The transition between turning and sitting in patients with Parkinson's disease: A wearable device detects an unexpected sequence of events |
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| Institution: | 1. Center for the study of Movement, Cognition, and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;2. Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA;3. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA;4. Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA;5. Department of Physical Therapy, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel;6. Department of Neurology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel;1. Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands;2. CAPES Foundation, Ministry of Education of Brazil, Brasília/DF, Brazil;3. Institute for Computing and Information Sciences, Nijmegen, The Netherlands;4. The Michael J Fox Foundation for Parkinson’s Research, New York, USA;5. UCB Biopharma, Monheim, Germany;6. UCB Biopharma Slough, United Kingdom;7. Aston University, Birmingham, UK;8. Media Lab, Massachusetts Institute of Technology, Cambridge, USA;9. Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands;1. Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH;2. Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH;3. Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH;1. Faculty of Biomedical Engineering, Czech Technical University in Prague, nam Sitna 3105, Czech Republic;2. Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic;1. UCB Pharma, Monheim am Rhein, Germany;2. MC10 Inc., Lexington, MA, USA;3. UCB Pharma, Raleigh, NC, USA;4. UCB Pharma, Brussels, Belgium;5. UCB Medical Devices, Bulle, Switzerland;6. UCB Pharma, Slough, UK;1. Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Israel;2. Tel Aviv-Yafo Academic College, Tel-Aviv, Israel;3. Movement Disorders Unit, Institute of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel;4. School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel;5. Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel;6. Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel;7. Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel;8. Departments of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel;1. Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom;2. The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom |
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| Abstract: | BackgroundWhen older adults turn to sit, about 80% of the subjects complete the turn before starting to sit i.e., a distinct-strategy, while in about 20%, part of the turning and sitting take place concurrently, i.e., an overlapping-strategy. A prolonged duration of the separation between tasks in the distinct-strategy (D-interval) and a prolonged duration of the overlap interval in overlapping-strategy (O-interval) are related to worse motor symptoms and poorer cognition. In the present study, we evaluated what strategy is employed by patients with Parkinson’s disease (PD) when they transition from turning to sitting.Methods96 participants with PD performed turn to sit as part of the Timed Up and Go test, both with and without medications, while wearing a body-fixed sensor. We quantified the turn-to-sit transition and determined which strategy (distinct or overlapping) was employed. We then stratified the cases and used regression models adjusted for age, gender, height, and weight to examine the associations of the D-interval or O-interval with parkinsonian features and cognition.ResultsMost patients (66%) employed the overlapping-strategy, both off and on anti-parkinsonian medications. Longer O-intervals were associated with longer duration of PD, more severe PD motor symptoms, a higher postural-instability-gait-disturbance (PIGD) score, and worse freezing of gait. Longer D-intervals were not associated with disease duration or PD motor symptoms. Neither the D- nor O-intervals were related to cognitive function. Individuals who employed the overlapping-strategy had more severe postural instability (i.e., higher PIGD scores), as compared to those who used the distinct-strategy.SignificanceIn contrast to older adults without PD, most patients with PD utilize the overlapping strategy. Poorer postural and gait control are associated with the strategy choice and with the duration of concurrent performance of turning and sitting. Additional work is needed to further explicate the mechanisms underlying these strategies and their clinical implications. |
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| Keywords: | Parkinson's disease Accelerometer Cognitive function Wearables Body-fixed sensor |
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