Motor imagery of gait tasks in individuals with Parkinson disease

We developed a questionnaire to assess motor imagery (MI) of gait and administered it to 34 controls and 28 individuals with PD. Our goals were: 1) compare gait MI in individuals with and without PD, 2) determine whether walking performance relates to gait MI and 3) compare gait MI in individuals with PD with and without freezing of gait. Gait MI was not different between PD and controls. There was no correlation between walking performance and gait MI, and no difference in gait MI between freezers and nonfreezers. The gait imagery questionnaire may be useful for imaging studies involving imagined gait

Effects of levodopa on vividness of motor imagery in Parkinson disease

INTRODUCTION: Motor imagery during functional magnetic resonance imaging is commonly used to understand the neural underpinnings of complex movements. This approach has recently been applied to individuals with Parkinson disease (PD) to better understand how brain function may relate to movement dysfunction. However, the ability of individuals with PD to imagine movements when “Off” dopamine replacement medication is poorly understood. Therefore, the primary purpose of the current study is to test the ability of people with PD to imagine movements while “On” and “Off” anti-Parkinson medication. METHODS: Vividness of imagery was assessed in 28 individuals with mild to moderate PD (Hoehn and Yahr stages 1–3) via the Kinesthetic Visual Imagery Questionnaire (KVIQ-20) both “On” and “Off” anti-Parkinson medication. Vividness of imagery of 32 age-matched older adults was also assessed. RESULTS: No differences in vividness of imagery were observed between “Off” and “On” medication states (p=0.15). Imagery was similar between controls and PD both “Off” (p=0.25) and “On” (p=0.46) anti-Parkinson medication. A significant correlation was observed between imagery and disease severity while “On” anti-Parkinson medication (r= −0.49; p=0.008). DISCUSSION AND CONCLUSIONS: Vividness of movement imagery was not different between “Off” and “On” anti-Parkinson medications or between PD and controls. These results suggest that people with PD are able to imagine similarly to older adults both when “On” and “Off” anti-Parkinson medication, and supports the use of motor imagery in the “Off” medication state

Keeping PACE With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy

The use of telehealth to deliver occupational therapy services rapidly expanded during the COVID-19 pandemic. There are frameworks to evaluate services delivered through telehealth; however, none are specific to occupational therapy. Therefore, occupational therapy would benefit from a framework to systematically evaluate components of telehealth service delivery and build evidence to demonstrate the distinct value of occupational therapy.  The PACE Framework outlines four priority domains to address areas of need: (1) Population and Health Outcomes; (2) Access for All Clients; (3) Costs and Cost Effectiveness; and (4) Experiences of Clients and Occupational Therapy Practitioners. This article describes the development and expert reviewer evaluation of the PACE Framework. In addition, the PACE Framework’s domains, subdomains, and outcome measure examples are described along with future directions for implementation in occupational therapy research, practice, and program evaluation.&nbsp

The effect of dopaminergic medication on beat-based auditory timing in Parkinson’s disease

Parkinson’s disease (PD) adversely affects timing abilities. Beat-based timing is a mechanism that times events relative to a regular interval, such as the ‘beat’ in musical rhythm, and is impaired in PD. It is unknown if dopaminergic medication influences beat-based timing in PD. Here we tested beat-based timing over two sessions in participants with PD (OFF then ON dopaminergic medication), and unmedicated control participants. People with PD and control participants completed two tasks. The first was a discrimination task in which participants compared two rhythms and determined whether they were the same or different. Rhythms either had a beat structure (metric simple rhythms), or did not (metric complex rhythms), as in previous studies. Discrimination accuracy was analyzed to test for the effects of beat structure, as well as differences between participants with PD and controls, and effects of medication (PD group only). The second task was the Beat Alignment Test (BAT), in which participants listened to music with regular tones superimposed, and responded as to whether the tones were ‘on’ or ‘off’ the beat of the music. Accuracy was analyzed to test for differences between participants with PD and controls, and for an effect of medication in patients.Both patients and controls discriminated metric simple rhythms better than metric complex rhythms. Controls also improved at the discrimination task in the second vs. first session, whereas people with PD did not. For participants with PD, the difference in performance between metric simple and metric complex rhythms was greater (sensitivity to changes in simple rhythms increased and sensitivity to changes in complex rhythms decreased) when ON vs. OFF medication. Performance also worsened with disease severity. For the Beat Alignment Test, no group differences or effects of medication were found. Overall, these findings suggest that timing is impaired in PD, and that dopaminergic medication influences beat-based and non-beat-based timing differently. Judging the beat in music does not appear to be affected by PD or by dopaminergic medication

Upper extremity freezing and dyscoordination in Parkinson\u27s disease: Effects of amplitude and cadence manipulations

Purpose. Motor freezing, the inability to produce effective movement, is associated with decreasing amplitude, hastening of movement, and poor coordination. We investigated how manipulations of movement amplitude and cadence affect upper extremity (UE) coordination as measured by the phase coordination index (PCI)—only previously measured in gait—and freezing of the upper extremity (FO-UE) in people with Parkinson's disease (PD) who experience freezing of gait (PD + FOG), do not experience FOG (PD-FOG), and healthy controls. Methods. Twenty-seven participants with PD and 18 healthy older adults made alternating bimanual movements between targets under four conditions: Baseline; Fast; Small; SmallFast. Kinematic data were recorded and analyzed for PCI and FO-UE events. PCI and FO-UE were compared across groups and conditions. Correlations between UE PCI, gait PCI, FO-UE, and Freezing of Gait Questionnaire (FOG-Q) were determined. Results. PD + FOG had poorer coordination than healthy old during SmallFast. UE coordination correlated with number of FO-UE episodes in two conditions and FOG-Q score in one. No differences existed between PD−/+FOG in coordination or number of FO-UE episodes. Conclusions. Dyscoordination and FO-UE can be elicited by manipulating cadence and amplitude of an alternating bimanual task. It remains unclear whether FO-UE and FOG share common mechanisms

Monitoring Motor Symptoms During Activities of Daily Living in Individuals With Parkinson's Disease

This literature review addressed wearable sensor systems to monitor motor symptoms in individuals with Parkinson's disease (PD) during activities of daily living (ADLs). Specifically, progress in monitoring tremor, freezing of gait, dyskinesia, bradykinesia, and hypokinesia was reviewed. Twenty-seven studies were found that met the criteria of measuring symptoms in a home or home-like setting, with some studies examining multiple motor disorders. Accelerometers, gyroscopes, and electromyography sensors were included, with some studies using more than one type of sensor. Five studies measured tremor, five studies examined bradykinesia or hypokinesia, thirteen studies included devices to measure dyskinesia or motor fluctuations, and ten studies measured akinesia or freezing of gait. Current sensor technology can detect the presence and severity of each of these symptoms; however, most systems require sensors on multiple body parts, which is challenging for remote or ecologically valid observation. Different symptoms are detected by different sensor placement, suggesting that the goal of detecting all symptoms with a reduced set of sensors may not be achievable. For the goal of monitoring motor symptoms during ADLs in a home setting, the measurement system should be simple to use, unobtrusive to the wearer and easy for an individual with PD to put on and take off. Machine learning algorithms such as neural networks appear to be the most promising way to detect symptoms using a small number of sensors. More work should be done validating the systems during unscripted and unconstrained ADLs rather than in scripted motions

Comparing interventions and exploring neural mechanisms of exercise in Parkinson disease: a study protocol for a randomized controlled trial

BACKGROUND: Effective treatment of locomotor dysfunction in Parkinson disease (PD) is essential, as gait difficulty is an early and major contributor to disability. Exercise is recommended as an adjunct to traditional treatments for improving gait, balance, and quality of life. Among the exercise approaches known to improve walking, tango and treadmill training have recently emerged as two promising therapies for improving gait, disease severity and quality of life, yet these two interventions have not been directly compared to each other. Prior studies have been helpful in identifying interventions effective in improving gait function, but have done little to elucidate the neural mechanisms underlying functional improvements. The primary objective of the proposed work is to compare the effects of three community-based exercise programs, tango, treadmill training and stretching, on locomotor function in individuals with PD. In addition, we aim to determine whether and how these interventions alter functional connectivity of locomotor control networks in the brain. METHODS/DESIGN: One hundred and twenty right-handed individuals with idiopathic PD who are at least 30 years of age will be assigned in successive waves to one of three community-based exercise groups: tango dancing, treadmill training or stretching (control). Each group will receive three months of exercise training with twice weekly one-hour group classes. Each participant will be evaluated at three time points: pre-intervention (baseline), post-intervention (3 months), and follow-up (6 months). All evaluations will include assessment of gait, balance, disease severity, and quality of life. Baseline and post-intervention evaluations will also include task-based functional magnetic resonance imaging (fMRI) and resting state functional connectivity MRI. All MRI and behavioral measures will be conducted with participants OFF anti-Parkinson medication, with behavioral measures also assessed ON medication. DISCUSSION: This study will provide important insights regarding the effects of different modes of exercise on locomotor function in PD. The protocol is innovative because it: 1) uses group exercise approaches for all conditions including treadmill training, 2) directly compares tango to treadmill training and stretching, 3) tests participants OFF medication, and 4) utilizes two distinct neuroimaging approaches to explore mechanisms of the effects of exercise on the brain. TRIAL REGISTRATION: ClinicalTrials.gov NCT01768832

The Effect of Dopaminergic Medication on Joint Kinematics during Haptic Movements in Individuals with Parkinson's Disease

This study examined whether altered joint angular motion during haptic exploration could account for a decline in haptic sensitivity in individuals with PD by analyzing joint position data during haptic exploration of a curved contour. Each participant's hand was passively moved by a robotic arm along the edges of a virtual box (5 cm × 15 cm) with a curved left wall. After each trial, participants indicated whether the contour was curved or straight. Visual, auditory, and tactile cues were occluded, and an electrogoniometer recorded shoulder and elbow joint angles during each trial. The PD group in the OFF state had a higher mean detection threshold (4.67 m −1 ) than the control group (3.06 m −1 ). Individuals with PD in the OFF state also had a significantly greater magnitude of shoulder abduction than those in the ON state (p = 0 003) and a smaller magnitude of elbow flexion than those in the ON state or compared to the control group (both p < 0 001). These findings suggest that individuals with PD employ joint configurations that may contribute to haptic insensitivity. Dopamine replacement therapy improved joint configurations during haptic exploration in patients with PD, suggesting a role for dopaminergic dysfunction in PD-related haptic insensitivity

Early presentation of gait impairment in Wolfram Syndrome

BACKGROUND: Classically characterized by early onset insulin-dependent diabetes mellitus, optic atrophy, deafness, diabetes insipidus, and neurological abnormalities, Wolfram syndrome (WFS) is also associated with atypical brainstem and cerebellar findings in the first decade of life. As such, we hypothesized that gait differences between individuals with WFS and typically developing (TD) individuals may be detectable across the course of the disease. METHODS: Gait was assessed for 13 individuals with WFS (min 6.4 yrs, max 25.8 yrs) and 29 age-matched, typically developing individuals (min 5.6 yrs, max 28.5 yrs) using a GAITRite ® walkway system. Velocity, cadence, step length, base of support and double support time were compared between groups. RESULTS: Across all tasks, individuals with WFS walked slower (p = 0.03), took shorter (p ≤ 0.001) and wider (p ≤ 0.001) steps and spent a greater proportion of the gait cycle in double support (p = 0.03) compared to TD individuals. Cadence did not differ between groups (p = 0.62). Across all tasks, age was significantly correlated with cadence and double support time in the TD group but only double support time was correlated with age in the WFS group and only during preferred pace forward (r(s)= 0.564, p = 0.045) and dual task forward walking (r(s)= 0.720, p = 0.006) tasks. Individuals with WFS also had a greater number of missteps during tandem walking (p ≤ 0.001). Within the WFS group, spatiotemporal measures of gait did not correlate with measures of visual acuity. Balance measures negatively correlated with normalized gait velocity during fast forward walking (rs = −0.59, p = 0.03) and percent of gait cycle in double support during backward walking (rs = −0.64, p = 0.03). CONCLUSIONS: Quantifiable gait impairments can be detected in individuals with WFS earlier than previous clinical observations suggested. These impairments are not fully accounted for by the visual or balance deficits associated with WFS, and may be a reflection of early cerebellar and/or brainstem abnormalities. Effective patient-centered treatment paradigms could benefit from a more complete understanding of the progression of motor and other neurological symptom presentation in individuals with WFS

The Effect of Dopaminergic Medication on Joint Kinematics during Haptic Movements in Individuals with Parkinson’s Disease

This study examined whether altered joint angular motion during haptic exploration could account for a decline in haptic sensitivity in individuals with PD by analyzing joint position data during haptic exploration of a curved contour. Each participant’s hand was passively moved by a robotic arm along the edges of a virtual box (5 cm × 15 cm) with a curved left wall. After each trial, participants indicated whether the contour was curved or straight. Visual, auditory, and tactile cues were occluded, and an electrogoniometer recorded shoulder and elbow joint angles during each trial. The PD group in the OFF state had a higher mean detection threshold (4.67 m−1) than the control group (3.06 m−1). Individuals with PD in the OFF state also had a significantly greater magnitude of shoulder abduction than those in the ON state (p=0.003) and a smaller magnitude of elbow flexion than those in the ON state or compared to the control group (both p<0.001). These findings suggest that individuals with PD employ joint configurations that may contribute to haptic insensitivity. Dopamine replacement therapy improved joint configurations during haptic exploration in patients with PD, suggesting a role for dopaminergic dysfunction in PD-related haptic insensitivity