A practical method for the detection of freezing of gait in patients with Parkinson's disease.

PURPOSE: Freezing of gait (FOG), increasing the fall risk and limiting the quality of life, is common at the advanced stage of Parkinson's disease, typically in old ages. A simple and unobtrusive FOG detection system with a small calculation load would make a fast presentation of on-demand cueing possible. The purpose of this study was to find a practical FOG detection system. PATIENTS AND METHODS: A sole-mounted sensor system was developed for an unobtrusive measurement of acceleration during gait. Twenty patients with Parkinson's disease participated in this study. A simple and fast time-domain method for the FOG detection was suggested and compared with the conventional frequency-domain method. The parameters used in the FOG detection were optimized for each patient. RESULTS: The calculation load was 1,154 times less in the time-domain method than the conventional method, and the FOG detection performance was comparable between the two domains (P=0.79) and depended on the window length (P<0.01) and dimension of sensor information (P=0.03). CONCLUSION: A minimally constraining sole-mounted sensor system was developed, and the suggested time-domain method showed comparable FOG detection performance to that of the conventional frequency-domain method. Three-dimensional sensor information and 3-4-second window length were desirable. The suggested system is expected to have more practical clinical applications.

Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up.

OBJECTIVE: Psychogenic gait disorder, defined as loss of ability to walk without neurological aetiologies, has poor rehabilitation options that are well documented. Left untreated these patients have substantial and long-lasting dysfunction. The present study examined the effect of a 3-week inpatient rehabilitation programme compared with a waiting list control condition, and whether eventual gains were maintained at 1-month and 1-year follow-up. DESIGN: A cross-over design evaluated the effect of treatment, and a carry-over effect was considered as a long-lasting treatment effect. Treatment consisted of adapted physical activity within a cognitive behavioural framework, and focused on offering an alternative explanation of symptoms, positively reinforcing normal gait and not reinforcing dysfunction. PATIENTS: A total of 60 patients were recruited from neurological departments and were randomly assigned to immediate treatment (intervention) or treatment after 4 weeks (controls). RESULTS: Cross-over design revealed that the mean difference between treatment vs no treatment was 8.4 Functional Independence Measure units (p < 0.001, 95% confidence interval 5.2-11.7), and 6.9 Functional Mobility Scale units (p < 0.001, 95% confidence interval 5.5-8.3). Patients significantly improved their ability to walk and their quality of life after inpatient rehabilitation compared with the untreated control group. The improvements in gait were sustained at 1-month and 1-year follow-up. CONCLUSION: Substantial and lasting improvement can be achieved by inpatient rehabilitation of patients with psychogenic gait, and the gains are maintained during follow-up.

Efectos de la activación de etiquetas refereidas a la vejez / Effects of category label activation about the elderly

El presente trabajo se enmarca en los efectos sobre el comportamiento que posee la activación no consciente de categorías sociales, tanto entre miembros del exogrupo (jóvenes), como del endogrupo (mayores). Concretamente, se trata de delimitar el efecto de la activación no consciente de etiquetas con distinta valencia que definen a un mismo grupo, o categoría social (viejo vs mayor), sobre conductas motoras simples no relacionadas directamente con la interacción con mayores. En el primer estudio (N= 62), realizado con personas jóvenes, se observa que tras la activación subliminal de la etiqueta negativa (viejo), los participantes mostraron tiempos de reacción superiores durante la primera fase de la tarea cuando se les activó la etiqueta negativa (viejo), que cuando se activó la etiqueta positiva (mayor). El segundo estudio (N= 40), realizado entre miembros del grupo de mayores, se observa este mismo resultado: aquellos mayores a los que se les activa subliminalmente la etiqueta negativa que designa a su grupo muestran tiempos de reacción más largos durante la primera fase de la prueba. Los resultados son discutidos en relación a sus implicaciones teóricas y aplicadas (AU)

The present research focuses on the study of behavioral effects of non-conscious activation of categories among outgroup (young people) and ingroup members (elderly people). Specifically, non-conscious activation of labels that designate the same group, but with different valence (old vs. elderly), showed an effect on a behavior not directly related to interaction with elderly. The first study with young individuals (N= 62) shows that, after non-conscious activation of a negative label (old), participants displayed longer RTs in the first phase of the task than in the case of positive label (elderly) priming. The second study (N= 40), performed with elderly people, shows a similar result, after non-conscious activation of a negative label (old), elderly people showed longer RTs in the first phase of the task, compared with the group in the non-conscious positive label activation condition. Results concerning the theoretical and practical implications are discussed (AU)

[Three-dimensional ultrasonic movement analysis of gait and hand-movements in schizophrenic patients]. / Ultraschallgestützte Analyse von Gang- und Handmotorik schizophrener Patienten.

Neurological signs and disturbed psychomotor performance are consistently confirmed by clinical studies on schizophrenic patients. They could either be caused by the illness itself or could occur as side-effects of antipsychotic medication. Based on the clinical observation, differential diagnosis between catatonic symptoms of schizophrenia and extrapyramidal side-effects often remains unclear. Apart from their diagnostic value, motor disturbances can also be predictive parameters for prognosis of the disease and clinical response to antipsychotic treatment. Motor disturbances are mainly assessed by use of clinical ratings. In the last years, new approaches like infrared or ultrasonic movement analysis systems have been introduced to objectively determine motor disturbances in schizophrenic patients. Ultrasonic movement analysis systems calculate the three-dimensional positions of tiny markers, which are attached to moving body parts, with high spatial and temporal resolution. Thus, key parameters of gait and hand-movements can be determined exactly. Results of several studies using these new methods indicate that schizophrenia causes a primary disturbance of motor performance. Treatment with conventional antipsychotics intensifies many of the disabling motor deficiencies, whereas the influence of atypical antipsychotics on motor performance is either not detectable or much smaller. All in all, most results of studies using objective methods for the assessment of motor performance underline the advantages of treatment with atypical antipsychotics compared to conventional antipsychotics, particularly with regard to the patient's motor performance.

Goal directed locomotion and balance control in autistic children.

This article focuses on postural anticipation and multi-joint coordination during locomotion in healthy and autistic children. Three questions were addressed. (1) Are gait parameters modified in autistic children? (2) Is equilibrium control affected in autistic children? (3) Is locomotion adjusted to the experimenter-imposed goal? Six healthy children and nine autistic children were instructed to walk to a location (a child-sized playhouse) inside the psychomotor room of the pedopsychiatric centre located approximately 5 m in front of them. A kinematic analysis of gait (ELITE system) indicates that, rather than gait parameters or balance control, the main components affected in autistic children during locomotion are the goal of the action, the orientation towards this goal and the definition of the trajectory due probably to an impairment of movement planning.

"Motor" impairment in Asperger syndrome: evidence for a deficit in proprioception.

Motor impairment has frequently been described in Asperger syndrome (AS), a pervasive developmental disorder included in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Previous research focusing on this motor dysfunction has yielded inconsistent results, and the "clumsiness" observed clinically remains poorly defined. To clarify further the issue of motor impairment, we compared a group of 10 children and young adults who met DSM-IV criteria for AS with a control group with no neurological impairment. Subjects were matched on age, sex, socioeconomic status, and Verbal IQ. A broad battery of motoric tests was administered. Subjects with AS were found to perform more poorly than controls on tests of apraxia, one-leg balance with eyes closed, tandem gait, and repetitive finger-thumb apposition. No significant differences were found on tests of finger tapping, grooved pegboard, trail making, or visual-motor integration. The pattern of impairments suggests that a proprioceptive deficit may underlie the incoordination observed in AS and that these individuals may be overreliant on visual input to maintain balance and position in space.