Necessary Skills and Knowledge for Staff Providing Telehealth Services

Background Although motor abnormalities have been flagged as potentially the most sensitive and specific clinical features for predicting the future progression to Parkinson's disease, little work has been done to characterize gait and balance impairments in idiopathic rapid eye movement sleep behavior disorder (iRBD). Objective The objective of this study was to quantitatively determine any static balance as well as gait impairments across the 5 independent domains of gait in polysomnography-confirmed iRBD patients using normal, fast-paced, and dual-task walking conditions. Methods A total of 38 participants (24 iRBD, 14 healthy controls) completed the following 5 different walking trials across a pressure sensor carpet: (1) normal pace, (2) fast pace, (3) while counting backward from 100 by 1s, (4) while naming as many animals as possible, (5) while subtracting 7s from 100. Results Although no gait differences were found between the groups during normal walking, there were significant differences between groups under the fast-paced and dual-task gait conditions. Specifically, in response to the dual tasking, healthy controls widened their step width without changing step width variability, whereas iRBD patients did not widen their step width but, rather, significantly increased their step width variability. Similarly, changes between the groups were observed during fast-paced walking wherein the iRBD patients demonstrated greater step length asymmetry when compared with controls. Conclusions This study demonstrates that iRBD patients have subtle gait impairments, which likely reflect early progressive degeneration in brainstem regions that regulate both REM sleep and gait coordination. Such gait assessments may be useful as a diagnostic preclinical screening tool for future fulminant gait abnormalities for trials of disease-preventive agents. (c) 2019 International Parkinson and Movement Disorder Societ

Développement d’un score de stabilité chez les personnes présentant des pathologies d’origine neurologique entraînant des troubles de la marche et/ou de l’équilibre

Many pathologies affect balance control during gait. Traumatic, neurological or age-related disorders can all limit more or less the stability, which is the capacity of subjects to recover from perturbations, and can lead to falls. For children, the stability is related to the developmental stages and its interpretation requires differentiating what pertains to the developmental instability and to the pathological instability. Instrumented movement analysis allows a reliable and precise recording of the gait parameters. Indexes were developed to improve the clinical evaluation of the patients walking but no one of them quantifies the stability feature.This thesis led to the production of a score quantifying the stability through variability of the spatiotemporal parameters, recorded by an electronic walkway system. The score, called Gait Variability Index (GVI), has been applied to asymptomatic and pathological populations, representative of the various ages of life: children, adults and elderly persons. Results for patients affected by cerebral palsy, Friedreich’s ataxia or after stroke demonstrate that the GVI is a coherent tool for the evaluation of instability. Beyond the clinical interest, it opens various studies perspectives in gait analysis, and is thought-provoking about the disruptive or regulating nature of variability.De nombreux troubles ont un retentissement sur le contrôle de l’équilibre dynamique au cours de la marche. Qu’ils soient d’origine traumatique, neurologique, ou liés à la sénescence, ils limitent plus ou moins la stabilité, c’est-à-dire la capacité des sujets à récupérer de perturbations internes ou externes, et peuvent conduire à la chute. Chez les enfants, la stabilité est de plus liée aux étapes développementales. Son interprétation nécessite donc de différencier ce qui relève de l’instabilité développementale et de l’instabilité pathologique. Les techniques instrumentées d’analyse du mouvement permettent un enregistrement fiable et précis des paramètres de la marche. Des index ont été développés pour faciliter l’évaluation clinique de la marche des patients mais aucun d’entre eux ne quantifie l’aspect stabilité.Ce travail de thèse a conduit à la production d’un score quantifiant la stabilité au travers de la variabilité des paramètres spatiotemporels, enregistrés par une piste de marche électronique. Ce score, dénommé Gait Variability Index (GVI), a été appliqué à des populations, asymptomatiques et pathologiques, représentatives des différents âges de la vie : l’enfant, l’adulte et la personne âgée. Les résultats obtenus chez des patients affectés de paralysie cérébrale, d’ataxie de Friedreich ou cérébrolésés démontrent que le GVI est un outil cohérent pour l’évaluation de l’instabilité. Outre l’intérêt clinique qu’il représente, celui-ci ouvre différentes perspectives pour son application et invite à la réflexion quant à la nature perturbatrice ou régulatrice de la variabilité

Use of Functional Ambulation Performance Score as measurement of gait ability: Review

International audienceGait analysis systems are widely used for the assessment of gait disabilities and provide more accurate and detailed information than clinical tests. Scores and indexes have been proposed to summarize the large volume of data produced, each emphasizing different aspects of gait. Based on specific spatiotemporal parameters, the Functional Ambulation Performance Score (FAPS) quantifies gait at a self-selected speed. Integrated within electronic walkways, the FAPS is commonly used for clinical evaluations and has been used in an increasing number of publications over the past few years. However, its use is sometimes distorted by misunderstandings of its composition and calculation, practical and/or conceptual limits, and even the meaning of the score. This technical report reviews the use of the FAPS for the evaluation of gait based on peer-reviewed articles and clinical experience and addresses important issues that must be considered for an optimal unbiased understanding and analysis of the score

Conception of a stability score in neurological diseases leading to gait and/or balance disorders

De nombreux troubles ont un retentissement sur le contrôle de l’équilibre dynamique au cours de la marche. Qu’ils soient d’origine traumatique, neurologique, ou liés à la sénescence, ils limitent plus ou moins la stabilité, c’est-à-dire la capacité des sujets à récupérer de perturbations internes ou externes, et peuvent conduire à la chute. Chez les enfants, la stabilité est de plus liée aux étapes développementales. Son interprétation nécessite donc de différencier ce qui relève de l’instabilité développementale et de l’instabilité pathologique. Les techniques instrumentées d’analyse du mouvement permettent un enregistrement fiable et précis des paramètres de la marche. Des index ont été développés pour faciliter l’évaluation clinique de la marche des patients mais aucun d’entre eux ne quantifie l’aspect stabilité.Ce travail de thèse a conduit à la production d’un score quantifiant la stabilité au travers de la variabilité des paramètres spatiotemporels, enregistrés par une piste de marche électronique. Ce score, dénommé Gait Variability Index (GVI), a été appliqué à des populations, asymptomatiques et pathologiques, représentatives des différents âges de la vie : l’enfant, l’adulte et la personne âgée. Les résultats obtenus chez des patients affectés de paralysie cérébrale, d’ataxie de Friedreich ou cérébrolésés démontrent que le GVI est un outil cohérent pour l’évaluation de l’instabilité. Outre l’intérêt clinique qu’il représente, celui-ci ouvre différentes perspectives pour son application et invite à la réflexion quant à la nature perturbatrice ou régulatrice de la variabilité.Many pathologies affect balance control during gait. Traumatic, neurological or age-related disorders can all limit more or less the stability, which is the capacity of subjects to recover from perturbations, and can lead to falls. For children, the stability is related to the developmental stages and its interpretation requires differentiating what pertains to the developmental instability and to the pathological instability. Instrumented movement analysis allows a reliable and precise recording of the gait parameters. Indexes were developed to improve the clinical evaluation of the patients walking but no one of them quantifies the stability feature.This thesis led to the production of a score quantifying the stability through variability of the spatiotemporal parameters, recorded by an electronic walkway system. The score, called Gait Variability Index (GVI), has been applied to asymptomatic and pathological populations, representative of the various ages of life: children, adults and elderly persons. Results for patients affected by cerebral palsy, Friedreich’s ataxia or after stroke demonstrate that the GVI is a coherent tool for the evaluation of instability. Beyond the clinical interest, it opens various studies perspectives in gait analysis, and is thought-provoking about the disruptive or regulating nature of variability

Analyse du mouvement et handicap : application à la marche pathologique

International audienc

MODULATORY ROLE OF THE MONOCARBOXYLATE TRANSPORTERS AT GLUTAMATERGIC POSTSYNAPSES

Monocarboxylate transporters (MCTs) are a conserved family that facilitates the flow of monocarboxylates across membranes. MCTs are often required to adapt monocarboxylate bioavailability to cell requirements, a plasticity crucial in energy-demanding nervous system communication. ln the vertebrate nervous system, the primary communication mode is excitatory glutamatergic neurotransmission. The loss of glutamate homeostasis leads to high glutamate, thus excitotoxicity. Glutamate signaling must therefore be tightly regulated. Understanding the underlying regulatory mechanisms is crucial, as their dysregulation leads to numerous neurological disorders. The postsynaptic density (PSD) represents one of these mechanisms and ensures the rigorous control of glutamatergic neurotransmission. Dynamic glutamate receptor (GluR) adaptations at postsynaptic sites, mediated by the PSD, provide regulated synaptic transmission-dependent responses. However, the proteins contributing to dynamic PSD function, such as the primary neuronal MCT MCT2 remain largely unknown. MCT2 ensures lactate uptake as fuel to sustain glutamatergic neurotransmission in an activity­ dependent manner. Notably, several MCT2 studies suggest its involvement in the PSD and a function as an auxiliary subunit of GluRs. Thus, we hypothesize that a dual role of MCT2 could serve as a link between metabolism and synaptic activity. Here, we use the Drosophila glutamatergic larval neuromuscular junction (NMJ) to delineate the role of MCTs at the postsynapse. Glutamatergic neurotransmission drives larval crawling. Using this behavioral readout, we screened for and identified CG8028, a yet uncharacterized Drosophi/a MCT, as a potential ionotropic GluR (iGluR) auxiliary subunit. Muscle-specific knock-down of and mutants homozygous for CG8028 display a crawling phenotype due to low abundant iGluRs at postsynaptic sites. lt is further supported by the robust integration of mouse MCT2 (mMCT2) at PSDs of Drosophi/a NMJs, suggesting that mMCT2/CG8028 regulates postsynaptic iGluR levels. Finally, mMCT2 surface localization in vitro is regulated by phosphorylation of its C-terminal PDZ ligand. Our results provide the first in vivo evidence for a potential non-canonical iGluR auxiliary subunit function of postsynaptic MCTs, which would link metabolic supply to glutamatergic synaptic activity