体感游戏对帕金森病患者认知、步态的影响

目的 研究体感游戏对帕金森病（Parkinson's disease, PD）患者认知、步态的影响。方法 2018年6月至2020年1月,35例PD患者随机分成对照组（n=17）和实验组（n=18）,其中5例脱落,两组各剩15例。对照组接受传统的步态训练4周,实验组在接受传统的步态训练基础上的增加游戏训练4周,治疗前、后采用帕金森综合评分量表第三部分(Unified Parkinson's Disease Rating Scale Ⅲ, UPDRS Ⅲ）、Berg平衡量表（Berg Balance Scale, BBS）、蒙特利尔认知评估（Montreal Cognitive Assessment, MoCA）、双负荷计时“起立-行走”测试(double test the time up and go, TUGTDT),10米步行测试对PD患者进行评分。30例患者完成了干预其中对照组15例,实验组15例。结果 实验组及对照组UPDRS Ⅲ、BBS、TUGTDT测试治疗后均较治疗前改善(P<0.05),实验组优于对照组(P<0.05);实验组10米步行测试、MoCA评分治疗后较治疗前改善(P<0.05)。结论 传统步态训练结合游戏较单纯传统步态训练更能改善帕金森患者的步态、平衡及认知。     

认知任务干扰脑卒中步态的前驱研究

目的:通过步态分析手段,探讨认知任务对脑卒中患者步态的影响,比较不同认知任务对步态影响的区别。方法:15例脑卒中患者参与本项研究。要求所有患者分别进行两种步行:自然状态下直线步行20m;步行的同时分别执行定向、记忆、计算和言语任务。采用Gaitwatch步态分析系统收集5次步行时的步态参数,包括步频、步幅、步速、双支撑相百分比和健侧摆动相百分比。结果:5组步频无显著性差异(F=1.972,P=0.169),5组步幅(F=13.142,P0.01)、步速(F=11.445,P=0.001)、双支撑相百分比(F=13.142,P0.01)和健侧摆动相百分比(F=11.000,P0.01)有显著性差异。与自然步行相比,4种认知任务时的步幅均显著降低,双支撑相百分比显著提高,定向任务和计算任务时的步速和健侧摆动相百分比显著降低。与计算任务相比,定向任务时的步幅、步速提高,双支撑相百分比降低;记忆任务时步幅、步速和健侧摆动相百分比提高,双支撑相百分比降低;言语任务时步幅和步速提高。结论:认知任务会降低脑卒中患者的步幅、步速和健侧摆动相百分比,延长双支撑相百分比,不同类型认知任务对步态的干扰不同。     

帕金森病患者步态适应性的研究进展

步态适应性是指通过改变步行方式来满足任务目标和环境需求的能力,该能力对人们在家庭和社区环境中安全地行走至关重要。帕金森病患者的步态适应性通常严重受损,但是临床上鲜少关注帕金森病步态适应性的量化评估。本文从帕金森病的步态适应性障碍、评估方法和步态适应性的康复策略等方面进行了综述,旨在呼吁早期关注帕金森病患者步行功能障碍,...     

Tinetti步态评价对帕金森病患者步态能力变化的敏感性

先前的研究曾发现动作分析对于步态的改变是敏感的 ,并提示帕金森病 (Parkinson’sdisease ,PD)患者经专门的指导能成功地改变时间及空间的步态变数 (即步速、步长 )并达到较正常的步行。现在 ,我们开展了资料分析来检验Tinetti步态评价 (tinettigaitassessment ,TGA)是否是能提供临床可行的替代动作分析的评价方法及其检查PD患者的步行能力的敏感性。资料与方法　选择社区成年居民 ,10例PD患者作为PD组 ,另 10例年龄和性别上相匹配的作为对照组 ,参与者无其它影响步行的神经、躯体疾病或精神障碍。当参与者走过室内 7 4m的地板 ,侧方…     

减重步行训练对帕金森病患者步态的影响

目的:探讨减重步行训练对帕金森病(PD)患者步态的影响。方法:PD患者50例随机分为对照组和训练组,各25例。对照组采用常规药物治疗,训练组在常规药物治疗基础上,加用减重步行训练。于治疗前及治疗4周后,监测2组步行参数(步频、步长、步速),采用PD统一评分量表(UPDRS)评估患者运动功能受损程度,采用Berg平衡量表(BBS)评价患者平衡功能,6min步行测试(6minwT)评价患者的步行运动功能。结果:训练组治疗后步长大于对照组(P<0.05),步频小于对照组(P<0.05)。训练组UPDRS II、UPDRS III、6minwT及BBS治疗后的评分与本组治疗前及对照组治疗后的评分相比,差异均有统计学意义(P<0.05)。结论:减重步行训练可改善PD患者的步态运动功能。     

司来吉兰联合综合训练对帕金森病步态冻结患者步态及认知功能的影响

目的 探讨司来吉兰联合综合训练对帕金森病步态冻结患者冻结步态及认知功能的影响。方法 选取河北北方学院附属第二医院2019年3月至2022年2月收治的101例帕金森病步态冻结患者作为研究对象,根据组间基线资料均衡的原则,采用随机的方法将患者分为对照组49例和观察组52例。对照组给予司来吉兰进行治疗,观察组给予司来吉兰联合综合训练进行治疗。比较两组患者治疗前后Webster评分、巴塞尔指数、治疗后步态相关参数、治疗后认知情况、治疗效果;治疗后焦虑评分、抑郁评分和幻觉情况。结果 两组患者治疗后Webster评分、步频下降,且治疗后观察组患者降低幅度更大,差异有统计学意义（P<0.05）;两组患者治疗后巴塞尔指数、步长、步速均增大,且观察组患者较对照组增长幅度更大,差异有统计学意义（P<0.05）;观察组患者治疗后MMSE评分、视空间和执行、抽象思维、治疗总有效率高于对照组,差异有统计学意义（P<0.05）。观察组患者治疗后抑郁评分低于对照组,差异有统计学意义（P<0.05）。结论 司来吉兰联合综合训练治疗帕金森病步态冻结患者对改善冻结步态、认知效果更好。     

帕金森病患者步态测量与定量分析

摘要 目的：提取帕金森病患者步态运动学和时空参数,通过实验分析找到可以作为步态量化评估的特征参数,为医生提供康复评估的依据。 方法：本文采用基于刚体的虚拟标识点方法在受试者下肢解剖学关键点设置标识点获取其步态信息。受试者被分为开机组(DBS ON),关机组(DBS OFF)和对照组(Control),运动捕捉仪记录受试者多个步态周期的虚拟标识点三维坐标。提取包括关节角度、支撑相比率、双支撑相比率、步态周期时间、步频、步长和步速等在内的步态运动学及时空参数。对三组步态特征参数进行单因素一元方差分析。 结果：各组间下肢各关节角度变化范围、支撑相比率、双支撑相比率、步长和步速差异均有显著性(P<0.01),且随受试者症状的减轻,关节角度变化范围、步长和步速有显著递增趋势 (DBS OFFDBS ON>Control)。 结论：基于刚体的虚拟标识点可以准确测量人体步态。提取出的关节角度变化范围、支撑相比率、双支撑相比率,步长和步速均可作为帕金森病患者康复评估的依据。     

节律性听觉注意刺激对帕金森病患者步态的影响

目的 探讨节律性听觉注意刺激对帕金森病患者步态的影响.方法 8例帕金森病患者(帕金森病组)和6名健康对照受试者(对照组)参与本研究.要求受试者完成以下2种条件下的步行:一是让受试者以自己感觉最舒适的速度自由步行2 min,二是要求受试者注意聆听频率高于基线步频10%的节拍器的声音(即加载节律性听觉注意刺激)且按此节律步行.采用三维运动分析仪记录受试者2种条件下的步态参数,使用额叶功能评定量表和Stroop-3测试评估患者的执行能力.结果 节律性听觉注意刺激明显提高了对照组的步频和步速,而帕金森病组步频明显提高,步长和步幅明显减小.在自由步行和加载节律性听觉刺激两种条件下,帕金森病组的步长、步幅和步速均显著低于对照组.听觉刺激减小了对照组的步速变异,增大了帕金森病组的步幅变异.自由步行条件下,2组受试者步态变异系数比较,差异无统计学意义;加载节律性听觉注意刺激后,帕金森病组的步长、步幅和步速变异系数明显高于对照组.执行能力测试显示,帕金森病患者存在执行能力障碍,且Stroop-3的错误率与加载听觉注意刺激条件下的步长呈显著负相关(r=-0.724,P=0.037).结论 外加高于基线步频10%的听觉注意刺激并不会改善帕金森病患者的步态,反而增加了患者的认知负荷.从而加剧步态紊乱,这可能是由于其执行功能障碍所致.

Abstract：

Objective To explore the effects of rhythmic auditory stimulation on the gait of patients with Parkinson's disease(PD). Methods Eight patients with PD and six healthy control subjects were studied.All subjects walked as usaal for 2 min and then Walked for 2 rain with rhythmic auditory attentional stimulation with a frequency 10% faster than their basic pace.The gait parameters in the two walking conditions were measured with three-dimension motion analysis equipment.In addition,executive function was evaluated using a frontal assessment battery (FAB)scale and the Stroop-3 test. Results In both walking conditions,average stride length and velocity were significantly lower in the PD patients than among the controls.The metronome at the higher frequency increased the cadence and stride velocity significantly in the controls.but in the PD patients it was associated with increased ca dence but decreased stride length.With auditory stimulation,the variability of velocity decreased significantly in the controls,but the variability in stride length increased significantly in the PD patients.Even with the auditory stimulation,the variability in step length,stride length and velocity were still significantly higher in the PD patients than among the controls.Executive dysfunction was clearly evident in the PD patients.Stroop-3 error rates were significantly negatively correlated with step length in the condition involving auditory stimulation.Conclusion Auditory attentional stimulation at a higher frequency becomes a new cognitive load for PD patients,and it cannot improve their gait.This may be related to executive dysfunction.     

帕金森病患者冻结步态评估工具的研究进展

冻结步态是帕金森病患者常见的一种步态障碍,我国帕金森病患者冻结步态的发生率接近50%。为有效应对和控制帕金森病患者的冻结步态,选择科学有效的评估工具对其进行客观、准确的评估十分重要。该文介绍了帕金森病患者冻结步态常见评估工具的应用现状及特点,并探讨各工具应用的优势与不足,为正确地评估帕金森病患者冻结步态提供借鉴。     

音乐运动疗法对帕金森病患者步态及运动功能的影响

目的:观察音乐运动疗法对帕金森病(PD)患者步态及运动功能的影响。方法:采用随机数字表法将67例PD患者分为观察组(34例)及对照组(33例)。2组患者均给予常规抗PD药物治疗及护理,对照组辅以常规运动治疗,观察组则给予音乐运动治疗,2组患者均每天治疗1次,每周治疗5 d。于治疗前、治疗8周后评估对比2组患者步态时空参...     

Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks

BACKGROUND AND PURPOSE: Exacerbation of movement disorders while doing 2 tasks (dual task performance) is a characteristic feature of Parkinson disease (PD). The aim of this investigation was to identify whether the type of secondary task (motor or cognitive) determined the severity of dual task interference. SUBJECTS AND METHODS: Footstep patterns for 15 people with PD and 15 comparison subjects without PD were compared when they walked: (1) at a self-selected speed, (2) while simultaneously performing a motor task (coin transference), and (3) while simultaneously performing a cognitive task (digit subtraction). Gait speed, stride length, cadence, and the percentage of the gait cycle in double-limb stance (DS) were examined with a computerized stride analyzer. RESULTS: When there was no second task, the mean stride length was less in the group with PD (1.29 m) than in the comparison group (1.51 m), and the mean gait speed was less in the group with PD (71.47 m/min) than in the comparison group (87.29 m/min). The mean cadence was less in the group with PD (110.79 steps/min) than in the comparison group (115.81 steps/min). The percentage of the gait cycle in DS was greater in the group with PD (33.38%) than in the comparison group (31.21%). Both groups reduced their stride length and speed when they had to change from unitask performance to dual task performance and DS increased. For the group with PD, cadence also decreased. For both groups, the type of secondary task had a negligible effect on the performance decrement. DISCUSSION AND CONCLUSION: Although the performance of simultaneous motor or cognitive tasks compromised gait in people with PD, the type of secondary task was not a major determinant of the severity of dual task interference.     

应用功能性步态评价预测帕金森病患者跌倒情况的研究

目的:本研究拟应用功能性步态评价(FGA)对帕金森病(PD)患者进行跌倒预测。方法:选择北京天坛医院神经内科入院PD患者121例。由1名治疗师进行FGA测评,6个月后,另外一名神经病学医师对患者进行电话随访。收集其6个月内的跌倒情况,绘制FGA的接受者操作特征曲线,并确定FGA预测跌倒的分界值、敏感性、特异性、似然比等。结果:FGA对未来6个月内的跌倒预测,其最佳分界值为18,敏感度为80.6%,特异度为80.0%,似然比为4.03。结论:FGA可用于预测未来6个月内PD患者的跌倒,是较好的评价工具。     

Goal-directed secondary motor tasks: their effects on gait in subjects with Parkinson disease

OBJECTIVE: To investigate the effects of secondary motor tasks of three levels of difficulty on the spatial and temporal parameters of gait in subjects with Parkinson disease (PD) compared with control subjects. DESIGN: A two-group repeated measures design using a sample of convenience. Subjects performed 10-meter gait trials walking (1) freely, (2) carrying a tray, and (3) carrying a tray with four plastic glasses. SETTING: Subjects were tested in the gait laboratory at Kingston Centre, Victoria, Australia. SUBJECTS: Twelve subjects with PD and 12 control subjects matched for age, height, and sex were recruited from the Movement Disorders Clinic at Kingston Centre. OUTCOME MEASURES: Gait speed, stride length, cadence, and the proportion of the walking cycle spent in double limb support were measured in moderately disabled subjects with PD and control subjects. RESULTS: For all of the walking conditions, subjects with PD walked more slowly (F(1,22) = 16.54, p = .001, partial nu2 = .429) and with shorter steps (F(1,22) = 15.07, p = .001, partial nu2 = .406) than control subjects. In addition there were significant group by condition interaction effects for gait speed (F(2, 44) = 4.42, p = .018, partial nu2 = .167) and stride length (F(2, 44) = 4.95, p = .012, partial nu2 = .184). There was little deterioration in gait when subjects in either group carried a tray while walking compared with free walking; however, when required to carry four plastic glasses on the tray while walking, subjects in the PD group showed marked deterioration in gait speed (t(11) = 3.19, p = .009, alpha = .025) and stride length (t(11) = 3.82, p = .003, alpha = .025). Performance in the control subjects changed only marginally across the conditions. CONCLUSION: Subjects with moderate disability in PD experience considerable difficulty when they are required to walk while attending to a complex visuomotor task involving the upper limbs.     

Assessing the effects of subthalamic nucleus stimulation on gait and mobility in people with Parkinson disease

Purpose.?To determine the effects of unilateral and bilateral subthalamic nucleus (STN) stimulation on gait and mobility in persons with Parkinson disease (PD).

Method.?We examined eight individuals with advanced PD who underwent staged stimulator implantation surgeries. Gait and mobility were assessed in the medication-on state with a variety of clinical and laboratory measures (Unified Parkinson Disease Rating Scale items, Timed Up and Go Test, gait speed) at three time points: prior to surgery, after the first surgery (unilateral stimulation) and after the second surgery (bilateral stimulation).

Results.?Despite overall improvements in motor function and reduction of dyskinesia, there were no significant group effects of unilateral or bilateral stimulation on gait and mobility compared to pre-surgical function. However, there were clinically meaningful changes, both improvements and declines, at the individual level.

Conclusions.?Because of the consequences of gait deficits and mobility limitations for people with PD, future research should examine the effects of STN stimulation on gait in the medication-on state using sensitive and specific measures such as gait speed. Accurate assessment of gait changes is necessary to improve the evaluation of STN effects and the prediction of individuals in need of rehabilitation services to manage gait and mobility deficits.     

Long-term effects of antidepressants on cognition in patients with Alzheimer's disease

PURPOSE: Approximately 25-40% of patients with Alzheimer's disease (AD) may develop depression. Antidepressants are typically used to treat depression in this population. However, their effect on cognition has been rarely studied and the results are conflicting. In addition, the long-term effects of antidepressants on cognition have not been studied. Therefore, the objective of the study was to evaluate the effects on cognition in patients with AD treated with antidepressants for at least 9 months. METHODS: Data on antidepressant use over a minimum period of 9 months were retrospectively collected for patients with AD receiving cholinesterase inhibitors. Data on cognition were analyzed to compare those taking antidepressant therapy and those not receiving antidepressants. RESULTS: Ninety-nine of 210 patients met our inclusion criteria. Fifty-eight patients were prescribed an antidepressant (e.g. selective serotonin reuptake inhibitors (SSRIs), newer generation antidepressants). Sertraline (mean dose: 82 mg/day) and citalopram (mean dose: 35 mg/day) were the most commonly prescribed antidepressants. The baseline mean Mini Mental State Examination (MMSE) score was 16.32 with an average annual rate of cognitive decline of 2.55 for patients receiving antidepressants compared with 16.59 (P = NS) and 2.27 (P = NS) for those not taking antidepressants. CONCLUSIONS: Our small sample data indicate no differences in baseline MMSE scores and cognitive decline between the two groups, suggesting antidepressants did not contribute significantly to cognitive decline over a utilization period of at least 9 months.     

The effects of light touch cue on gait initiation in patients with Parkinson's disease

IntroductionOne of the common impairments in patients with Parkinson's disease (PD) is disturbance of gait initiation. A light touch cue improves postural stability in patients with PD. Little is known about the effects of a light touch cue on gait initiation. This study investigated the effects of a light touch on gait initiation in patients with PD.MethodsThis study was a cross-sectional study design. Sixteen patients with PD (Hoehn & Yahr stage 2–3) participated in the study and were evaluated two gait conditions (no touch (NT) and light touch (LT) conditions). Gait initiation was divided into 5 events including event A, B, C, D, and E. Outcome measures included maximum center of pressure (COP) displacement and velocity in anteroposterior (AP) and mediolateral (ML) directions, and the first step time.ResultsParticipants with LT had greater COP displacement compared with the NT condition in all events of gait initiation except COP-AP displacement in event D. Additionally, the COP velocity in LT condition was faster than the NT condition in COP-ML velocity in event A, COP-AP velocity in event B, COP-AP velocity and COP-ML velocity in event C. Moreover, participants with LT presented significantly shorter the first step time than the NT condition.ConclusionsThese findings demonstrated that a light touch cue improved gait initiation in patients with PD by increased weight shifting to initial stance limb, increased postural stability of stance limb, increased velocity of weight transfer toward stance limb, and a shortened first step time.     

Cardiac denervation in patients with Parkinson disease

More than 40 neuroimaging studies have reported evidence for loss of sympathetic noradrenergic nerves in PD. Cardiac sympathetic denervation is virtually universal in patients with PD and neurogenic orthostatic hypotension. About one half of patients with PD who do not have orthostatic hypotension also have evidence for loss of noradrenergic innervation. The loss progresses over years, in a pattern suggesting "dying-back". Because patients with familial PD from mutation of the gene encoding alpha-synuclein or from triplication of the normal gene have low myocardial concentrations of 6-[18F]fluorodopamine-derived radioactivity, cardiac sympathetic denervation seems linked etiologically with alpha-synucleinopathy. Baroreflex-cardiovagal failure and cardiac sympathetic denervation can occur before onset of the movement disorder, suggesting that neurocardiologic testing might provide a biomarker for detecting presymptomatic or early PD and for following responses to putative neuroprotective treatments.     

The biomechanics and motor control of gait in Parkinson disease.

Parkinson disease is a progressive neurological condition characterised by hypokinesia (reduced movement), akinesia (absent movement), tremor, rigidity and postural instability. These movement disorders are associated with a slow short-stepped, shuffling gait pattern. Analysis of the biomechanics of gait in response to medication, visual cues, attentional strategies and neurosurgery provides insight into the nature of the motor control deficit in Parkinson disease and the efficacy of current therapeutic interventions. In this article we supplement a critical evaluation of the Parkinson disease gait literature with two case examples. The first case describes the kinematic gait response of an individual with Parkinson disease to visual cues in the "off" phase of the levodopa medication cycle. The second case investigates the biomechanics and motor control of turning during walking in a patient with Parkinson disease compared with elderly and young control subjects. The results are interpreted in light of the need for gait analysis to investigate complex functional walking tasks rather than confining assessment to straight line walking, which has been the trend to date.