiological periods of beta synchrony are associated with a cortical state in which postural set is reinforced, but the speed of new movements impaired. The findings are of relevance to Parkinson's disease, in which subcortical and cortical beta-band synchronization is exaggerated in the setting of increased tone and slowed movements.

Late event-related potentials and movement complexity in young adults with Down syndrome.

OBJECTIVES: Through event-related potential (ERP) recording, to better understand the perceptive-motor slowness in adults with Down syndrome (DS); in particular, to assess whether motor preparation influences the speed of allocation of perceptual attention as reflected by the P3 latency. PATIENTS AND METHODS: ERPs were obtained in adults with and without DS through an auditory oddball paradigm under a passive and two active (simple vs. complex motor response) conditions. Reaction times (RTs) were recorded in the two active conditions. RESULTS: There was no influence of movement complexity on either RT or P3b latency in the control group. In the DS group, RT was delayed under simple vs. complex conditions whereas P3b latency was not affected. N2a and N2b were often missing in DS individuals. CONCLUSION: Motor preparation processes per se rather than interaction with perceptual attention could be defective in individuals with DS when the motor component of the response is minimal.

Phasic increases in cortical beta activity are associated with alterations in sensory processing in the human.

Oscillatory activity in the beta (beta)-frequency band (13-35 Hz) can be recorded over the sensorimotor cortex in humans. It is coherent with electromyographic activity (EMG) during tonic contraction, but whether the cortical beta-oscillations are primarily motor or sensorimotor in function remains unclear. We tested the hypothesis that cortical beta-activity is associated with an up-regulation of sensory inputs that may be relevant to the organization of the motor response. We recorded cortical somatosensory potentials (SEPs) elicited by electrical stimuli to the median nerve at the wrist triggered by increases of electroencephalographic (EEG) beta-activity in the contralateral fronto-central EEG and compared these to SEPs presented at random intervals. The involvement of motor cortex in the triggering EEG activity was confirmed by a simultaneous elevation of cortico-spinal synchrony in the beta-band. The negative cortical evoked potential peaking at 20 ms and the positive evoked potential peaking at 30 ms after median nerve shocks were increased in size when elicited after phasic increases in beta-activity. The functional coupling of sensory and motor cortices in the beta-band was confirmed in recordings of electrocorticographic activity in two patients with chronic pain syndromes, suggesting a means by which beta-activity may simultaneously influence cortical sensory processing, motor output and promote sensory-motor interaction.