Does freezing in Parkinson's disease change limb coordination? A kinematic analysis
Does freezing in Parkinson's disease change limb coordination? A kinematic analysis
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DOI：
10.1007/s00415-006-0514-3
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发表时间：
2007-09-01
影响因子：
6
通讯作者：
Kaat, Desloovere
中科院分区：
文献类型：
--
作者：
Alice, Nieuwboer;Fabienne, Chavret;Kaat, Desloovere
本研究的目的是分析冻结前的步幅的运动学特征，并将其与自愿停止和持续步态进行比较。此外，我们调查了步态轮廓是否不同的身体一侧的功能。纳入10例患者，平均年龄为64.8岁（SD 5.1）。在Vicon 3D步态实验室中，患者进行了几次正常行走和自愿停止的试验，或者暴露于在药物周期的关闭阶段引起冻结的环境中。时空和关键的运动学数据的四步冻结前进行了比较身体两侧和步行条件下使用多元回归模型进行重复测量。在冷冻之前，患者在矢状面的运动范围严重减少（范围在31%和61.5%之间），最明显的是在踝关节和髋关节。运动的一般形状保持在冻结前的配置文件中，在站立时膝关节和髋关节运动的分离基本上是完整的，但在摆动时减少了分离。还存在踝关节蹬离运动减少，背屈固定，髋关节和膝关节屈曲增加以及骨盆前倾。在自主（停止）和非自主减速（冻结）期间，冻结前最后一个完整步幅的身体一侧显示出显著较小的关节范围（p <0.01）。体侧差异大于每侧内连续步骤的顺序恶化。冻结不同于正常的步态减速，因为推进运动的减少更大。尽管加快步伐，时间赤字并没有影响整体运动的形状，除了有一个弯曲的步行模式的趋势。在大多数情况下，步态在冻结前终止的身体一侧是双优势的一侧，但并不总是如此。
The aim of this study was to analyse the kinematic characteristics of the strides before freezing and compare this with a voluntary stop and ongoing gait. Also, we investigated whether gait profiles were different as a function of the side of the body. Ten patients were included with a mean age of 64.8 years (SD 5.1). Within a Vicon 3D gait laboratory, patients performed several trials of normal walking and voluntary stops or were exposed to circumstances, which provoked freezing in the off-phase of the medication cycle. Spatiotemporal and key kinematic data of the four strides prior to freezing were compared between body sides and walking conditions using multiple regression models for repeated measures. Prior to freezing patients had severely decreased movement ranges in the sagittal plane (ranging between 31% and 61.5%), most notably in the ankle and hip joints. The general shape of movement remained in the pre-freezing profiles with largely intact dissociation of knee and hip movement in stance but reduced dissociation in swing. Also present were reduced push-off movements in the ankle with fixed dorsiflexion, increased flexion in hip and knee and anterior tilt of the pelvis. During both voluntary (stopping) and involuntary deceleration (freezing), the body side with the last complete stride before the freeze, showed significantly smaller joint ranges (p < .01). Body side differences were larger than sequential deterioration of consecutive steps within each side. Freezing is distinct from normal deceleration of gait in that the reduction of propulsive movement is much greater. Despite hastening of steps, timing deficits did not affect overall movement shapes, except for the tendency to have a flexed walking pattern. The side of the body where gait terminated before freezing was in most cases the side of symptom-dominance, but not consistently so.