Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson's disease.
Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson's disease.
复制标题
帕金森病对深部脑刺激的步态和平衡反应的定量分析。
DOI：
10.1016/j.gaitpost.2012.10.025
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发表时间：
2013
期刊：
影响因子：
2.4
通讯作者：
Giuffrida,JosephP
中科院分区：
文献类型：
--
作者：
Mera,ThomasO;Filipkowski,DanielleE;Riley,DavidE;Whitney,ChristinaM;Walter,BenjaminL;Gunzler,StevenA;Giuffrida,JosephP
帕金森病（PD）患者的步态和平衡障碍可能会使人衰弱，并可能导致跌倒风险增加。脑深部电刺激（DBS）是一种治疗选择，一旦药物治疗的好处是有限的，由于运动波动和运动障碍。针对步态和平衡优化DBS参数可能比针对其他PD运动症状更具挑战性。此外，标准临床PD评估量表（统一帕金森病评定量表）的评定者间可靠性可能会引入偏倚，并清除可能对PD治疗产生不同反应的步态和平衡的重要特征。研究目的是评价临床医生的步态和平衡评分评分者间的可靠性，步态和平衡的不同方面，以及如何从运动传感器数据中提取的运动学特征响应刺激的步态和平衡的灵敏度。招募了42名诊断为PD的受试者，他们有不同程度的步态和平衡障碍。所有受试者均接受了多巴胺能药物治疗，20例受试者既往接受过DBS手术。受试者在胸骨和每个脚跟和大腿上佩戴运动传感器的同时执行七项步态和平衡子组。评分者间信度因评分项目而异。至少有一个运动学特征和相应的ADORS评分之间的相关系数大于0.75的7个项目。对于三个BPRS项目，从DBS-OFF到DBS-ON，运动学特征得到改善（p<0.05）。尽管实现了高相关性与运动学特征，评估个人的运动学特征可能有助于解决评分员之间的可靠性问题和评分员偏见与专注于不同方面的运动任务。
Gait and balance disturbances in Parkinson's disease (PD) can be debilitating and may lead to increased fall risk. Deep brain stimulation (DBS) is a treatment option once therapeutic benefits from medication are limited due to motor fluctuations and dyskinesia. Optimizing DBS parameters for gait and balance can be significantly more challenging than for other PD motor symptoms. Furthermore, inter-rater reliability of the standard clinical PD assessment scale, Unified Parkinson's Disease Rating Scale (UPDRS), may introduce bias and washout important features of gait and balance that may respond differently to PD therapies. Study objectives were to evaluate clinician UPDRS gait and balance scoring inter-rater reliability, UPDRS sensitivity to different aspects of gait and balance, and how kinematic features extracted from motion sensor data respond to stimulation. Forty-two subjects diagnosed with PD were recruited with varying degrees of gait and balance impairment. All subjects had been prescribed dopaminergic medication, and 20 subjects had previously undergone DBS surgery. Subjects performed seven items of the gait and balance subset of the UPDRS while wearing motion sensors on the sternum and each heel and thigh. Inter-rater reliability varied by UPDRS item. Correlation coefficients between at least one kinematic feature and corresponding UPDRS scores were greater than 0.75 for six of the seven items. Kinematic features improved (p<0.05) from DBS-OFF to DBS-ON for three UPDRS items. Despite achieving high correlations with the UPDRS, evaluating individual kinematic features may help address inter-rater reliability issues and rater bias associated with focusing on different aspects of a motor task.