Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson's Disease.
Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson's Disease.
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DOI：
10.3389/fnhum.2020.602595
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发表时间：
2020
影响因子：
2.9
通讯作者：
Ting LH
中科院分区：
文献类型：
--
作者：
Martino G;McKay JL;Factor SA;Ting LH
腿部僵硬与帕金森病（PD）患者频繁的福尔斯有关，表明其在功能平衡和步态障碍中的潜在作用。由于次要任务引起的神经状态变化，例如，激活操作可能加剧（或“激活”）僵硬，可能增加福尔斯的风险。然而，标准临床强直量表的主观解释和粗略分类阻碍了对静息和激活腿强直的系统、客观评估。摆锤测试是一种客观诊断方法，我们假设该方法足够灵敏，可以表征静息和激活腿部僵硬。我们记录了15名PD患者在摆锤试验中股直肌和股二头肌的运动学数据和肌电图信号，这些数据和信号跨越了一系列腿部僵硬的严重程度。从腿部摆动运动学的记录数据中，我们测量了生物力学结果，包括第一次摆动偏移，第一次伸展峰，振荡的次数和持续时间，静止角，放松指数，最大和最小角速度。我们研究了生物力学结果和临床腿部僵硬评分之间的关系。我们评估了通过激活操作增加刚度对生物力学结果的影响。最后，我们评估了生物力学结果或激活结果的变化是否与跌倒史相关。我们的结果表明，摆锤测试的生物力学评估可以客观地量化帕金森病腿部僵硬。我们发现，临床检查期间高刚度的存在显著影响生物力学结果，即，第一延伸峰、振荡数、松弛指数和最大角速度。临床评估的低刚性组之间的激活操作的效果没有差异，表明激活刚性可能独立于静息刚性，应作为独立变量进行评分。此外，我们发现跌倒史在那些刚性随着次要任务而增加的人中更常见，如生物力学结果所测量的。我们的结论是，不同的机制，有助于休息和激活刚性可能发挥重要的，但尚未探索的功能作用，平衡障碍。摆锤试验可能有助于更好地了解PD运动症状的基本机制，评估治疗效果，并预测福尔斯的风险。
Leg rigidity is associated with frequent falls in people with Parkinson’s disease (PD), suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate (or “activate”) rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls.
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影响因子：
158.5
作者：
Krack, P;Batir, A;Pollak, P
通讯作者：
Pollak, P
影响因子：
8.6
作者：
Hong, Minna;Perlmutter, Joel S.;Earhart, Gammon M.
通讯作者：
Earhart, Gammon M.
影响因子：
14.5
作者：
DIETZ, V;QUINTERN, J;BERGER, W
通讯作者：
BERGER, W
影响因子：
1.7
作者：
Ertuglu LA;Karacan I;Yilmaz G;Türker KS
通讯作者：
Türker KS
DOI：
10.1155/2012/918719
发表时间：
2012
期刊：
Parkinson's disease
影响因子：
--
作者：
Kelly VE;Eusterbrock AJ;Shumway-Cook A
通讯作者：
Shumway-Cook A