Inclusion And Exclusion Criteria
Articles recording the EMG signal in individuals with PD during forward, straight line walking were included. Studies which focused on specific phases of walking such as turning, gait initiation and termination or a special type of walk such as backward walking or walking in the Timed Up and Go test were excluded. Studies that only analysed static standing, posture and tremor or specific gait events observed in PD such as freezing of gait were excluded. Studies involving groups with pathologies outside of PD were excluded. Dopaminergic studies and DBS studies were only included when the EMG signal during a walking task was reported. Only articles written in English were considered. Reviews, abstracts, cohort studies, case studies, editorials, commentaries, discussion papers, conference proceedings and studies lacking full text were excluded. Eligibility and inclusion were determined by three reviewers . Discrepancies were resolved through discussion resulting in a unanimous decision or a majority consensus.
The Route To Better Walking
The good news for people with PD is that with exercise and physical therapy it is possible to cope better with freezing, turn and walk more normally and improve balance. Through practice and sessions, a physical therapist can help people with PD avoid tripping by helping them learn to take larger steps. Additionally, joining an exercise class tailored to people with PD can help. If you take levodopa, be sure to exercise while it is working the drug helps your body learn and remember motor skills.
Tricks that can help overcome freezing:
- Walk to a regular beat to help prevent freezing. Try a metronome.
- Take large, voluntary marching steps.
- Step over an imaginary line or laser pointer.
- Work with a therapist to find the solution that works best for you.
People respond differently to audio, visual or sensory cues. Dr. Horak and her team are testing a device that provides sensory feedback vibration on the foot to stimulate automatic stepping.
Another consideration for people who have freezing is anxiety, a common PD symptom. People who have anxiety experience freezing more often. It is a vicious circle being anxious about freezing can trigger it. Treating anxiety may help freezing.
Continuous Gait Disturbances: The Traditional Approach
Classic studies of Parkinsonian gait have focused on the continuous gait disturbances, especially those that can be readily seen using visual observation. These include slowed ambulation with decreased or absent arm swing, longer double limb support ,, , , and impaired postural control., , , One of the keys to these gait problems is the inability of patients with PD to generate sufficient stride length, , . In fact, the reduced and shortened stride length may explain many of the continuous gait disturbances in PD including the reduced gait speed and the increased time with the feet on the ground.
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Caring For Someone With Parkinsons
Practice patience and understanding when dealing with Parkinsons. You may be very frustrated and challenged as a caregiver, but those with Parkinsons are just as frustrated. Their physical and mental conditions can be debilitating, depressing, and humiliating.
Diet and nutrition can have a huge impact on the health and comfort of a Parkinson patient. Eating well, getting more rest, sleeping well, fresh air, and exercise can make a difference. Getting the right medication and complementary therapies is also important.
As Parkinsons impacts a patients motor skills, modifications to the living environment may have to be made to accommodate wheelchairs and limited mobility issues. Professional in-home assistance for Parkinsons can allow Parkinson patients to remain independent and can enhance quality of life.
Most importantly, seek help and support from family, friends, and caregiving support groups. Take advantage of the resources in your community. Shouldering all the burden can take a toll on a caregiver.
Take care of yourself or you wont be able to take care of your loved one. Follow the preventive advice provided above for yourself as well, and take deep breaths!
Resources
Changes In Gait Over 6 Years
Our first aim was to describe gait changes in PD and controls over an extended period of 6 years. As expected, many gait characteristics changed in both PD and control cohorts; changes in gait occurred more frequently and at greater magnitudes in PD compared to changes in controls. Several changes were unique to each cohort, highlighting the specificity of gait change.
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What Causes Gait To Change
PD causes damage to the nerves in the brain and in the body, as well as causing accumulations of the protein alpha-synuclein, called Lewy bodies.
The motor symptoms of PD, like Parkinsonian gait, are caused by damage to the part of the brain called the substantia nigra pars compacta. The neurons in the substantia nigra produce dopamine, a neurotransmitter that transmits signals from the substantia nigra to other parts of the brain to produce smooth, purposeful movement.2,4
Damage to the neurons in the substantia nigra causes a reduction in dopamine, creating the motor symptoms seen in people with PD.2,4
Limitations Of Reviewed Studies
A small selection of superficial lower limb muscles was assessed during walking in individuals with PD with certain muscle groups studied less. Information about the contribution of muscles to movement is necessary for understanding compensatory mechanisms resulting in impaired gait and dynamic postural control and for developing interventions. Only one study recorded the hip adductors, a muscle group with a cross-sectional area , which relates to muscle force, comparable to the CSA of the quadriceps group, and almost three times greater than the CSA of the hamstrings. This creates a vacuum in our knowledge of motor activity during walking in PD particularly given that mediolateral sway and instability are greater in individuals with PD. The reviewed studies reported group differences in a wide range of EMG parameters including temporal information , amplitude , coactivation indices, synergies, symmetry/variability indices and nonlinear indices. However, spectral characteristics of the EMG signals and intermuscular coherence, which may provide information about motor unit recruitment and neuronal networks controlling muscle activity, were not analysed.
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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
How Does Pd Affect Muscle Activity
Table 4 Methodology and signal processing techniques for non-intervention studies.
Studies investigating the activity of MG muscle in individuals provided more conclusive results, with the majority reporting reduced activity in the PD group compared to HOA. As the MG muscle is important for forward propulsion of the body and vertical support, a decrease in activity may result in reduced gait speed and loss of postural balance along the vertical axis. Three studies reported prolonged increased activity of knee flexors and extensors,, in individuals with PD. Biomechanically, the enhanced proximal muscle activity may compensate for the reduced function of distal muscles. Greater contraction of the quadriceps during the stance phase will increase extension of the knee, leading to greater stability in this joint during single stance which may compensate for reduced stability at the ankle joint. Greater activity of hamstrings during swing will increase hip extension and knee flexion and may replace some of the foot placement and initial loading role of the distal muscles acting on the ankle joint. Increased muscle activity entails a larger metabolic demand which may limit walking speed and mobility. Differential compensatory changes in lower limb muscles during walking have been observed in other neurological pathologies such as post-polio syndrome and stroke,.
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Gait And Balance Problems
Parkinsons disease is a neurodegenerative;disorder characterized by progressive damage to;dopamine-producing;nerve cells in a specific;region of the brain. Dopamine is a neurotransmitter, or cell signaling molecule, that relays information between nerve cells and muscles. One of the most debilitating effects of Parkinsons disease is the loss of coordination and control in body movements, which in many cases leads to severe;walking disabilities.
Low Levels Of Vitamin B12 May Worsen Walking Cognition In Parkinsons Patients
Supplement May Boost Balance, Memory, But Impact on Disease Trajectory Unknown
A study of patients with early Parkinsons disease found that groups with lower levels of vitamin B12 faced on average a more rapid acceleration of both motor and cognitive symptoms, which slowed in some cases after taking a daily multivitamin.;
In the two-year study, blood levels of vitamin B12 were tested in 680 patients who had recently been diagnosed with Parkinsons. Researchers led by first author Chadwick Christine, MD, a;neurologist with;the UCSF Weill Institute for Neurosciences, also assessed patients gait and mobility, ability to perform activities of daily living, cognition and symptoms of depression.
Our findings demonstrate that low B12 levels are associated with greater walking and balance problems, possibly due to the known effect of B12 deficiency on the central and peripheral nervous systems, said Christine. Alternatively, low B12 may have a direct effect on the progression of Parkinsons disease, or it may be a marker of an unknown associated factor, perhaps correlating with another aspect of the disease or nutritional status.
The study was published March 6, 2018, in the early view version of the journal Movement Disorders.
Deficiencies of B12, which are more common in people with Parkinsons than the age-matched general population, are associated with weakness, tiredness, numbness, tingling and walking difficulties symptoms that are found in Parkinsons disease.
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What Causes Parkinsons Disease
Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.
People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.
Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.
The Spread Of Parkinsons
Researchers have found that areas of the brain stem below the substantia nigra show cell loss in Parkinsons. And cells in these areas have been found to contain clumps of alpha-synuclein protein, which may form before those in the substantia nigra.
These findings have led some researchers to suggest that . Indeed, there is evidence that, for some, Parkinsons may start in the gut and travel up the vagus nerve, which connects the gut and the brain, to the substantia nigra.
The theory that Parkinsons may spread up the brain stem and progress throughout the brain is the basis of the Braak staging of Parkinsons.
The 6 stages in Braaks theory aim to describe the spread of Parkinsons through the brain:
While there is still some debate over the origin of Parkinsons, and even competing and more complex theories about the spread of Parkinsons, attempts to understand how and why different areas of the brain are involved in the motor and non-motor symptoms are helping in the development of better treatments.
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Comparison With Other Gait Disorders
Subcortical arteriosclerotic encephalopathy , also called lower-body parkinsonism, and cerebellar ataxia are two other gait disorders whose symptoms seem to closely resemble that of Parkinson’s. However, through regression analysis studies have revealed that in Parkinson’s, increasing the velocity of walking changes the stride length linearly . However, in SAE and cerebellar ataxia stride length had a disproportionate contribution to increasing velocity, indicating that SAE and cerebellar ataxia have common underlying mechanisms different from those of Parkinson’s.
A Study Of Moderate Exercise
The researchers examined 60 people aged 50-80 with Parkinsons disease to see what effects aerobic walking would have on the symptoms of the disease. They also wanted to find out if a program of moderate intensity exercise was beneficial, safe and tolerable.
Participants were asked to take part in 45-minute sessions of moderate intensity walking, three times a week for 6 months. The participants would wear heart rate monitors during this exercise, and would also take tests to measure their aerobic fitness, memory, mood, motor functions and thinking abilities.
The walking sessions met the definition of moderate intensity aerobic exercise, with the average walking speed approximately 2.9 miles per hour and with participants exercising at 47% of their heart rate reserve.
The research was supported by the Department of Veterans Affairs, the National Center for Research Resources, the National Institute of Environmental Health Sciences, the Charles W. and Harriet J. Seedorff Family and the National Institutes of Health.
The researchers found that the brisk walking sessions resulted in the following improvements:
- Motor function and mood: 15% improvement
- Attention/response control: 14% improvement
- Tiredness: 11% reduction
- Aerobic fitness and gait speed: 7% increase.
In the motor functioning tests, there was an average improvement of 2.8 points among the participants, a score that is deemed to be a clinically important difference.
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Physical Therapy Can Help
In addition to medication, physical therapy can help with walking. There are several strategies that can be used to overcome freezing episodes.
Strategies include taking a high marching step, counting to three before stepping, or walking along to the rhythm of a metronome. Using visual cues such or stepping over a target such as a laser beam or line on the floor can also help with gait.
Assistive devices such as walkers or canes can be helpful in reducing the risk of falling.
Engage with the community by asking a question, telling your story, or participating in a forum.
Advancement In Parkinsons Disease
With the progress of Parkinsons disease with time, symptoms associated with the problem become worse typically and many new problems emerge. Despite patients receive benefits with the intake of anti-Parkinson medication; the benefit fails to last for a long time even when they intake it frequently.
Most of the patients usually experience involuntary movements to make them, as looking fidgety when they intake the medicine and otherwise works the best. Hence, it is very much essential to emphasize such movements typically and do not bother about the condition of patients too much.
Other problems, which may take place with the progress of Parkinsons disease, are-
- Problems associated with balance and gait, along with falls
- Difficulty in communication or impairment of speech
- Difficulty in swallowing
- Cognitive impairment, such as memory and thinking
- Behavioral problems
- Light-headedness.
Some of the problems are of very much difficult to treat with medicines. However, any experienced doctor or a neurologist specializes in movement disorder will still may provide the necessary support and guidance for patients even during the advanced phases of the Parkinsons disease.
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Increased Gait Variability In Patients With Pd
Gait disturbances in PD also include features that are not always easily quantifiable in routine clinical observation but become apparent when gait is evaluated quantitatively with gait analysis systems. Such changes include increased left-right gait asymmetry and diminished left-right bilateral coordination., , , , , A loss of consistency in the ability to produce a steady gait rhythm, resulting in higher stride-to-stride variability, is also a characteristic feature of gait in PD., , ,
General Anesthesia And Parkinsons Disease
C.-W. CHEN, K.-B. CHEN, Y.-C. KUO
Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: Postoperative cognitive dysfunction is common among the elderly. These changes may even be so severe that some elderly people actually become demented after undergoing an operation. There was minimal evidence to support continued postoperative cognitive decline beyond 5 years or more. The aim of this study is to explore whether general anesthesia impact the incidence of Parkinsons disease in nationwide population.
Background: Parkinsons disease is one of the important diseases among older population and leads to disability. The exact mechanism of PD is variant. Whether general anesthesia is a potential risk factor for the development of PD is controversial. Therefore, this study aimed to evaluate the association between previous exposure to different types of GA and the incidence of PD.
Methods: Using claims data of 1,000,000 insured residents covered in the national health insurance, we enrolled 4,931 newly diagnosed dementia cases with age more than 50 years-old in 2005-2009. The control group of 19,720 individuals without PD was matched for age, gender, and index date. GA were categorized as three subtypes, including endotracheal tube intubation general anesthesia , intravenous injection general anesthesia or intramuscular injection general anesthesia , and heavy sedation. Multivariate logistic regression model was used for analyses.
To cite this abstract in AMA style:
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