Bilateral coordination of walking and freezing of gait in Parkinson's disease
Bilateral coordination of walking and freezing of gait in Parkinson's disease
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DOI：
10.1111/j.1460-9568.2008.06167.x
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发表时间：
2008-04-01
影响因子：
3.4
通讯作者：
Hausdorff, Jeffrey M.
中科院分区：
文献类型：
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作者：
Plotnik, Meir;Giladi, Nir;Hausdorff, Jeffrey M.
帕金森病 (PD) 中的冻结步态 (FOG) 最常发生在转身或迈步过程中，这两项任务可能需要双腿之间高度的双边协调。我们的目的是检验以下假设：双侧步态协调损伤与 PD 中的 FOG 相关。我们比较了经历过 FOG 的 PD 患者 (PD + FOG; n = 21) 和未经历过 FOG 的 PD 患者 (PD - FOG; n = 13) 在平地上行走时的运动特征。为了研究双侧迈步协调性，我们将一只脚的步幅持续时间定义为一个步态周期或 360 度，确定对侧脚跟着地的相对时间，并将其定义为阶段 phi（理想情况下，phi = 180 度）。 phi 的变异系数与 phi 与 180 度之间的平均绝对差之和定义为相位协调指数（PCI），分别代表相位生成中的变异性和不准确性。在“关闭”状态期间（= 停止抗帕金森病药物治疗 12 小时），与 PD - FOG 相比，PD + FOG 的 PCI 值更高（协调性较差）（P < 0.024）。还研究了跨步相位调整 Delta phi。两组均以相同程度缩放其“收敛”调整（朝向 180 度），但当生成发散 Delta phi（远离 180 度）时，PD + FOG 患者与 PD - FOG 患者相比表现出更大的误差（P < 0.006）。这项研究表明，经历过 FOG 的 PD 患者在双侧运动协调方面存在明显的障碍。行走时双侧协调性差可能容易导致 FOG，尤其是在需要高度左右协调的挑战性任务中。
Freezing of gait (FOG) in Parkinson's disease (PD) occurs most frequently during turns or step initiation, two tasks that likely demand a high degree of bilateral coordination between the legs. Our objective was to test the hypothesis that impairments in bilateral coordination of stepping are associated with FOG in PD. We compared locomotion features while walking on level ground between patients with PD that experience FOG (PD + FOG; n = 21) and patients with PD that do not (PD - FOG; n = 13). To study bilateral stepping coordination, we defined the stride duration of one foot as a gait cycle or 360 degrees, determined the relative timing of contralateral heel-strikes and defined this as the phase, phi (ideally, phi = 180 degrees). The sum of the coefficient of variation of phi and the mean absolute difference between phi and 180 degrees was defined as the phase coordination index (PCI), representing variability and inaccuracy, respectively, in phase generation. During the 'Off' state (= 12 h off anti-parkinsonian medication), PCI values were higher (poorer coordination) in PD + FOG compared with PD - FOG (P < 0.024). Stride-to-stride phase adjustments, Delta phi, were also studied. Both groups scaled their 'converging' adjustments (towards 180 degrees) to the same extent, but when generating diverging Delta phi (away from 180 degrees), PD + FOG patients exhibited larger errors compared with PD - FOG patients (P < 0.006). This study demonstrates that patients with PD who experience FOG have distinctive impairments in the bilateral coordination of locomotion. Poor bilateral coordination of walking may predispose to FOG, especially during challenging tasks that demand a high degree of left-right coordination.