Step initiation in Parkinson's disease: Influence of levodopa and external sensory triggers
Step initiation in Parkinson's disease: Influence of levodopa and external sensory triggers
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DOI：
10.1002/mds.870120211
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发表时间：
1997-03-01
影响因子：
8.6
通讯作者：
Obeso, JA
中科院分区：
文献类型：
--
作者：
BurleighJacobs, A;Horak, FB;Obeso, JA
我们研究了帕金森病（PD）患者步态起始缺陷的预期姿势调整，以确定这些缺陷是否可以通过左旋多巴或外部刺激来改善。地面反作用力和身体运动学记录自发和皮肤线索触发的步骤启动正常受试者和PD受试者时，关闭和ON。辅助预期姿势摇摆与表面平移加上皮肤线索的影响也进行了检查。当关闭时，PD受试者的自发步骤特征为步骤启动时，产生的力量减少，运动速度降低，预期姿势调整的执行减慢。当PD受试者处于ON状态时，这些损伤明显不那么明显。当皮肤线索被用作前进信号时，PD和正常受试者的运动力和速度都增加。当受试者主动启动一个步骤，以响应表面平移，PD和正常受试者执行的预期姿势调整步骤更迅速，但PD受试者，无论是ON和OFF，未能增加力量，执行推离更迅速。总之，多巴胺能治疗和外部刺激类似地改善与PD中的步骤启动相关的预期姿势调整的力产生不足。研究结果还表明，在姿势调整阶段的自我产生的，但不是外部触发，步骤启动的力量生产受到多巴胺能通路的影响。
We studied anticipatory postural adjustments contributing to gait initiation deficits in patients with Parkinson's disease (PD) to determine if these deficits could be improved by administration of levodopa or by external stimuli. Ground reaction forces and body kinematics were recorded for self-generated and cutaneous cue-triggered step initiation in normal subjects and in PD subjects when OFF and when ON. The effects of assisting anticipatory postural sway with a surface translation coupled with a cutaneous cue were also examined. Decreased force production, decreased velocity of movement, and slowed execution of the anticipatory postural adjustments for self-generated step characterized step initiation in PD subjects when OFF. These impairments were significantly less evident when the PD subjects were ON. Both PD and normal subjects increased force and velocity of movement when a cutaneous cue was used as a go signal. When subjects voluntarily initiated a step in response to the surface translation, both PD and normal subjects executed the anticipatory postural adjustments for step more rapidly, but the PD subjects, both ON and OFF, failed to increase force to execute push-off more rapidly. In conclusion, dopaminergic therapy and an external stimulus similarly improve the deficient force production for the anticipatory postural adjustments associated with step initiation in PD. The findings also suggest that force production during the postural adjustment phase of self-generated, but not externally triggered, step initiation is influenced by dopaminergic pathways.