Is freezing of gait in Parkinson's disease a result of multiple gait impairments? Implications for treatment.
Is freezing of gait in Parkinson's disease a result of multiple gait impairments? Implications for treatment.
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DOI：
10.1155/2012/459321
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Hausdorff JM
中科院分区：
文献类型：
--
作者：
Plotnik M;Giladi N;Hausdorff JM
几种步态障碍与帕金森病（PD）患者的步态冻结（FOG）有关。这些包括节奏控制、步态对称、双侧步态协调、动态姿势控制和台阶缩放的恶化。我们认为，这些看似独立的步态特征可能具有相互作用，在某些情况下，共同驱动预设的运动系统进入FOG发作。这个新的理论框架通过评估所谓的“序列效应”之间的潜在关系来说明，即步长缩放的损害，以及在FOG之前的步态不对称。我们进一步讨论了影响步态控制以维持功能步态的因素。“触发器”，例如，注意力转移或轨迹转换，可能先于FOG。我们提出了不同类别的干预措施，并描述了支持这一观点的现有工作的例子：(a)旨在保持良好的运动控制水平的干预措施，特别是在与FOG相关的方面；(b)旨在避免FOG“触发点”的措施；(c)那些只是为了在雾霾发生后逃离的。提出的理论框架为关于导致FOG的机制的可测试假设奠定了基础，也可能导致新的治疗思路。
Several gait impairments have been associated with freezing of gait (FOG) in patients with Parkinson's disease (PD). These include deteriorations in rhythm control, gait symmetry, bilateral coordination of gait, dynamic postural control and step scaling. We suggest that these seemingly independent gait features may have mutual interactions which, during certain circumstances, jointly drive the predisposed locomotion system into a FOG episode. This new theoretical framework is illustrated by the evaluation of the potential relationships between the so-called “sequence effect”, that is, impairments in step scaling, and gait asymmetry just prior to FOG. We further discuss what factors influence gait control to maintain functional gait. “Triggers”, for example, such as attention shifts or trajectory transitions, may precede FOG. We propose distinct categories of interventions and describe examples of existing work that support this idea: (a) interventions which aim to maintain a good level of locomotion control especially with respect to aspects related to FOG; (b) those that aim at avoiding FOG “triggers”; and (c) those that merely aim to escape from FOG once it occurs. The proposed theoretical framework sets the stage for testable hypotheses regarding the mechanisms that lead to FOG and may also lead to new treatment ideas.
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