Biomechanical analysis of sit-to-walk in different Parkinson's disease subtypes.

BACKGROUND: The Parkinson's disease Postural Instability and Gait Difficulty subtype is well-known to exhibit higher levels of gait and postural instability and higher frequency of falls. However, no studies have investigated the impact of Parkinson's disease subtypes when performing a highly-challenging postural task, such as sit-to-walk. This task is often used daily and can highlight balance impairments. Thus, the aim of this study was to compare Tremor Dominant and Postural Instability and Gait Difficulty subtypes during sit-to-walk measured by performance, kinematic and kinetic analyses. METHODS: Twenty-four people with Parkinson's disease participated in this study, and were divided into two groups: Tremor Dominant (n = 14) and Postural Instability and Gait Difficulty subtype (n = 10). They performed the sit-to-walk under a time constraint (to pick up a phone placed 4 meters away in order to answer an urgent call). Sit-to-walk overall performance, kinetic and kinematic data were assessed as outcome measures. FINDINGS: The Postural Instability and Gait Difficulty group demonstrated a slower anteroposterior center-of-mass velocity at seat-off, a longer duration of transitional phase and poorer movement fluidity. Furthermore, the Postural Instability and Gait Difficulty group showed a longer sit-to-walk total time. These results indicate that the Postural Instability and Gait Difficulty group performed the task slowly and split the task into two subtasks (sit-to-stand and walking), rather than performing a single, continuous task. INTERPRETATION: The Postural Instability and Gait Difficulty group is unable to perform the sit-to-walk continuously, which might reflect the clinical impairments observed in this Parkinson's disease subtype.

Motor adjustments during time-constrained sit-to-walk in people with Parkinson's disease.

INTRODUCTION: Sit-to-walk (STW) is a sequential task and a merge of sit-to-stand (STS) and gait initiation that are impaired in people with Parkinson's disease (PD). Performing sequential task under time constraint (e.g., stand up and walk to answer an urgent call) might influence people with PD due to their deficits on internal regulation of continuous, rhythmic and fast movements. It is known the PD behavior during STS and gait initiation tasks are impaired, however, little is known regarding PD behavior on STW. Thus, the aim of this study was to assess the motor behavior of people with PD and healthy older adults during the STW task under time constraint. METHODS: Fourteen people with idiopathic PD and 14 healthy older adults (OA) participated in this study. They performed the STW task under a time constraint. STW performance (STW total duration, duration of each of the 4 phases of the STW, and the drop in the center of mass (COM) momentum, identified as Fluidity Index - FI), kinematics and kinetics outcomes were assessed throughout the task. RESULTS: The PD group showed increased STW total time and lower FI, longer seat-off (Phase 1) time and first step (Phase 4) when compared to the OA group. Furthermore, the PD group showed more motor impairments (kinematics and kinetics) than the OA group throughout the task from seat-off until heel-off. Also, people with PD exhibited larger mediolateral COM displacement in the standing phase (Phase 2) and greater ground reaction force (GRF) in Phases 1 and 3. CONCLUSIONS: We observed that people with PD exhibited more restrictions when compared with healthy older adults on their STW performance, COM and GRF parameters during the STW under time constraint. Some clinical impairments usually observed in people with PD might explain their STW performance such as, motor planning deficits, less automatic motor control and mediolateral balance impairments.

Handwriting training in Parkinson's disease: A trade-off between size, speed and fluency.

BACKGROUND: In previous work, we found that intensive amplitude training successfully improved micrographia in Parkinson's disease (PD). Handwriting abnormalities in PD also express themselves in stroke duration and writing fluency. It is currently unknown whether training changes these dysgraphic features. OBJECTIVE: To determine the differential effects of amplitude training on various hallmarks of handwriting abnormalities in PD. METHODS: We randomized 38 right-handed subjects in early to mid-stage of PD into an experimental group (n = 18), receiving training focused at improving writing size during 30 minutes/day, five days/week for six weeks, and a placebo group (n = 20), receiving stretch and relaxation exercises at equal intensity. Writing skills were assessed using a touch-sensitive tablet pre- and post-training, and after a six-week retention period. Tests encompassed a transfer task, evaluating trained and untrained sequences, and an automatization task, comparing single- and dual-task handwriting. Outcome parameters were stroke duration (s), writing velocity (cm/s) and normalized jerk (i.e. fluency). RESULTS: In contrast to the reported positive effects of training on writing size, the current results showed increases in stroke duration and normalized jerk after amplitude training, which were absent in the placebo group. These increases remained after the six-week retention period. In contrast, velocity remained unchanged throughout the study. CONCLUSION: While intensive amplitude training is beneficial to improve writing size in PD, it comes at a cost as fluency and stroke duration deteriorated after training. The findings imply that PD patients can redistribute movement priorities after training within a compromised motor system.

Freezing of gait in Parkinson's disease: Evidence of sensory rather than attentional mechanisms through muscle vibration.

INTRODUCTION: The role of proprioceptive integration impairments as the potential mechanism underlying Freezing of gait (FOG) in Parkinson's disease (PD) is still an open debate. The effects of muscle vibration (a well-known manipulation of proprioception) could provide the answer to the debate. The aim of this study was to determine whether proprioceptive manipulation, through muscle vibration, could reduce FOG severity. METHODS: Sixteen PD patients who experience FOG were required to walk with small step lengths (15 cm). Cylindrical vibration devices were positioned on triceps surae tendon. Three vibration conditions were tested: No vibration (OFF), vibration on the less affected limb (LA), or on the more affected limb (MA). Additionally, we assessed the effects of applying vibration before and after FOG onset. The FOG duration and the foot used to take the next step were assessed. RESULTS: FOG significantly decreased only with vibration of LA in comparison to OFF, and when vibration was applied after FOG onset. CONCLUSION: Our results show that muscle vibration is a promising technique to alleviate the severity of FOG. Improvements to FOG behavior were restricted to the less affected limb, suggesting that only the less damaged side of the basal ganglia may have preserved capacity to process sensory feedback. These results also suggest the likelihood of sensory deficits in FOG that cannot be explained by cognitive mechanisms, since vibration effects were only observed unilaterally.

Manipulating vibratory devices' orientation and position enhances proprioceptive disturbance during upright stance.

We tested local vibration effects during upright standing considering: (i) the orientation of vibratory devices in relation to muscle fibres; (ii) the muscle region stimulated; and (iii) the number of stimulation spots. Results showed a higher balance disturbance with vibration devices oriented parallel to triceps surae muscle fibres. The single stimulation of the proximal region of the tibialis anterior muscle belly induces the same proprioceptive disturbance as stimulating multiple regions simultaneously.

Does proprioceptive system stimulation improve sit-to-walk performance in healthy young adults?

[Purpose] Sit-to-walk performance is linked to proper proprioceptive information processing. Therefore, it is believed that an increase of proprioceptive inflow (using muscle vibration) might improve sit-to-walk performance. However, before testing muscle vibration effects on a frail population, assessment of its effects on healthy young people is necessary. Thus, the aim of this study was to investigate the effects of muscle vibration on sit-to-walk performance in healthy young adults. [Subjects and Methods] Fifteen young adults performed the sit-to-walk task under three conditions: without vibration, with vibration applied before movement onset, and with vibration applied during the movement. Vibration was applied bilaterally for 30 s to the tibialis anterior, rectus femoris, and upper trapezius muscles bellies. The vibration parameters were as follows: 120 Hz and 1.2 mm. Kinematics and kinetic data were assessed using a 3D motion capture system and two force plates. The coordinates of reflective markers were used to define the center-of-mass velocities and displacements. In addition, the first step spatiotemporal variables were assessed. [Results] No vibration effect was observed on any dependent variables. [Conclusion] The results show that stimulation of the proprioceptive system with local muscle vibration does not improve sit-to-walk performance in healthy young adults.

Improvements in metabolic and neuromuscular fitness after 12-week bodypump® training.

Greco, CC, Oliveira, AS, Pereira, MP, Figueira, TR, Ruas, VD, Gonçalves, M, and Denadai, BS. Improvements in metabolic and neuromuscular fitness after 12-week Bodypump® training. J Strength Cond Res 25(12): 3422-3431, 2011-The purpose of this study was to evaluate the effects of a 12-week group fitness training program (Bodypump®) on anthropometry, muscle strength, and aerobic fitness. Nineteen women (21.4 ± 2.0 years old) were randomly assigned to a training group (n = 9) and to a control group (n = 10). We show that this training program improved the 1 repetition maximum squats by 33.1% (p < 0.001) and the maximal isometric voluntary contraction (MVC) by 13.6% (p < 0.05). Additionally, decreases in knee extensor electromyographic activity during the MVC (30%, p < 0.01) and during the squats (15%, p < 0.05) and lunges of a simulated Bodypump® session were observed after the training. Concomitantly, blood lactate and heart rate after squats of a simulated Bodypump® session were decreased by 33 and 7% (p < 0.05), respectively. Body mass, body fat, and the running velocity at the onset of blood lactate accumulation did not change significantly in response to this training program. We conclude that Bodypump® training improves muscular strength and decreases metabolic stress during lower limb exercises. However, no significant improvements in running aerobic fitness nor in body mass and body fat were observed. Practitioners of Bodypump® training may benefit from the increased muscular strength and the decreased muscular fatigability during exercise tasks whose motor patterns are related to those involved in this training program. However, these functional gains do not seem to be transferable into running aerobic fitness.