Marked alterations in the gait timing and rhythmicity of patients with de novo Parkinson's disease
Marked alterations in the gait timing and rhythmicity of patients with de novo Parkinson's disease
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DOI：
10.1111/j.1460-9568.2006.05033.x
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发表时间：
2006-09-01
影响因子：
3.4
通讯作者：
Hausdorff, Jeffrey M.
中科院分区：
文献类型：
--
作者：
Baltadjieva, Rossitza;Giladi, Nir;Hausdorff, Jeffrey M.
人们对帕金森氏症(PD)患者的步态特征知之甚少。我们假设，在这些患者中，步态的时空特征的变化是可以量化的。对35例特发性帕金森病患者(平均年龄60岁)、早期(Hoehn和Yahr分期1.8+/-0.5，中位数2.0，范围1.0~2.5)与年龄和性别匹配的健康对照组(n=22)的步态进行比较。患者走得更慢，摆动次数减少，同时也表现出左/右摆动不对称增加，步态时间明显不一致。相比之下，在脚跟着地时的峰值力量和地面反作用力的步距变异性(反映肌肉输出一致性的一个指标)方面，没有观察到显著的组间差异。这些发现表明，在初发帕金森病患者中，可以观察到步态模式的变化，尽管步态模式的显著变化在视觉上可能还不明显(例如，相当完整的步态速度)。此外，结果表明，观察到的变化不仅仅是治疗的副作用或疾病的并发症。取而代之的是，有证据表明步态中存在运动编程缺陷，这表现为步态变异性和时间不对称的增加。帕金森病明显影响步态节律的调节，即使在疾病早期，观察到的改变不是任何药物治疗的结果。
Little is known about the gait characteristics of subjects with de novo Parkinson's disease (PD). We hypothesized that alterations in the spatio-temporal characteristics of gait will already be quantifiable in these patients. The gait of 35 patients with idiopathic PD (mean age 60 years) who were in the early stages of the disease (Hoehn and Yahr stage 1.8 +/- 0.5, median 2.0, range 1.0-2.5) and were not yet treated with any anti-parkinsonian medications were compared with the gait of age- and sex-matched healthy controls (n = 22). The patients walked more slowly and with reduced swing times while also exhibiting increased left/right swing asymmetry and marked inconsistencies in the timing of gait. By contrast, significant group differences in the peak forces at heel-strike and in the stride-to-stride variability of the ground reaction forces (a reflection of muscle output consistency) were not observed. These findings indicate that in de novo PD, an altered gait pattern is observed, even though dramatic changes in the gait pattern may not yet be apparent visually (e.g. fairly intact gait speed). Furthermore, the results demonstrate that the observed alterations are not just side-effects of treatments or complications of the disease. Instead, there is evidence for motor programming deficits in gait, as revealed by increased gait variability and asymmetry in timing. PD apparently impinges on the regulation of a consistent gait rhythm, even early in the course of the disease when observed alterations are not the result of any pharmacologic treatment.