Cues and sensory manipulations to modulate long-range autocorrelations in gait variability among patients with Parkinson's disease

Parkinson's disease causes gait disorders in terms of both spatiotemporal parameters (speed, step length, cadence) and variability (magnitude, temporal organization), increasing the risk of falls and their consequences. The use of external stimuli (tactile, auditory, visual) is recommended to treat these disorders. These "cueings" have positive effects on spatiotemporal parameters, but there are many questions concerning their impact on the temporal organization of patients' gait, measured via long-range autocorrelations (LRA) computation. In this thesis, the patients' senses were manipulated (touch, hearing, vision) to determine their effects on the LRA present in their gait. Firstly, tactile cueing showed similar effects to auditory cueing on patients' LRA. With regard to auditory cueing, we have established that a cueing frequency that fluctuates according to a structured variability may be the best choice for maintaining a good level of LRA. Concerning vision, virtual reality makes it easy to manipulate visual feedbacks. Via a systematic review of the literature with meta-analysis, we showed that virtual reality is effective in improving patients' balance. Next, we manipulated patients' vision by adding natural optic flow in immersive virtual reality during treadmill walking. This ecological addition enabled us to restore LRA similar to those measured during overground walking, possibly increasing the validity of this measurement when analyzing it in a laboratory setting.(MED - Sciences médicales) -- UCL, 202

Comparison between the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Screening Questionnaire: Which tool for what purpose? A semi-systematic review.

BACKGROUND: Prevention of chronicization of low back pain requires accurate detection of at-risk patients. Questionnaires have been validated, including the STarT Back Screening Tool (SBST) and the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). This review aims to compare these questionnaires in terms of predictive value and in terms of aims, to guide the choice in clinical practice. METHODS: This study is a semi-systematic literature review. Studies evaluating at least one of the questionnaires and written between 1997 and October 10th 2017 were selected from Pubmed database. Inclusion criteria were pain duration<3months, outcomes including pain, function and/or global recovery. For work outcomes, inclusion criteria were extended to chronic patients. Studies had to provide information on sensitivity, specificity and area under the ROC Curve (AUC). RESULTS: Twenty-eight studies met our inclusion criteria (7 SBST, 21 original OMPSQ, 3 short OMPSQ). The OMPSQ best predicted a Pain NRS≥3 at 3 months (AUC=0.64 (0.50-0.78)) and at 6 months (AUC between 0.70 (no confidence interval provided) and 0.84 (0.71-0.97)). The SBST and the OMPSQ are comparable to predict an Oswestry Disability Index≥30% at 6 months. A single study showed no difference between the SBST and the OMPSQ to predict absenteeism≥30 days at 6 months. The two questionnaires cannot be compared for "global recovery" outcomes. CONCLUSION: The OMPSQ seems better than the SBST for predicting "pain" and "work" outcomes, the SBST may be better for "function" outcomes. These results should be taken with caution because of the high heterogeneity between studies. It should be noted that the OMPSQ was elaborated with the aim of creating a prognostic tool while the SBST was devised as a treatment-allocating tool and is easier to use in clinical practice. This should guide the choice of using one questionnaire rather than the other

Comparison of the effects of rhythmic vibrotactile stimulations and rhythmic auditory stimulations on Parkinson's disease patients' gait variability: a pilot study

Introduction: Parkinson's disease patients' gait is characterized by shorter step length, reduced gait velocity and deterioration of temporal organization of stride duration variability (modified Long Range Autocorrelations). The objective of this study was to compare effects of rhythmic auditory stimulations (RAS) and Rhythmic Vibrotactile Stimulations (RVS) on Parkinson's disease patients' gait. Methods: Ten Parkinson's disease patients performed three walking conditions lasting 5-7 min each: control condition (CC), RAS condition and RVS condition. Inertial measurement units were used to assess spatiotemporal gait parameters. Stride duration variability was assessed in terms of magnitude using coefficient of variation and in terms of temporal organization (i.e., Long Range Autocorrelations computation) using the evenly spaced averaged Detrended Fluctuation Analysis (α-DFA exponent). Results: Gait velocity was significantly higher during RAS condition than during CC (Cohen's d = 0.52) and similar to RVS condition (Cohen's d = 0.17). Cadence was significantly higher during RAS (Cohen's d = 0.77) and RVS (Cohens' d = 0.56) conditions than during CC. Concerning variability, no difference was found either for mean coefficient of variation or mean α-DFA between conditions. However, a great variability of individual results between the RAS and the RVS conditions is to be noted concerning α-DFA. Conclusions: RAS and RVS improved similarly PD patients' spatiotemporal gait parameters, without modifying stride duration variability in terms of magnitude and temporal organization at group level. Future studies should evaluate the relevant parameters for administering the right cueing type for the right patient

Comment évaluer le risque de chronicisation d’une lombalgie ?

Plusieurs outils ont été validés pour le dépistage du risque de développer une lombalgie chronique, dont le Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ, versions longue et courte) et le Start Back Screening Tool (SBST). L’objectif de ce travail est d’aider le clinicien à choisir l’outil qui convient le mieux à ses besoins. Une validation préliminaire de la version courte en français de l’OMPSQ montre des propriétés psychométriques comparables à celles de la version longue. Une revue de littérature a analysé 101 articles. Dans l’ensemble, les trois questionnaires ont des propriétés prédictives modérées. L’OMPSQ a été conçu comme un outil pronostique alors que le but du SBST est d’orienter le choix thérapeutique. Les connaissances et attitudes de professionnels de la réadaptation de deux hôpitaux de taille moyenne ont été évalués. La plupart des répondants ne connaissaient pas ces questionnaires. Lorsque les questionnaires leur étaient présentés, l’attitude globale était positive, même si plusieurs objections ont été formulées. En conclusion, des outils valides existent pour la détection des patients à risque. Cependant, un effort important est nécessaire pour former les professionnels de santé

Comment évaluer le risque de chronicisation d’une lombalgie ?

Plusieurs outils ont été validés pour le dépistage du risque de développer une lombalgie chronique, dont le Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ, versions longue et courte) et le Start Back Screening Tool (SBST). L’objectif de ce travail est d’aider le clinicien à choisir l’outil qui convient le mieux à ses besoins. Une validation préliminaire de la version courte en français de l’OMPSQ montre des propriétés psychométriques comparables à celles de la version longue. Une revue de littérature a analysé 101 articles. Dans l’ensemble, les trois questionnaires ont des propriétés prédictives modérées. L’OMPSQ a été conçu comme un outil pronostique alors que le but du SBST est d’orienter le choix thérapeutique. Les connaissances et attitudes de professionnels de la réadaptation de deux hôpitaux de taille moyenne ont été évalués. La plupart des répondants ne connaissaient pas ces questionnaires. Lorsque les questionnaires leur étaient présentés, l’attitude globale était positive, même si plusieurs objections ont été formulées. En conclusion, des outils valides existent pour la détection des patients à risque. Cependant, un effort important est nécessaire pour former les professionnels de santé

Influence of Autocorrelated Rhythmic Auditory Stimulations on Parkinson’s Disease Gait Variability: Comparison With Other Auditory Rhythm Variabilities and Perspectives

Parkinson’s Disease patients suffer from gait impairments such as reduced gait speed, shortened step length, and deterioration of the temporal organization of stride duration variability (i.e., breakdown in Long-Range Autocorrelations). The aim of this study was to compare the effects on Parkinson’s Disease patients’ gait of three Rhythmic Auditory Stimulations (RAS), each structured with a different rhythm variability (isochronous, random, and autocorrelated). Nine Parkinson’s Disease patients performed four walking conditions of 10–15 min each: Control Condition (CC), Isochronous RAS (IRAS), Random RAS (RRAS), and Autocorrelated RAS (ARAS). Accelerometers were used to assess gait speed, cadence, step length, temporal organization (i.e., Long-Range Autocorrelations computation), and magnitude (i.e., coefficient of variation) of stride duration variability on 512 gait cycles. Long-Range Autocorrelations were assessed using the evenly spaced averaged Detrended Fluctuation Analysis (α-DFA exponent). Spatiotemporal gait parameters and coefficient of variation were not modified by the RAS. Long-Range Autocorrelations were present in all patients during CC and ARAS although all RAS conditions altered them. The α-DFA exponents were significantly lower during IRAS and RRAS than during CC, exhibiting anti-correlations during IRAS in seven patients. α-DFA during ARAS was the closest to the α-DFA during CC and within normative data of healthy subjects. In conclusion, Isochronous RAS modify patients’ Long-Range Autocorrelations and the use of Autocorrelated RAS allows to maintain an acceptable level of Long-Range Autocorrelations for Parkinson’s Disease patients’ gait

Immersive Virtual Reality to Restore Natural Long-Range Autocorrelations in Parkinson’s Disease Patients’ Gait During Treadmill Walking

Effects of treadmill walking on Parkinson’s disease (PD) patients’ spatiotemporal gait parameters and stride duration variability, in terms of magnitude [coefficient of variation (CV)] and temporal organization [long range autocorrelations (LRA)], are known. Conversely, effects on PD gait of adding an optic flow during treadmill walking using a virtual reality headset, to get closer to an ecological walk, is unknown. This pilot study aimed to compare PD gait during three conditions: Overground Walking (OW), Treadmill Walking (TW), and immersive Virtual Reality on Treadmill Walking (iVRTW). Ten PD patients completed the three conditions at a comfortable speed. iVRTW consisted in walking at the same speed as TW while wearing a virtual reality headset reproducing an optic flow. Gait parameters assessed were: speed, step length, cadence, magnitude (CV) and temporal organization (evenly spaced averaged Detrended Fluctuation Analysis, α exponent) of stride duration variability. Motion sickness was assessed after TW and iVRTW using the Simulator Sickness Questionnaire (SSQ). Step length was greater (p = 0.008) and cadence lower (p = 0.009) during iVRTW compared to TW while CV was similar (p = 0.177). α exponent was similar during OW (0.77 ± 0.07) and iVRTW (0.76 ± 0.09) (p = 0.553). During TW, α exponent (0.85 ± 0.07) was higher than during OW (p = 0.039) and iVRTW (p = 0.016). SSQ was similar between TW and iVRTW (p = 0.809). iVRTW is tolerable, could optimize TW effects on spatiotemporal parameters while not increasing CV in PD. Furthermore, iVRTW could help to capture the natural LRA of PD gait in laboratory settings and could potentially be a challenging second step in PD gait rehabilitation

Comparison between the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Screening Questionnaire: which tool for what purpose? A semi-systematic review

Background : Prevention of chronicization of low back pain requires accurate detection of at-risk patients. Questionnaires have been validated, including the STarT Back Tool (SBST) and the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). This review aims to compare these questionnaires in terms of predictive value and in terms of aims, to guide the choice in clinical practice. Methods : This study is a semi-systematic literature review. Studies evaluating at least one of the questionnaires and written between 1997 and October 10th 2017 were selected from Pubmed database. Inclusion criteria were pain duration <3 months, outcomes including pain, function and/or global recovery. For work outcomes, inclusion criteria were extended to chronic patients. Studies had to provide information on sensitivity, specificity and Area Under the ROC Curve (AUC). Results : 28 studies met our inclusion criteria (7 SBST, 21 original OMPSQ, 3 short OMPSQ). The OMPSQ best predicted a Pain NRS ≥3 at 3 months (AUC = 0.64 (0.50-0.78)) and at 6 months (AUC between 0.70 (no confidence interval provided) and 0.84 (0.71-0.97)). The SBST and the OMPSQ are comparable to predict an Oswestry Disability Index ≥ 30% at 6 months. A single study showed no difference between the SBST and the OMPSQ to predict absenteeism ≥30 days at 6 months. The two questionnaires cannot be compared for "global recovery" outcomes. Conclusion : The OMPSQ seems better than the SBST for predicting "pain" and "work" outcomes, the SBST may be better for "function" outcomes. These results should be taken with caution because of the high heterogeneity between studies. It should be noted that the OMPSQ was elaborated with the aim of creating a prognostic tool while the SBST was devised as a treatment-allocating tool and is easier to use in clinical practice. This should guide the choice of using one questionnaire rather than the other

Is Pathology-Specific Virtual Reality Rehabilitation Better Than Commercial Virtual Reality to Improve Balance and Functional Mobility in Parkinson’s Disease Patients?

Background Virtual Reality (VR) rehabilitation is an innovative way to treat balance and mobility impairments in Parkinson’s Disease (PD) individuals. Studies use VR designed for rehabilitation (Specific Virtual Reality; SVR) and others use commercial VR (Non- Specific Virtual Reality; NSVR). Also, neurorehabilitation principles have been proposed to identify what potentially make VR interventions effective. Objective To perform a systematic review with meta-analysis comparing VR effectiveness versus Conventional Therapy (CT) for balance, functional mobility and quality of life in PD. Second objectives are to assess SVR over NSVR effect and analyze fulfilled neurorehabilitation principles across included studies. Methods Randomized control trials studying VR versus CT effects on balance, functional mobility and quality of life outcomes in PD adults were selected from PubMed and Embase. Subgroup analyses were conducted according to VR type, disease severity and treatment duration. Risk of bias was assessed using PEDro checklist and Cochrane’s Risk of Bias tool 2 (RoB-2). Percentages of fulfilled neurorehabilitation principles across studies were extracted. GRADE approach was used to define certainty of evidence. Results Twenty studies were included for quantitative analysis. VR results were superior to CT for balance but similar for functional mobility and quality of life. SVR and NSVR were 10 similar for balance and functional mobility outcomes. Finally, SVR studies did not fulfill more neurorehabilitation principles than NSVR studies. Conclusions VR could enhance balance rehabilitation in PD but with a low certainty of evidence. SVR solutions were not superior to NSVR and should fulfill more relevant neurorehabilitation principles in the future

Autocorrelated Rhythmic Auditory Stimulations as the best way to use a metronome for Parkinson’s Disease patients: a prospective cohort study

Background : Parkinson’s Disease (PD) patients suffer from gait impairments responsible for falls: reduced speed and stride length and deterioration of stride duration variability. Previous studies on isochronic Rhytmic Auditory Stimulation (RAS) showed good effects on speed and stride length but deleterious effects on stride duration variability. The aim of this study is to compare between 3 different RAS (isochronic, random and autocorrelated) on PD patients’ gait parameters and stride duration variability. Methods : Nine PD patients (Hoehn & Yahr stage 1-3) performed 4 x 10 min overground walking. Each session corresponded to a specific condition: Spontaneous Condition (SC), Isochronic RAS (IC), Random RAS (RC) and Autocorrelated RAS (AC). Unidimensional accelerometers were used to measure ankle movements on 512 consecutive gait cycles. Based on these data and using a software, gait parameters were assessed: gait speed, cadence, step length, temporal organization (i.e. Long-Range Autocorrelations; LRA) and magnitude (i.e. coefficient of variation; CV) of stride duration variability. LRA were assessed using the Rescaled Range Analysis (Hurst exponent) and the Power Spectral Density (α exponent). A one-way repeated measures ANOVA was applied to determine the effect of the various RAS on spatiotemporal gait parameters and on stride duration variability. Results : Spatiotemporal parameters and CV were not modified by the RAS. LRA were present in all patients during SC. On contrary, all RAS altered the LRA. Compared to the exponents assessed during SC, H and α exponents were significantly lower during IC and RC. H during AC was decreased and reached a slight significant difference with that of SC (p=0.036) but α didn’t. H and α during AC were the highest between all RAS conditions. Conclusions : LRA are broken during the IC. On the contrary, the use of autocorrelated RAS (AC) allows to maintain an acceptable level of LRA for PD patients’ gait stability. The autocorrelated RAS would therefore possibly be the best way to apply auditory cueing to PD patients compared to the other RAS conditions but this must be confirmed by future longitudinal studies