The turning and barrier course reveals gait parameters for detecting freezing of gait and measuring the efficacy of deep brain stimulation
The turning and barrier course reveals gait parameters for detecting freezing of gait and measuring the efficacy of deep brain stimulation
复制标题
DOI：
10.1371/journal.pone.0231984
复制
发表时间：
2020-04-29
期刊：
影响因子：
3.7
通讯作者：
Bronte-Stewart, Helen
中科院分区：
文献类型：
--
作者：
O'Day, Johanna;Syrkin-Nikolau, Judy;Bronte-Stewart, Helen
步态冻结(雾)是帕金森氏病的一种毁灭性的运动症状，会导致摔倒、行动不便和生活质量下降。在临床环境中，可靠地引起雾一直是困难的，因为对病理生理学的发现和/或治疗效果的记录有限，例如不同频率的丘脑深部脑刺激(STN DBS)。在这项研究中，我们使用国际标准的FOG问卷问题3(FOG-Q3，r=0.74p<；0.001)对仪表化步态任务-转弯和障碍过程进行了验证。TBC很容易组装，并模拟了引发雾气的真实环境。与向前行走相比，经历过雾(冰柜)的帕金森氏症患者在体外循环中冻结的时间更长(p=0.007)。与前向行走相比，冷冻室在非冰冻步态中表现出更大的心律失常(p=0.006)；在非冷冻室或对照组中，没有检测到任务之间的这种步态心律失常的差异。在所有步行任务中，冷冻组的非冰冻步态比非冷冻组或对照组更易发生心律失常(p<；0.05)。Logistic回归模型表明，步态节律性、步态时间、小腿角度范围和不对称性的组合最有可能将一步归类为雾(受试者操作特征曲线下面积=0.754)。在60赫兹和140赫兹STN DBS(p<；0.05)中，冰柜的冻结时间百分比和非冰冻步态的心律失常减少，其小腿角速度在TBC中增加到非冰冻值。TBC是一种标准化工具，用于诱发雾并展示60赫兹和140赫兹STN DBS对步态损伤和雾的疗效。TBC揭示了区分冷冻柜和非冷冻柜的步态参数和预测最好的雾；这些参数可以作为帕金森氏病雾的闭环神经刺激的相关控制变量。
Freezing of gait (FOG) is a devastating motor symptom of Parkinson's disease that leads to falls, reduced mobility, and decreased quality of life. Reliably eliciting FOG has been difficult in the clinical setting, which has limited discovery of pathophysiology and/or documentation of the efficacy of treatments, such as different frequencies of subthalamic deep brain stimulation (STN DBS). In this study we validated an instrumented gait task, the turning and barrier course (TBC), with the international standard FOG questionnaire question 3 (FOG-Q3, r = 0.74, p < 0.001). The TBC is easily assembled and mimics real-life environments that elicit FOG. People with Parkinson's disease who experience FOG (freezers) spent more time freezing during the TBC compared to during forward walking (p = 0.007). Freezers also exhibited greater arrhythmicity during non-freezing gait when performing the TBC compared to forward walking (p = 0.006); this difference in gait arrhythmicity between tasks was not detected in non-freezers or controls. Freezers' non-freezing gait was more arrhythmic than that of non-freezers or controls during all walking tasks (p < 0.05). A logistic regression model determined that a combination of gait arrhythmicity, stride time, shank angular range, and asymmetry had the greatest probability of classifying a step as FOG (area under receiver operating characteristic curve = 0.754). Freezers' percent time freezing and non-freezing gait arrhythmicity decreased, and their shank angular velocity increased in the TBC during both 60 Hz and 140 Hz STN DBS (p < 0.05) to non-freezer values. The TBC is a standardized tool for eliciting FOG and demonstrating the efficacy of 60 Hz and 140 Hz STN DBS for gait impairment and FOG. The TBC revealed gait parameters that differentiated freezers from non-freezers and best predicted FOG; these may serve as relevant control variables for closed loop neurostimulation for FOG in Parkinson's disease.