Everyday walking with Parkinson's disease: understanding personal challenges and strategies

PURPOSE: This qualitative study was designed to explore the personal experience of everyday walking with Parkinson's disease (PD), the challenges and the strategies employed to compensate for difficulties, to help contextualise the scientific knowledge base. METHODS: Semi-structured interviews were undertaken with a sample of 20 people with idiopathic PD (12 male, 8 female; mean age 65 years (range 50 - 80); mean disease duration 10 years (range 2.5 - 26). Verbatim interview transcripts were analyzed thematically using NUD*IST N6 qualitative data analysis software. RESULTS: Walking was invariably performed as an integral part of a purposeful activity within a specific context, termed walking 'plus', with challenges encountered by people with PD in three main areas: Undertaking tasks; negotiating environments; and making transitions to walking. The two key strategies to compensate for difficulties experienced were monitoring through the use of concentration, and correcting through generating rhythm and size of steps. Carers supported monitoring and correcting. CONCLUSION: People with PD need to constantly assess and drive their walking performance. Attentional resources, which can themselves be compromised in PD, were used to accomplish what is normally a largely automatic activity. Personal accounts support scientific hypotheses. Rehabilitation interventions and measurements in PD need to reflect both the physical and psychosocial context of everyday walking

Abnormal connectivity between the default mode and the visual system underlies the manifestation of visual hallucinations in Parkinson’s disease:A task-based fMRI study

Background: The neural substrates of visual hallucinations remain an enigma, due primarily to the difficulties associated with directly interrogating the brain during hallucinatory episodes. Aims: To delineate the functional patterns of brain network activity and connectivity underlying visual hallucinations in Parkinson’s disease. Methods: In this study, we combined functional magnetic resonance imaging (MRI) with a behavioral task capable of eliciting visual misperceptions, a confirmed surrogate for visual hallucinations, in 35 patients with idiopathic Parkinson’s disease. We then applied an independent component analysis to extract time series information for large-scale neuronal networks that have been previously implicated in the pathophysiology of visual hallucinations. These data were subjected to a task-based functional connectivity analysis, thus providing the first objective description of the neural activity and connectivity during visual hallucinations in patients with Parkinson’s disease. Results: Correct performance of the task was associated with increased activity in primary visual regions; however, during visual misperceptions, this same visual network became actively coupled with the default mode network (DMN). Further, the frequency of misperception errors on the task was positively correlated with the strength of connectivity between these two systems, as well as with decreased activity in the dorsal attention network (DAN), and with impaired connectivity between the DAN and the DMNs, and ventral attention networks. Finally, each of the network abnormalities identified in our analysis were significantly correlated with two independent clinical measures of hallucination severity. Conclusions: Together, these results provide evidence that visual hallucinations are due to increased engagement of the DMN with the primary visual system, and emphasize the role of dysfunctional engagement of attentional networks in the pathophysiology of hallucinations

Barriers to reporting non-motor symptoms to health-care providers in people with Parkinson's

Background: Non-motor symptoms (NMS) are common in Parkinson's disease (PD) and cause significant distress. A high rate of non-declaration of NMS by patients to healthcare providers (HCP) means that many NMS remain untreated. Current understanding of the factors preventing disclosure of NMS to HCPs is limited. The present study aimed to i) further assess the prevalence of NMS and associated distress, ii) establish current rates of NMS reporting across a range of sources, and iii) explore overall and any symptom specific barriers to help-seeking for NMS. Methods: 358 PD patients completed a cross-sectional survey of NMS severity, reporting and barriers to help-seeking. A series of Generalised Estimating Equations were used to determine whether barriers were symptom specific. Results: A mean of 10.5 NMS were reported by each patient. Rates of non-reporting of NMS ranged from 15 to 72% of those experiencing distressing symptoms. The most commonly reported barriers to help-seeking were acceptance of symptoms; lack of awareness that a symptom was associated with PD, and belief that no effective treatments were available. Symptom specific barriers were found for sexual dysfunction (embarrassment), unexplained pain and urinary problems (belief about lack of treatment availability). Conclusion: A diverse range of barriers prevent PD patients reporting NMS to HCPs and these barriers differ between NMS. The study provides the foundations for developing interventions to increase reporting by targeting individual NMS. Increasing rates of help-seeking for NMS by patients to their Parkinson's healthcare providers will increase appropriate clinical care which may improve quality of life and well-being

Wearable Platform for Automatic Recognition of Parkinson Disease by Muscular Implication Monitoring

The need for diagnostic tools for the characterization of progressive movement disorders - as the Parkinson Disease (PD) - aiming to early detect and monitor the pathology is getting more and more impelling. The parallel request of wearable and wireless solutions, for the real-time monitoring in a non-controlled environment, has led to the implementation of a Quantitative Gait Analysis platform for the extraction of muscular implications features in ordinary motor action, such as gait. The here proposed platform is used for the quantification of PD symptoms. Addressing the wearable trend, the proposed architecture is able to define the real-time modulation of the muscular indexes by using 8 EMG wireless nodes positioned on lower limbs. The implemented system “translates” the acquisition in a 1-bit signal, exploiting a dynamic thresholding algorithm. The resulting 1-bit signals are used both to define muscular indexes both to drastically reduce the amount of data to be analyzed, preserving at the same time the muscular information. The overall architecture has been fully implemented on Altera Cyclone V FPGA. The system has been tested on 4 subjects: 2 affected by PD and 2 healthy subjects (control group). The experimental results highlight the validity of the proposed solution in Disease recognition and the outcomes match the clinical literature results

A double closed loop to enhance the quality of life of Parkinson's disease patients: REMPARK system

This paper presents REMPARK system, a novel approach to deal with Parkinson's Disease (PD). REMPARK system comprises two closed loops of actuation onto PD. The first loop consists in a wearable system that, based on a belt-worn movement sensor, detects movement alterations that activate an auditory cueing system controlled by a smartphone in order to improve patient's gait. The belt-worn sensor analyzes patient's movement through real-time learning algorithms that were developed on the basis of a database previously collected from 93 PD patients. The second loop consists in disease management based on the data collected during long periods and that enables neurologists to tailor medication of their PD patients and follow the disease evolution. REMPARK system is going to be tested in 40 PD patients in Spain, Ireland, Italy and Israel. This paper describes the approach followed to obtain this system, its components, functionalities and trials in which the system will be validated.Postprint (published version

SensorShoe: Mobile Gait Analysis for Parkinson's Disease Patients

We present the design and initial evaluation of a mobile gait analysis system, SensorShoe. The target user group is represented by Parkinson's Disease patients, which need continuous assistance with the physical therapy in their home environment. SensorShoe analyses the gait by using a low-power sensor node equipped with movement sensors. In addition, SensorShoe gives real-time feedback and therapy assistance to the patient, and provides the caregivers an effective remote monitoring and control tool

Neural Models of Normal and Abnormal Behavior: What Do Schizophrenia, Parkinsonism, Attention Deficit Disorder, and Depression Have in Common?

Defense Advanced Research Projects Agency and Office of Naval Research (N00014-95-1-0409); National Science Foundation (IRI-97-20333

Acute modulation of brain connectivity in Parkinson disease after automatic mechanical peripheral stimulation: A pilot study

The present study shows the results of a double-blind sham-controlled pilot trial to test whether measurable stimulus-specific functional connectivity changes exist after Automatic Mechanical Peripheral Stimulation (AMPS) in patients with idiopathic Parkinson Disease.Eleven patients (6 women and 5 men) with idiopathic Parkinson Disease underwent brain fMRI immediately before and after sham or effective AMPS. Resting state Functional Connectivity (RSFC) was assessed using the seed-ROI based analysis. Seed ROIs were positioned on basal ganglia, on primary sensory-motor cortices, on the supplementary motor areas and on the cerebellum. Individual differences for pre- and post-effective AMPS and pre- and post-sham condition were obtained and first entered in respective one-sample t-test analyses, to evaluate the mean effect of condition.Effective AMPS, but not sham stimulation, induced increase of RSFC of the sensory motor cortex, nucleus striatum and cerebellum. Secondly, individual differences for both conditions were entered into paired group t-test analysis to rule out sub-threshold effects of sham stimulation, which showed stronger connectivity of the striatum nucleus with the right lateral occipital cortex and the cuneal cortex (max Z score 3.12) and with the right anterior temporal lobe (max Z score 3.42) and of the cerebellum with the right lateral occipital cortex and the right cerebellar cortex (max Z score 3.79).Our results suggest that effective AMPS acutely increases RSFC of brain regions involved in visuo-spatial and sensory-motor integration.This study provides Class II evidence that automatic mechanical peripheral stimulation is effective in modulating brain functional connectivity of patients with Parkinson Disease at rest.Clinical Trials.gov NCT01815281