scholarly journals A Novel Easy-of-Use Smartphone-Based Assessment of Gait Characteristics in Parkinson’s Disease (Preprint)

2020 ◽  
Author(s):  
Dongning Su ◽  
Zhu Liu ◽  
Xin Jiang ◽  
Fangzhao Zhang ◽  
Wanting Yu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Gold Standard ◽  
Rating Scale ◽  
Standard System ◽  
Functional Characteristics ◽  
Velocity Signal ◽  
Single Task ◽  
Gait Assessment

BACKGROUND Parkinson’s disease (PD) is common movement disorder and patients with PD had multiple gait impairments, leading to increased risk of falls, and diminished quality of life. The gait measurement in patients with Parkinson’s disease (PD) is thus important for the management of PD. OBJECTIVE We have developed and validated a smartphone-based assessment of gait, allowing the remote gait assessment in healthy cohorts. We here aimed to test the validity of this App-based gait measurement in people with PD and explore the association between the gait metrics measured by App and the clinical and functional characteristics in PD. METHODS Fifty-two participants with clinically-diagnosed PD completed assessments of walking, MDS-Unified Parkinson's Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A) and Depression (HAM-D) rating scale tests. Participants followed multi-media instructions provided by the App to complete two 20-meter trials each of walking normally (single-task) and walking while performing a serial subtraction dual task (dual-task). The locomotion data were simultaneously collected with the App and a gold-standard system. The gait stride times (ST) and stride time variability (STV) were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone, and from the wearable sensor system. RESULTS High correlations between the ST and STV derived from the App and those from gold-standard system were observed (r=0.98~0.99, p<.0001), revealing excellent validity of the App-based gait assessment in PD. Compared to single-task, the ST (F=13.1, p=.0005) and STV (F=6.3, p=.01) in dual-task condition were significantly greater. Participants with greater STV in both conditions had greater total score of UPDRS III (r=0.37~0.39, p=.0007~.01), HAM-A (single-task: r=0.49, p=.007; dual-task: r=0.48, p=.009) and HAM-D (single-task: r=0.44, p=.01; dual-task: r=0.49, p=.009); and those with greater dual-task STV (r=0.48, p=.001) and/or dual-task cost to STV (r=0.44, p=.004) had lower MoCA score. CONCLUSIONS These results demonstrated that this ease-of-its-use smartphone-based gait measurement is validated and provides meaningful metrics that are associated with clinical and functional characteristics in PD.

scholarly journals Simple Smartphone-Based Assessment of Gait Characteristics in Parkinson Disease: Validation Study

10.2196/25451 ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. e25451
Author(s):  
Dongning Su ◽  
Zhu Liu ◽  
Xin Jiang ◽  
Fangzhao Zhang ◽  
Wanting Yu ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Movement Disorder ◽  
Dual Task ◽  
Gold Standard ◽  
Rating Scale ◽  
Time Variability ◽  
Stride Time ◽  
Task Condition ◽  
Single Task ◽  
Gait Assessment

Background Parkinson disease (PD) is a common movement disorder. Patients with PD have multiple gait impairments that result in an increased risk of falls and diminished quality of life. Therefore, gait measurement is important for the management of PD. Objective We previously developed a smartphone-based dual-task gait assessment that was validated in healthy adults. The aim of this study was to test the validity of this gait assessment in people with PD, and to examine the association between app-derived gait metrics and the clinical and functional characteristics of PD. Methods Fifty-two participants with clinically diagnosed PD completed assessments of walking, Movement Disorder Society Unified Parkinson Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scale tests. Participants followed multimedia instructions provided by the app to complete two 20-meter trials each of walking normally (single task) and walking while performing a serial subtraction dual task (dual task). Gait data were simultaneously collected with the app and gold-standard wearable motion sensors. Stride times and stride time variability were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone and from the wearable sensor system. Results High correlations were observed between the stride time and stride time variability derived from the app and from the gold-standard system (r=0.98-0.99, P<.001), revealing excellent validity of the app-based gait assessment in PD. Compared with those from the single-task condition, the stride time (F1,103=14.1, P<.001) and stride time variability (F1,103=6.8, P=.008) in the dual-task condition were significantly greater. Participants who walked with greater stride time variability exhibited a greater UPDRS III total score (single task: β=.39, P<.001; dual task: β=.37, P=.01), HAM-A (single-task: β=.49, P=.007; dual-task: β=.48, P=.009), and HAM-D (single task: β=.44, P=.01; dual task: β=.49, P=.009). Moreover, those with greater dual-task stride time variability (β=.48, P=.001) or dual-task cost of stride time variability (β=.44, P=.004) exhibited lower MoCA scores. Conclusions A smartphone-based gait assessment can be used to provide meaningful metrics of single- and dual-task gait that are associated with disease severity and functional outcomes in individuals with PD.

scholarly journals Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson’s Disease by Wearable Sensors: Controlled Study (Preprint)

2019 ◽  
Author(s):  
Jingying Wang ◽  
Dawei Gong ◽  
Huichun Luo ◽  
Wenbin Zhang ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Rating Scale ◽  
Wearable Sensors ◽  
Challenge Test ◽  
Initial Step ◽  
Controlled Study ◽  
Walking Test ◽  
Single Task

BACKGROUND Gait impairments including shuffling gait and hesitation are common in people with Parkinson’s disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. OBJECTIVE This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). METHODS A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. RESULTS The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (<i>F</i><sub>1,48</sub>=69.75, <i>P</i>&lt;.001, partial eta-square=0.59), initial step angle (<i>F</i><sub>1,48</sub>=15.56, <i>P</i>&lt;.001, partial eta-square=0.25), and last step angle (<i>F</i><sub>1,48</sub>=61.99, <i>P</i>&lt;.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: <i>F</i><sub>1,38</sub>=5.77, <i>P</i>=.02, partial eta-square=0.13; DBS: <i>F</i><sub>1,52</sub>=8.53, <i>P</i>=.005, partial eta-square=0.14) and last step angles (ACLT: <i>F</i><sub>1,38</sub>=10, <i>P</i>=.003, partial eta-square=0.21; DBS: <i>F</i><sub>1,52</sub>=4.96, <i>P</i>=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: <i>r</i>=–0.60, <i>P</i>&lt;.001; dual task: <i>r</i>=–0.52, <i>P</i>&lt;.001), initial step angle (single task: <i>r</i>=–0.35, <i>P</i>=.006; dual task: <i>r</i>=–0.35, <i>P</i>=.01), and last step angle (single task: <i>r</i>=–0.43, <i>P</i>=.001; dual task: <i>r</i>=–0.41, <i>P</i>=.002). CONCLUSIONS This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.

scholarly journals Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson’s Disease by Wearable Sensors: Controlled Study

10.2196/16650 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e16650
Author(s):  
Jingying Wang ◽  
Dawei Gong ◽  
Huichun Luo ◽  
Wenbin Zhang ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Rating Scale ◽  
Wearable Sensors ◽  
Challenge Test ◽  
Initial Step ◽  
Controlled Study ◽  
Walking Test ◽  
Single Task

Background Gait impairments including shuffling gait and hesitation are common in people with Parkinson’s disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. Objective This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). Methods A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. Results The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=–0.60, P<.001; dual task: r=–0.52, P<.001), initial step angle (single task: r=–0.35, P=.006; dual task: r=–0.35, P=.01), and last step angle (single task: r=–0.43, P=.001; dual task: r=–0.41, P=.002). Conclusions This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.

The efficacy of cognitive-cycling dual-task training in patients with early-stage Parkinson’s disease: A pilot study

2020 ◽  
Vol 47 (4) ◽  
pp. 415-426
Author(s):  
Hsiu-Chen Chang ◽  
Chiung-Chu Chen ◽  
Yi-Hsin Weng ◽  
Wei-Da Chiou ◽  
Ya-Ju Chang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Performance ◽  
Dual Task ◽  
Rating Scale ◽  
Early Stage ◽  
Freezing Of Gait ◽  
Timed Up And Go ◽  
Gait Performance ◽  
The Mean

BACKGROUND: Recent studies have suggested that cognitive-motor dual-task (DT) training might improve gait performance, locomotion automaticity, balance, and cognition in patients with Parkinson’s disease (PD). OBJECTIVE: We aimed to investigate the efficacy of cognitive-cycling DT training in patients with early-stage PD. METHODS: Participants were scheduled to perform cognitive tasks simultaneously with the cycling training twice per week for eight weeks for a total of 16 sessions during their on-states. Clinical assessments were conducted using the unified Parkinson’s disease rating scale (UPDRS), modified Hoehn and Yahr stage, Timed Up and Go (TUG) test, gait and cognitive performances under dual-task paradigm, the new freezing of gait questionnaire, Schwab and England Activities of Daily Living scale, 39-item Parkinson’s disease questionnaire, and cognitive performance. RESULTS: Thirteen eligible patients were enrolled in the study. The mean age was 60.64±5.32 years, and the mean disease duration was 7.02±3.23 years. Twelve PD patients completed 16 serial cognitive-cycling sessions for two months. After 16 sessions of training (T2), the UPDRS III scores improved significantly in both the off- and on-states, and TUG were significantly less than those at pretraining (T0). During both the single-task and the DT situations, gait performance and spatial memory cognitive performance significantly improved from T0 to T2. CONCLUSION: The present study demonstrated that cognitive-cycling DT training improves the motor functions, gait and cognitive performances of PD patients.

A novel method for automatic classification of Parkinson gait severity using front-view video analysis

2020 ◽  
pp. 1-11
Author(s):  
Taha Khan ◽  
Ali Zeeshan ◽  
Mark Dougherty
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Automatic Classification ◽  
Rank Test ◽  
Support Vector ◽  
Front View ◽  
Gait Impairment ◽  
Gait Assessment

BACKGROUND: Gait impairment is an essential symptom of Parkinson’s disease (PD). OBJECTIVE: This paper introduces a novel computer-vision framework for automatic classification of the severity of gait impairment using front-view motion analysis. METHODS: Four hundred and fifty-six videos were recorded from 19 PD patients using an RGB camera during clinical gait assessment. Gait performance in each video was rated by a neurologist using the unified Parkinson’s disease rating scale for gait examination (UPDRS-gait). The proposed algorithm detects and tracks the silhouette of the test subject in the video to generate a height signal. Gait features were extracted from the height signal. Feature analysis was performed using the Kruskal-Wallis rank test. A support vector machine was trained using the features to classify the severity levels according to UPDRS-gait in 10-fold cross-validation. RESULTS: Features significantly (p< 0.05) differentiated between median-ranks of UPDRS-gait levels. The SVM classified the levels with a promising area under the ROC of 80.88%. CONCLUSION: Findings support the feasibility of this model for Parkinson’s gait assessment in the home environment.

scholarly journals Relationship between Sensorimotor Inhibition and Mobility in Older Adults with and without Parkinson’s Disease

2020 ◽  
Author(s):  
Douglas N Martini ◽  
Rosie Morris ◽  
Tara M Madhyastha ◽  
Thomas J Grabowski ◽  
John Oakley ◽  
...  
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Stride Length ◽  
Inertial Sensors ◽  
Postural Sway ◽  
Single Task ◽  
Immediate Recall ◽  
Foot Strike

Abstract Background Reduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson’s disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sensorimotor inhibition relates to impairments in mobility and cognition in people with PD and OAs. Methods Cortical sensorimotor inhibition was characterized with short-latency afferent inhibition (SAI) in 81 people with PD and 69 OAs. Six inertial sensors recorded single- and dual-task gait and postural sway characteristics during a two-minute walk and a one-minute quiet stance. Cognition was assessed across the memory, visuospatial, executive function, attention, and language domains. Results SAI was significantly impaired in the PD compared to the OA group. The PD group preformed significantly worse across all gait and postural sway tasks. In PD, SAI significantly correlated with single-task foot strike angle and stride length variability, sway area, and jerkiness of sway in the coronal and sagittal planes. In OAs, SAI significantly related to single-task gait speed and stride length, dual-task stride length, and immediate recall (memory domain). No relationship among mobility, cognition, and SAI was observed. Conclusions Impaired SAI related to slower gait in OA and to increased gait variability and postural sway in people with PD, all of which have been shown to be related to increased fall risk.

scholarly journals Dual-Task Performance in GBA Parkinson’s Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Karin Srulijes ◽  
Kathrin Brockmann ◽  
Senait Ogbamicael ◽  
Markus A. Hobert ◽  
Ann-Kathrin Hauser ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Deficits ◽  
Dual Task ◽  
Rating Scale ◽  
Motor Task ◽  
Heterozygous Mutation ◽  
Dual Tasking ◽  
Dual Task Performance ◽  
Quantitative Gait Analysis

Introduction. Parkinson’s disease patients carrying a heterozygous mutation in the geneglucocerebrosidase(GBA-PD) show faster motor and cognitive decline than idiopathic Parkinson’s disease (iPD) patients, but the mechanisms behind this observation are not well understood. Successful dual tasking (DT) requires a smooth integration of motor and nonmotor operations. This study compared the DT performances between GBA-PD and iPD patients.Methods.Eleven GBA-PD patients (p.N370S, p.L444P) and eleven matched iPD patients were included. Clinical characterization included a motor score (Unified PD Rating Scale-III, UPDRS-III) and nonmotor scores (Montreal Cognitive Assessment, MoCA, and Beck’s Depression Inventory). Quantitative gait analysis during the single-task (ST) and DT assessments was performed using a wearable sensor unit. These parameters corrected for UPDRS and MoCA were then compared between the groups.Results.Under the DT condition “walking while checking boxes,” GBA-PD patients showed slower gait and box-checking speeds than iPD patients. GBA-PD and iPD patients did not show significant differences regarding dual-task costs.Conclusion. This pilot study suggests that DT performance with a secondary motor task is worse in GBA-PD than in iPD patients. This finding may be associated with the known enhanced motor and cognitive deficits in GBA-PD compared to iPD and should motivate further studies.

Parkinson's Disease Cognitive Functional Rating Scale

2012 ◽  
Author(s):  
Jaime Kulisevsky ◽  
Ramón Fernández de Bobadilla ◽  
Javier Pagonabarraga
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale

scholarly journals Azathioprine immunosuppression and disease modification in Parkinson’s disease (AZA-PD): a randomised double-blind placebo-controlled phase II trial protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040527
Author(s):  
Julia C Greenland ◽  
Emma Cutting ◽  
Sonakshi Kadyan ◽  
Simon Bond ◽  
Anita Chhabra ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Immune System ◽  
Phase Ii ◽  
Rating Scale ◽  
Positron Emission Tomography Imaging ◽  
Clinical Markers ◽  
Double Blind ◽  
Positron Emission ◽  
Immunosuppressant Medication

IntroductionThe immune system is implicated in the aetiology and progression of Parkinson’s disease (PD). Inflammation and immune activation occur both in the brain and in the periphery, and a proinflammatory cytokine profile is associated with more rapid clinical progression. Furthermore, the risk of developing PD is related to genetic variation in immune-related genes and reduced by the use of immunosuppressant medication. We are therefore conducting a ‘proof of concept’ trial of azathioprine, an immunosuppressant medication, to investigate whether suppressing the peripheral immune system has a disease-modifying effect in PD.Methods and analysisAZA-PD is a phase II randomised placebo-controlled double-blind trial in early PD. Sixty participants, with clinical markers indicating an elevated risk of disease progression and no inflammatory or immune comorbidity, will be treated (azathioprine:placebo, 1:1) for 12 months, with a further 6-month follow-up. The primary outcome is the change in the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale gait/axial score in the OFF state over the 12-month treatment period. Exploratory outcomes include additional measures of motor and cognitive function, non-motor symptoms and quality of life. In addition, peripheral and central immune markers will be investigated through analysis of blood, cerebrospinal fluid and PK-11195 positron emission tomography imaging.Ethics and disseminationThe study was approved by the London-Westminster research ethics committee (reference 19/LO/1705) and has been accepted by the Medicines and Healthcare products Regulatory Agency (MHRA) for a clinical trials authorisation (reference CTA 12854/0248/001–0001). In addition, approval has been granted from the Administration of Radioactive Substances Advisory Committee. The results of this trial will be disseminated through publication in scientific journals and presentation at national and international conferences, and a lay summary will be available on our website.Trial registration numbersISRCTN14616801 and EudraCT- 2018-003089-14.

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