Article

Rhythmic auditory stimulation with visual stimuli on motor and balance function of patients with Parkinson's disease

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Abstract

Discuss the effect of rhythmic auditory stimulation with visual stimuli on motor and balance function in patients with Parkinson's disease (PD). One hundred and sixteen patients with PD participated in this study. The control group used a routine drug treatment for eight weeks. The comprehensive treatment group used conventional drug treatment with sound rhythm metronome released as the rhythmical auditory stimulation, in accordance with the ground fixed ribbon rhythmic visual stimulation walking training for eight weeks. After four and eight weeks, the two groups of subjects took the walking parameters test, and used the disease Parkinson score scale to assess the damaged degree of motor function of PD patients. The Berg Balance Scale was used to evaluate the balance function of the PD patients. A six minute walk test was used to evaluate the walking motor function of the patients. The comparison between the groups suggests that after treatment of rhythmic auditory stimulation with visual stimulation group, the step size increased, frequency decreased, pace increased, and PD score scale part II decreased. As well, the PD score scale part III reduced, the six minute walking distance increased, and the Berg Balance Scale score increased significantly. There were significant differences compared with the control group after the treatment (p < 0.01). Comparison of time points suggests that after rhythmic auditory stimulation with visual stimulation group trained for eight weeks, the step size increased, frequency decreased, pace increased, and PD score scale part II were reduced. As well the PD score scale part III reduced, six minute walking distance increased, Berg Balance Scale increased. There were significant differences compared with the parameters of training for four weeks (p < 0.01). Rhythmic auditory stimulation with visual stimulation can improve motor and balance function of patients with PD.

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... ising body weight support. Five trials [22,23,26,[35][36][37] investigated over-ground walking programs, of which one trial [37] incorporated audio cueing and one trial [36] a Nordic walking program. One trial [38] investigated a task-specific home exercise program and two trials [39,40] investigated sit-to-stand training. ...
... ising body weight support. Five trials [22,23,26,[35][36][37] investigated over-ground walking programs, of which one trial [37] incorporated audio cueing and one trial [36] a Nordic walking program. One trial [38] investigated a task-specific home exercise program and two trials [39,40] investigated sit-to-stand training. ...
... The average program duration ran for seven weeks (range 2 to 12 weeks). The majority of control groups received no intervention, maintaining their current level of physical activity [22,23,[27][28][29][30]32,34,[36][37][38][39][40][41]. Two control groups received education on health issues [33,35] and one control group were asked to refrain from regular physical activity [26]. ...
Article
Background: Task-specific training is an effective form of rehabilitation for improving mobility in neurological conditions. However, it remains unclear if task-specific training is effective in people with progressive disease. Objective: To establish the efficacy of task-specific training on the mobility of individuals with progressive neurological conditions. Data sources: Electronic databases MEDLINE, EMBASE and CINAHL. Study eligibility criteria: Randomised controlled trials investigating the effect of task-specific training on mobility and falls rate in individuals with progressive neurological conditions. Study appraisal/synthesis methods: Risk of bias of individual studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analysis. Results: Analysis of 16 trials found treadmill training improved comfortable walking velocity (m/s) in people with Parkinson’s disease (MD 0.21m/s, 95%CI 0.15 to 0.27) and multiple sclerosis (MD 0.36m/s, 95%CI 0.20 to 0.52). Treadmill training improved stride length (m) (MD 0.12m, 95%CI 0.02 to 0.23) and step length (m) (MD 0.12m, 95%CI 0.01 to 0.23) in people with Parkinson’s disease and walking endurance in people with multiple sclerosis (MD 26.53m, 95%CI 12.23 to 40.84). Treadmill training had no effect on cadence and did not improve walking endurance in Parkinson’s disease. Over-ground walking did not improve mobility in Parkinson’s disease or multiple sclerosis. Limitations: Study sample sizes were small and findings must be interpreted with caution. Conclusion: Treadmill training may be effective for improving mobility in people with Parkinson’s disease and multiple sclerosis. The effectiveness of over-ground walking is uncertain.
... After further reading the articles, two (37,38) were excluded because their outcome indicators did not meet the inclusion criteria. Data of two articles (28,39) only reported the P-value, and the original data could not be obtained even after contacting the article's author. Three articles (9, 40, 41) did not report the mean ± SD. ...
... Other studies added parameters based on the patient's walking frequency (44,49). The cadence of RAS can be determined by computing the average walking speed of the patient according to the daily walking speed and developing a beat that matches the average walking speed of the patient through the software beat (39). Other studies used the rhythm of music to provide RAS training to the patients (29,48). ...
Article
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Objective This study aimed to summarize the effectiveness of rhythmic auditory stimulation (RAS) for the treatment of gait and motor function in Parkinson's disease (PD) through a systematic review and meta-analysis. Methods All studies were retrieved from eight databases. The effects of RAS on PD were determined using the following indicators: gait parameters including step length, stride width, step cadence, velocity, stride length; motor function including 6 min walk test (6MWT) and timed up-and-go test (TUGT); the Unified Parkinson's Disease Rating Scale (UPDRS); and the Berg Balance Scale (BBS). The risk map of bias of the quality of the studies and the meta-analysis results of the indicators was prepared with RevMan 5.2 software. Results Twenty-one studies were included in the systematic review, and 14 studies were included in the meta-analysis. In the meta-analysis, the results of gait parameters, namely, velocity, step length, and stride length, were statistically significant ( P < 0.05), whereas the results of cadence and stride width were not statistically significant ( P ≧ 0.05). The results of 6MWT and TUGT for motor function as well as UPDRS-II, UPDRS-III, and BBS were statistically significant ( P < 0.05). Conclusions RAS could improve gait parameters, walking function, balance function, and daily living activities of individuals with PD. The application of RAS in conventional rehabilitation approaches can enhance motor performance in PD. Future studies should use a large sample size and a rigorous design to obtain strong conclusions about the advantages of RAS for the treatment of gait and motor function in PD.
... After receiving some meaningful or preset auditory information input, the brain will process it at the cognitive level. For example, the rhythmic sound stimulation [2,3] , which is widely used in the rehabilitation of the lower limbs, will let the patients move the lower limbs rhythmically according to the speci c prompt sounds in the treatment process. In fact, these prompt sounds are given special signi cance. ...
... After the patients hear the syllable prompts, the brain will carry out cognitive processing analysis on them, which is also the unique feature of auditory stimulation [4] . Auditory stimuli can be divided into the following types according to the content of the information package: (1) pure sound without meaning, such as noise, background sound, etc.; (2) environmental sound, such as nger knocking, footsteps, etc.; (3) semantic sound with meaning. ...
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Background: Auditory feedback is one of the most important feedback in cognitive process. It plays an important guiding role in cognitive motor process. However, previous studies on auditory stimuli mainly focused on the cognitive effects of auditory stimuli on cortex, while the role of auditory feedback stimuli in motor imagery tasks is still unclear. Methods: 18 healthy subjects were recruited to complete the motor imagination task stimulated by meaningful words and meaningless words. In order to explore the role of auditory stimuli in motor imagination tasks, we studied EEG power spectrum, frontal parietal mismatch negativity (MMN) and inter test phase-locked consistency (ITPC). one-way Analysis of Variance (ANOVA) and Least Significant Difference (LSD) correction were used to test the differences between the two experimental groups and the differences of different bands in each experimental group. Results: EEG power spectrum analysis showed that the activity of contralateral motor cortex was significantly increased under the stimulation of meaningful words, and the amplitude of mismatch negative wave was also significantly increased. ITPC is mainly concentrated in μ, α and γ bands in the process of motor imagery task guided by the auditory stimulus of meaningful words, while it is mainly concentrated in the β band under the meaningless words stimulation. Conclusions: This results may be due to the influence of auditory cognitive process on motor imagery. We speculate that there may be a more complex mechanism for the effect of auditory stimulation on the inter test phase lock consistency. When the stimulus sound has the corresponding meaning to the motor action, the parietal motor cortex may be more affected by the prefrontal cognitive cortex, thus changing its normal response mode. This mode change is caused by the joint action of motor imagination, cognitive and auditory stimuli. This study provides a new insight into the neural mechanism of motor imagery task guided by auditory stimuli, and provides more information on the activity characteristics of the brain network in motor imagery task by cognitive auditory feedback.
... RAS has been used to improve gait in those with PD via external sensory cues consisting of metronome beats. Studies have shown the positive effects of RAS on FOG and gait parameters (112). Although other sensory cues such as visual and proprioceptive cues have been examined, auditory cues appear to be most effective in improving gait in PD (113). ...
... The effect of RAS has been investigated in studies that involve a single training session (immediate effects) with Parkinson subjects (7,8), Huntington subjects (9), and Alzheimer subjects (10). As well as in studies that involve several training sessions (intervention effect) with Parkinson subjects (11)(12)(13), stroke subjects (14)(15)(16)(17)(18)(19), and subjects with cerebral palsy (19). The effects of RAS, including rhythmic auditory cueing, on spatio- temporal parameters of gait (20,21) and upper extremity function (21) have been reviewed in the neurological population, and a meta-analysis has been conducted in the stroke population (21). ...
Article
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Introduction: Motor and cognitive symptoms are frequent in persons with neurological disorders and often require extensive long-term rehabilitation. Recently, a variety of musicbased interventions have been introduced into neurological rehabilitation as training tools. Aim: This review aims to a) describe and define music-based intervention modalities and content which are applied in experimental studies, and b) describe the effects of these interventions on motor and/or cognitive symptoms in the neurological population. EVIDENCE ACQUISITIONː The databases PubMed and Web of Science were searched. Cited references of included articles where screened for potential inclusion. A systematic literature search up to 20th of June 2016 was conducted to include controlled trials and cohort studies that have used music-based interventions for ≥3 weeks in the neurological population (in- and outpatients) targeting motor and/or cognitive symptoms. No limitations to publication date was set. EVIDENCE SYNTHESISː Nineteen articles comprising thirteen randomised controlled trials (total participants Nexp = 241, Nctrl = 269), four controlled trials (Nexp = 59, Nctrl = 53) and two cohort studies (N = 27) were included. Fourteen studies were conducted in stroke, three in Parkinson's disease, and two in multiple sclerosis population. Modalities of musicbased interventions were clustered into four groups: instrument-based, listening-based, rhythm-based, and multicomponent-based music interventions. Overall, studies consistently showed that music-based interventions had similar or larger effects than conventional rehabilitation on upper limb function (N=16; fine motricity, hand and arm capacity, finger and hand tapping velocity/variability), mobility (N=7; gait parameters), and cognition (N = 4; verbal memory and focused attention). CONCLUSIONSː Variety of modalities using music-based interventions has been identified and grouped into four clusters. Effects of interventions demonstrate an improvement in the domains assessed. Evidence is most available for improving motricity in stroke. More studies are warranted to investigate cognition as well as motor and cognition dysfunctions in combination. Clinical implications: Instrument-based music interventions can improve fine motor dexterity and gross motor functions in stroke. Rhythm-based music interventions can improve gait parameters of velocity and cadence in stroke, Parkinson's disease and multiple sclerosis. Cognition in the domains of verbal memory and focused attention can improve after listening-based music interventions in stroke.
... This suggests that the type of cognitive processing required to perform the acoustic odd-ball task does not have a negative effect on walking performance. Studies in PD patients have shown that rhythmic auditory stimulation improves motor functions and balance (Song et al., 2015). Our P3 task involved random acoustic stimulation that may have enhanced the rhythmicity of walking without competing with walking for attentional resources. ...
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Objective: To compare interference between walking and a simple P3 auditory odd-ball paradigm in patients with Huntington's disease (HD) and age-and sex-matched controls. Methods: Twenty-four early-to-middle-stage HD patients and 14 age-and sex-matched healthy volunteers were examined. EEG—EMG recordings were obtained from 21 scalp electrodes and eight bipolar derivations from the legs. Principal component analysis was used to obtain artifact-free recordings. The stimulation paradigm consisted of 50 rare and 150 frequent stimuli and was performed in two conditions: standing and walking along a 10 by 5 m path. P3 wave amplitude and latency and EEG and EMG spectral values were compared by group and experimental condition and correlated with clinical features of HD. Results: P3 amplitude increased during walking in both HD patients and controls. This effect was inversely correlated with motor impairment in HD patients, who showed a beta-band power increase over the parieto-occipital regions in the walking condition during the P3 task. Walking speed and counting of rare stimuli were not compromised by concurrence of motor and cognitive demands. Conclusion: Our results showed that walking increased P3 amplitude in an auditory task, in both HD patients and controls. Concurrent cognitive and motor stimulation could be used for rehabilitative purposes as a means of enhancing activation of cortical compensatory reserves, counteracting potential negative interference and promoting the integration of neuronal circuits serving different functions.
... A further analysis determining treatment duration across more than or less than 5 weeks revealed medium positive effect size (g: 0.61, 95% C.I: 0.44 to 0.78, I 2 : 71.2%, p > 0.1) with substantial heterogeneity. Further sub-group analysis for less than 5 session per week of training revealed small positive effect size (g: 0.39, 95% C.I: 0.08 to 0.7, I 2 : 0%, p < 0.11) with negligible heterogeneity 122,123 . Randomized controlled trials. ...
Article
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The use of rhythmic auditory cueing to enhance gait performance in parkinsonian patients’ is an emerging area of interest. Different theories and underlying neurophysiological mechanisms have been suggested for ascertaining the enhancement in motor performance. However, a consensus as to its effects based on characteristics of effective stimuli, and training dosage is still not reached. A systematic review and meta-analysis was carried out to analyze the effects of different auditory feedbacks on gait and postural performance in patients affected by Parkinson’s disease. Systematic identification of published literature was performed adhering to PRISMA guidelines, from inception until May 2017, on online databases; Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE and PROQUEST. Of 4204 records, 50 studies, involving 1892 participants met our inclusion criteria. The analysis revealed an overall positive effect on gait velocity, stride length, and a negative effect on cadence with application of auditory cueing. Neurophysiological mechanisms, training dosage, effects of higher information processing constraints, and use of cueing as an adjunct with medications are thoroughly discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance motor performance and quality of life in the parkinsonian community.
... RAS has been used to improve gait in those with PD via external sensory cues consisting of metronome beats. Studies have shown the positive effects of RAS on FOG and gait parameters (112). Although other sensory cues such as visual and proprioceptive cues have been examined, auditory cues appear to be most effective in improving gait in PD (113). ...
Article
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Parkinson’s disease is a neurodegenerative disorder that has received considerable attention in allopathic medicine over the past decades. However, it is clear that, to date, pharmacological and surgical interventions do not fully address symptoms of PD and patients’ quality of life. As both an alternative therapy and as an adjuvant to conventional approaches, several types of rhythmic movement (e.g., movement strategies, dance, tandem biking, and Tai Chi) have shown improvements to motor symptoms, lower limb control, and postural stability in people with PD (1–6). However, while these programs are increasing in number, still little is known about the neural mechanisms underlying motor improvements attained with such interventions. Studying limb motor control under task-specific contexts can help determine the mechanisms of rehabilitation effectiveness. Both internally guided (IG) and externally guided (EG) movement strategies have evidence to support their use in rehabilitative programs. However, there appears to be a degree of differentiation in the neural substrates involved in IG vs. EG designs. Because of the potential task-specific benefits of rhythmic training within a rehabilitative context, this report will consider the use of IG and EG movement strategies, and observations produced by functional magnetic resonance imaging and other imaging techniques. This review will present findings from lower limb imaging studies, under IG and EG conditions for populations with and without movement disorders. We will discuss how these studies might inform movement disorders rehabilitation (in the form of rhythmic, music-based movement training) and highlight research gaps. We believe better understanding of lower limb neural activity with respect to PD impairment during rhythmic IG and EG movement will facilitate the development of novel and effective therapeutic approaches to mobility limitations and postural instability.
... Baduanjin improved the gait performance, functional mobility, sleep quality and prevented falls [85,86]. Rhythmic auditory stimulation with visual stimuli to PD were effective to Chinese population [87]. There are several classes of Tai Chi or dancing for PD in China. ...
Article
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Abstract The number and health burden of Parkinson’s disease increase rapidly in China. It is estimated that China will have nearly half of the Parkinson’s disease population in the world in 2030. In this review, we present an overview of epidemiology and health economics status of Parkinson’s disease across China and discuss the risk factors of Parkinson’s disease and related complications. From the view of clinical research, we also discuss the current status of clinical trials, diagnostic biomarkers, treatment of Parkinson’s disease, tertiary network and post-occupation education in Chinese Parkinson’s disease clinics.
... There is growing evidence to support the role of such non-pharmacological interventions (in particular physiotherapy) in mild and moderate stages of PD [8,9]. Compensation strategies such as rhythmic auditory cueing have an immediate and short effect on walking speed, stride length and cadence [10][11][12][13][14][15][16]. However, the evidence of non-pharmacological interventions https://doi. ...
Article
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Non-pharmacological interventions such as physiotherapy are recognized as important elements in the overall clinical management of motor impairments in PD, but evidence of physiotherapy in advanced disease stages is sparse. A recent trial found positive effects of multimodal balance training in people with mild to moderate PD, with greater and more sustained effects when rhythmical auditory stimuli were added. It is unclear whether such multimodal balance training is also effective in people with advanced PD (Hoehn & Yahr stage 4). Methods We performed a pilot prospective single-blind, randomized clinical trial to study the effectiveness of multimodal training with and without rhythmical auditory stimuli. We screened 76 people with Parkinson's disease and Hoehn & Yahr stage 4 by telephone; 35 patients were assigned randomly into two groups: (1) multimodal balance training with rhythmical auditory stimuli (RAS-supported intervention, n = 17) and (2) multimodal balance training without rhythmical auditory cues (n = 18). Training was performed for 5 weeks, two times/week. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by the same two blinded assessors at baseline, immediately post intervention, and after one and 6-months follow-up. Results Immediately post-intervention, both intervention groups improved significantly on Mini-Best scores, without differences between both intervention modalities. In both groups, results were retained at one-month follow-up. At 6-months follow-up, the effects were retained only in the RAS-supported intervention group. For both intervention groups, no improvements were found on secondary outcome measures for gait. Conclusion Both RAS-supported multimodal balance training and regular multimodal balance training improve balance in PD patients in advanced disease stages. Effects appear to sustain longer in the RAS-supported training group.
... However, the third S1-M1 co-activation which occupied the last 40 sec of the block in the control group, vanished in PD-patients. PD patients have problems using the somatosensory information for preparing the next motor pattern, a deficiency which may be compensated for by visual or auditory stimuli [38][39][40]. The lack of the third S1-M1 co-activation pattern could be an indicator of this PD disorder. ...
Article
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Two new recurrence plot methods (the binary recurrence plot and binary cross recurrence plot) were introduced here to study the long-term dynamic of the primary motor cortex and its interaction with the primary somatosensory cortex, the anterior motor thalamus of the basal ganglia motor loop and the precuneous nucleus of the default mode network. These recurrence plot methods: 1. identify short-term transient interactions; 2. identify long-lasting delayed interactions that are common in complex systems; 3. work with non-stationary blood oxygen level dependent (BOLD) data; 4. may study the relationship of centers with non-linear functional interactions; 5 may compare different experimental groups performing different tasks. These methods were applied to BOLD time-series obtained in 20 control subjects and 20 Parkinson´s patients during the execution of motor activity and body posture tasks (task-block design). The binary recurrence plot showed the task-block BOLD response normally observed in the primary motor cortex with functional magnetic resonance imaging methods, but also shorter and longer BOLD-fluctuations than the task-block and which provided information about the long-term dynamic of this center. The binary cross recurrence plot showed short-lasting and long-lasting functional interactions between the primary motor cortex and the primary somatosensory cortex, anterior motor thalamus and precuneous nucleus, interactions which changed with the resting and motor tasks. Most of the interactions found in healthy controls were disrupted in Parkinson’s patients, and may be at the basis of some of the motor disorders and side-effects of dopaminergic drugs commonly observed in these patients.
Article
Background and purpose: Rhythmic auditory cueing and treadmill walking can improve spatiotemporal gait parameters through entrainment of movement patterns. Careful selection of cue frequencies is necessary if treadmill walking is to be employed, because cadence and step length are differentially affected by walking on a treadmill and overground. The purpose of this study was to describe the treatment of gait impairments for individuals with Parkinson disease, using strategically selected rhythmic auditory cue frequencies on both a treadmill and overground. Case description: Three individuals with Hoehn & Yahr stage 2 Parkinson disease participated in this case series. Intervention: All participants completed 6 weeks of gait training, in which each session employed rhythmic auditory cueing during treadmill-based gait training followed by overground gait training. We provided targeted rhythmic auditory cueing with a metronome set to 85% and 115% of their self-selected cadence for treadmill and overground training, respectively. We performed clinical tests of gait and balance prior to, midway, and following training, and at a 3-month follow-up. Outcomes: All participants improved overground gait speed (participant 1: +0.27 m/s; participant 2: +0.20 m/s; and participant 3: +0.18 m/s) and stride length (15.7 ± 4.17 cm) with small changes to cadence. Likewise, there were only small changes in balance. Discussion: We hypothesize that the large improvements in gait speed are due to the concomitant increases in stride length. Further research is needed to test the effect of targeted rhythmic auditory cueing during treadmill and overground gait.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A309).
Article
Resumen Antecedentes y objetivo Los trastornos de la marcha son síntomas motores muy discapacitantes en la enfermedad de Parkinson (EP). En las últimas décadas se han introducido nuevas técnicas de neurorrehabilitación a través de señales externas, demostrándose beneficios sobre el rendimiento motor en la marcha. El objetivo es conocer la evidencia científica de la intervención a través de estímulos externos rítmicos auditivos o visuales sobre los trastornos de la marcha en personas con EP, examinar las características principales de los protocolos de entrenamiento y los efectos sobre los distintos componentes de la marcha. Materiales y métodos Se llevó a cabo una revisión sistemática de estudios clínicos aleatorizados en las bases de datos de Pubmed/Medline, BVS, Cochrane Library, PEDro, WoS, Science Direct y EBSCO. También se revisaron revistas especializadas y referencias de estudios ya identificados. Resultados Se localizaron 550 artículos, y se seleccionaron 8 estudios que cumplieron con los criterios de selección. En todos los estudios se hallaron diferencias estadísticamente significativas tras la intervención a través de estímulos externos, en una o varias de las variables analizadas. Conclusiones La intervención a través de estímulos externos rítmicos auditivos o visuales mejora los trastornos de la marcha en personas con EP, pero son necesarias nuevas investigaciones para obtener mayor evidencia científica y poder definir la señal externa utilizada.
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The aim of the study was to investigate the efficacy of homemade tolcapone in treatment of patients with Parkinson’s disease (PD). Eighty patients with PD were subjected to randomized, double-blind, placebo-controlled and parallel-group study. PD patients were randomly divided into the tolcapone treatment group (41 cases) and placebo group (39 cases). Each patient received 1 pill of tolcapone or placebo, 3 times per day for 26 weeks. Efficacy was evaluated using the internationally used unified Parkinson’s disease rating scale (UPDRS) scoring system for PD symptoms. After the treatment for 26 weeks, the cognitive function, tremor, muscle stiffness, voluntary movement and autonomic nerve symptoms were compared between the two groups using UPDRS scores. Compared with the placebo group, cognitive function, muscle stiffness and voluntary movement reduction were significantly improved in patients of the tolcapone group (P0.05). Tolcapone, a catechol-O-methyl transferase (COMT) inhibitor, can improve the motor function of patients with PD, especially exercise and muscle stiffness. Tolcapone can also improve the cognitive function of patients.
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Objective To systematically review the existing evidence of spontaneous synchronization in human gait. Data Sources EBSCO, PubMed, Google Scholar, and psychINFO were searched from inception to July 2020 using all possible combinations of (1) “spontaneous interpersonal synchronization” or “spontaneous interpersonal coordination or “unintentional interpersonal synchronization” or “unintentional interpersonal coordination” and (2) “human movement” or “movement” or “walking” or “ambulation” or “gait”. Study Selection Studies had to focus on spontaneous synchronization in human gait, published in a peer-reviewed journal, present original data (no review papers were included) and written in English. The search yielded 137 result and the inclusion criteria were met by 16 studies. Data Extraction Participant demographics, study purpose, setup, procedure, biomechanical measurement, coordination analytical technique, and findings were extracted. Our synthesis focused on the context in which this phenomenon has been studied, the role of sensory information in the emergence of spontaneous interpersonal synchronization in human gait, and the metrics used to quantify this behavior. Data Synthesis The included 16 articles ranged from 2007-2019 and used healthy, primarily young, subjects to investigate the role of spontaneous interpersonal synchronization on gait behavior, with the majority utilizing a side-by-side walking/running paradigm. All articles reported data supporting spontaneous interpersonal synchronization, with the strength of the synchronization depending on the sensory information available to the participants. Conclusions Walking alongside an intact locomotor system may provide an effective, and biologically variable, attractor signal for rehabilitation of gait behavior. Future research should focus on the utility of spontaneous interpersonal synchronization in clinical populations as a non-invasive method to enhance gait rehabilitation.
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The role of auditory information on perceptual-motor processes has gained increased interest in sports and psychology research in recent years. Numerous neurobiological and behavioral studies have demonstrated the close interaction between auditory and motor areas of the brain, and the importance of auditory information for movement execution, control, and learning. In applied research, artificially produced acoustic information and real-time auditory information have been implemented in sports and rehabilitation to improve motor performance in athletes, healthy individuals, and patients affected by neurological or movement disorders. However, this research is scattered both across time and scientific disciplines. The aim of this paper is to provide an overview about the interaction between movement and sound and review the current literature regarding the effect of natural movement sounds, movement sonification, and rhythmic auditory information in sports and motor rehabilitation. The focus here is threefold: firstly, we provide an overview of empirical studies using natural movement sounds and movement sonification in sports. Secondly, we review recent clinical and applied studies using rhythmic auditory information and sonification in rehabilitation, addressing in particular studies on Parkinson’s disease and stroke. Thirdly, we summarize current evidence regarding the cognitive mechanisms and neural correlates underlying the processing of auditory information during movement execution and its mental representation. The current state of knowledge here reviewed provides evidence of the feasibility and effectiveness of the application of auditory information to improve movement execution, control, and (re)learning in sports and motor rehabilitation. Findings also corroborate the critical role of auditory information in auditory-motor coupling during motor (re)learning and performance, suggesting that this area of clinical and applied research has a large potential that is yet to be fully explored.
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In healthy adults (n = 35) was used the model the set study of recognition angry facial expression. The load on working memory by extending the interstimuli time up to 16 sec between the target (facial image) and starting (spot light) stimuli does not lead to a significant slowdown of switching of the set. Differences in the magnitude of the induced synchronization of the alpha rhythm in interstimulus period obtained in the subjects with the change in recognition of emotional facial expressions and the subjects "without errors". At the last group synchronization is clearly more pronounced. The implementation of successive cognitive acts is modulated by selective attention, whichis evident in the level of changes the induced synchronization/desynchronization of alpha range potential. The proposed mechanism "inhibitory control" provides the flexibility of cognitive processes by suppressing effect on cortical processes irrelevant factors during interstimulation pauses. This "protective" mechanism, we believe due to little effect of the loading on working memory.
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Olfactory dysfunction is the most frequently seen non-motor symptom of Idiopathic Parkinson's disease (IPD). The aim of this study is to analyze selective olfactory dysfunction, and olfactory bulb volume (OBV) in subtypes of IPD, and compare them with those of the healthy controls. Our study included 41 patients with IPD and age and gender matched 19 healthy controls. IPD patients were either tremor dominant (65.9%; TDPD) or non-tremor dominant (34.1%; NTDPD) type. All patients underwent neurological, ear, nose, and throat examinations, and orthonasal olfaction testing. Magnetic resonance imaging (MRI) technique was used to measure the volume of the olfactory bulb. A significant decrease in olfactory identification scores was found in the patient group. The patients had difficulty in discriminating between odors of mothballs, chocolate, Turkish coffee and soap. OBV did not differ between the patient, and the control groups. In the TDPD group, odor identification ability was decreased when compared to the control group. However, odor test results of NTDPD, control and TDPD groups were similar. OBV estimates of the TDPD group were not different from those of the control group, while in the NTDPD group OBVs were found to be decreased. In all patients with Parkinson's disease OBV values did not vary with age of the patients, duration of the disease, age at onset of the disease, and Unified Parkinson's Disease Rating Scale motor scores (UPDRS-m). Olfactory function is a complex process involving olfactory, and cortical structures as well. In Idiopathic Parkinson's disease, changes in OBV do not seem to be directly related to olfactory dysfunction.
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Introduction: Selegiline and rasagiline are established in the treatment of Parkinson's disease. As no direct comparative randomised controlled trials on these drugs are available, an indirect meta-analysis was conducted. Objective: Goal of the meta-analysis was to examine the clinical differentiation between rasagiline and selegiline based on efficacy and safety in Parkinson's disease. Methods: Literature databases, study registries and references of relevant publications were the basis of our literature search. Studies were selected according to Jadad and Delphi criteria. The analysis used a fixed effects model based on standardised mean differences for efficacy criteria and risk differences of safety outcomes. As outcomes, UPDRS (primary) and UPDRS motor functions, mental and ADL, the Schwab and England scale, the off-time as well as safety as secondary outcomes were used. Results: Rasagiline showed a statistically significant advantage in the primary endpoint UPDRS total scores (monotherapy: p = 0.048, sensitivity analysis: p = 0.023; pooled analyses: p = 0.043, sensitivity analysis p = 0.014) and the secondary endpoint UPDRS motor functions (monotherapy: p = 0.049, sensitivity analysis p = 0.031; pooled analyses: not significant, sensitivity analysis: p = 0.046). For the other secondary outcome parameters, a numerical advantage for rasagiline was found. Discontinuation rates due to adverse effects showed a tendency in favour of rasagiline. Risk for adverse events such as dizziness , hallucinations, diarrhoea and syncope were lower with rasagiline than selegiline (each p < 0.15). Conclusion: This meta-analysis showed a statistically significant and clinically relevant advantage for rasagiline over selegiline in the primary endpoint. The superiority of rasagiline was further substantiated with advantages in tolerability and safety.
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Introduction: Retrieval-induced forgetting (RIF) paradigms are used to investigate successful forgetting of irrelevant information. Responses to the RIF paradigm can vary substantially, but to date there has been limited investigation of the individual difference factors that contribute to RIF performances. This study investigated whether individual differences in baseline RIF ability impacted on RIF performance after temporarily induced frontal dysfunction. To examine this question, left dorsolateral prefrontal cortex (DLPFC) function was temporarily reduced using transcranial direct current stimulation (tDCS). Method: Fourteen individuals received tDCS (sham/active) on two separate occasions and completed a RIF paradigm within 30 minutes of receiving tDCS. Results: As expected, the group of individuals who demonstrated high levels of RIF after sham tDCS demonstrated a significant reduction in RIF performance after active tDCS. Unexpectedly, however, those individuals who demonstrated low or reverse RIF effects after sham tDCS showed a significant increase in RIF after active tDCS. Conclusions: This is the first study to show that individual differences in premorbid RIF affect RIF performance after temporary reduction in left DLPFC function. These findings suggest that premorbid RIF ability may be an important factor to consider when investigating the impact of frontal dysfunction on RIF in patient populations.
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The purpose of this study was to examine whether the prevalence of Parkinson's disease (PD) continues to rise after 80 years of age. This is a two-stage, multi-center, cross-sectional study using a stratified cluster sampling approach was employed. Subjects included veterans at ≥ 60 years of age living in veterans' communities for at least one month in 18 major cities across China. In the first step, possible PD was screened using a PD screening scale. Demographic and relevant information were collected. In the second step, PD diagnosis was established using the United Kingdom Parkinson's Disease Society Brain Bank (UKPDSBB) diagnostic criteria. The study was conducted during the period from December 2009 to December 2012. The study included 277 veterans' communities. Among the approached 11,593 subjects, 9676 subjects, (9096 men, 580 women) responded. The response rate was 83.46%.The age was ≥ 80 years in 6722 (69.47%) subjects. A diagnosis of PD was established in 228 subjects (2.36%) in the entire sample. The rate of PD was 2.65% in those with an age of ≥ 80 years. The rate of PD increased with increasing age (0%, 1.84%, 2.60% and 3.68% in the subjects at < 70, 70-79, 80-89 and ≥ 90 years of age, respectively; χ2 = 10.891, p = 0.001 in chi-square test). The rate of PD was higher in men (2.44%) than in women (1.46%) on the surface. However, no significant difference was detected (p = 0.241). The prevalence of PD continues to increase beyond the age of 80 years. The prevalence of PD in Chinese veterans is not lower than that in other countries and regions.
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Here we provide a simulation of the properties of SPs on gold nanoplatelets with various cross-sections inscribed in a circle and investigate their field distributions to assign multiple surface plasmon resonances. The manipulated propagation can be obtained through the evolution of edges and corners. Furthermore, the particle morphology and the associated spectral positions alone do not uniquely reflect the important details of the local field distribution as well as the resonance modes. The plasmon modes are investigated to be mainly excited along the edges and in the side and slope side surfaces. The strong field distributions generally can be found around the corners and the plasmons transmit through corners to adjacent edges also can be investigated. Besides the plasmons excited along the edges can be found for the triangular nanoplatelets, plasmons excited in the interior region of the triangular surfaces also can be investigated. Despite in the infrared region, plasmon modes have been investigated to be along the edges for the hexagonal nanoplatelets. Also, it can be seen that the change of nanoplatelet thickness can support different plasmon modes ranging from dipolar resonance mode to quadrupolar resonance mode. The thickness far below the skin depth can display complex plasmon modes along the edges and in the side and slope side surfaces as well as the strong coupling between the upper and bottom surfaces. The observed plasmon resonance modes in our simulation reflect the interference of all these contributions including the plasmons along the edges and in the side surfaces. This is an essential step towards a thorough understanding of plasmon modes and the effect of edge and corner evolution in polygonous nanoplatelets.
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Objective: To determine whether rhythmic music and metronome cues alter spatiotemporal gait measures and gait variability in people with Alzheimer disease (AD). Design: A repeated-measures study requiring participants to walk under different cueing conditions. Setting: University movement laboratory. Participants: Of the people (N=46) who met study criteria (a diagnosis of probable AD and ability to walk 100m) at routine medical review, 30 (16 men; mean age ± SD, 80±6y; revised Addenbrooke's Cognitive Examination range, 26-79) volunteered to participate. Interventions: Participants walked 4 times over an electronic walkway synchronizing to (1) rhythmic music and (2) a metronome set at individual mean baseline comfortable speed cadence. Main outcome measures: Gait spatiotemporal measures and gait variability (coefficient of variation [CV]). Data from individual walks under each condition were combined. A 1-way repeated-measures analysis of variance was used to compare uncued baseline, cued, and retest measures. Results: Gait velocity decreased with both music and metronome cues compared with baseline (baseline, 110.5cm/s; music, 103.4cm/s; metronome, 105.4cm/s), primarily because of significant decreases in stride length (baseline, 120.9cm; music, 112.5cm; metronome, 114.8cm) with both cue types. This was coupled with increased stride length variability compared with baseline (baseline CV, 3.4%; music CV, 4.3%; metronome CV, 4.5%) with both cue types. These changes did not persist at (uncued) retest. Temporal variability was unchanged. Conclusions: Rhythmic auditory cueing at comfortable speed tempo produced deleterious effects on gait in a single session in this group with AD. The deterioration in spatial gait parameters may result from impaired executive function associated with AD. Further research should investigate whether these instantaneous cue effects are altered with more practice or with learning methods tailored to people with cognitive impairment.
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Under carefully controlled conditions, rhythmic auditory cueing can improve gait in patients with Parkinson's disease (PD). In complex environments, attention paid to cueing might adversely affect gait, for example when a simultaneous task-such as avoiding obstacles-has to be executed. We primarily examined whether concurrent auditory cueing interferes with an obstacle avoidance task in patients with PD. The secondary aim was to study differences between patients with and without freezing of gait. Nineteen patients with PD (8 with freezing) were examined on a treadmill in 4 conditions: normal walking; walking with auditory cueing; walking with an obstacle avoidance task; and walking with auditory cueing and obstacle avoidance. Outcome measures included kinematic gait parameters and obstacle crossing parameters. Auditory cueing improved gait in PD, without negative effects on concurrent obstacle avoidance. Additionally, freezers avoided obstacles less efficiently than non-freezers. PD patients are able to successfully execute an obstacle avoidance task, when auditory cueing is administered simultaneously. The different obstacle avoidance behavior in freezers may contribute to their higher fall risk.
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Gait disturbance is an almost universal complaint suffered by PD patients as they inevitably progress to the more severe stages of the disease. This can be partially corrected by external cues guiding placement of each step. "Walking glasses", spectacles that present the patient with visual cues to aid walking without necessitating marking the floor or using a walking stick, have been used with varying degrees of success. We explored the use of a novel design of walking glasses that provide flexibility of visual and auditory cueing and would be very cheap to mass-produce. Performance was measured by timing 15 Parkinson's disease patients' walking over a "real-life" predefined 30&emsp14;m course using different patterns of visual and auditory stimulation. Using the glasses, 8 of 15 patients achieved a meaningful benefit in walking speed of 21.5% (95% CI 3.9%). A further two patients had subjective benefit. It was found that both visual and auditory cues were beneficial, different patterns suiting different patients and more effective in different circumstances. Overall, the best pattern was visual cueing alone with a fixed cue present all the time. This pilot study shows promising improvement in the gait of a significant proportion of Parkinson's disease patients through the use of a simple, inexpensive and robust design of walking glasses, suggesting practical applicability in a therapy setting to large numbers of such patients.
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Parkinson's disease is a relatively common progressive neurodegenerative disorder, one of whose main features is difficulty with walking. This can be partially corrected by providing cues for the placement of each step. We piloted the potential benefit of simple custom-designed 'walking glasses' worn by the patient that provide visual and auditory cues to aid in step placement. We used a repeated measures design to compare gait performance when unaided and when using the walking glasses with different patterns of visual and auditory stimulation by timing patients' walking over a 'real-life' predefined 30-m course. Hospital outpatient clinic. Fifteen patients with idiopathic Parkinson's disease who had significant gait problems and no other condition affecting gait performance. Timed walk. Using the glasses, 8 of 15 patients achieved a significant and meaningful average improvement in walking time of at least 10% (mean (95% confidence interval) improvement in these patients was 21.5% (3.9%)), while a further 2 had subjective and modest objective benefit. Different patterns of visual and auditory cues suited different patients. Visual cueing alone with a fixed horizontal cue line present all the time statistically resulted in the greatest improvement in walking time. This pilot study shows promising improvement in the gait of a significant proportion of Parkinson's disease patients through the use of a simple, inexpensive and robust design of walking glasses, suggesting practical applicability in a therapy setting to large numbers of such patients.
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Freezing is a disabling symptom in patients with Parkinson's disease. We investigated the effectiveness of a new rehabilitation strategy based on treadmill training associated with auditory and visual cues. Forty Parkinsonian patients with freezing were randomly assigned to two groups: Group 1 underwent a rehabilitation program based on treadmill training associated with auditory and visual cues, while Group 2 followed a rehabilitation protocol using cues and not associated with treadmill. Functional evaluation was based on the Unified Parkinson's Disease Rating Scale Motor Section (UPDRS III), Freezing of Gait Questionnaire (FOGQ), 6-minute walking test (6MWT), gait speed, and stride cycle. Patients in both the groups had significant improvements in all variables considered by the end of the rehabilitation program (all P = 0.0001). Patients treated with the protocol including treadmill, had more improvement than patients in Group 2 in most functional indicators (P = 0.007, P = 0.0004, P = 0.0126, and P = 0.0263 for FOGQ, 6MWT, gait speed, stride cycle, respectively). The most striking result was obtained for 6MWT, with a mean increase of 130 m in Group 1 compared with 57 m in Group 2. Our results suggest that treadmill training associated with auditory and visual cues might give better results than more conventional treatments. Treadmill training probably acts as a supplementary external cue.
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To revalidate the Freezing of Gait Questionnaire (FOG-Q), patients with Parkinson's disease (PD) were randomly assigned to receive rasagiline (1 mg/day) (n = 150), entacapone (200 mg with each dose of levodopa) (n = 150), or placebo (n = 154). Patients were assessed at baseline and after 10 weeks using the FOG-Q, Unified Parkinson's Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), and Parkinson's Disease Questionnaire (PDQ-39). FOG-Q dimensionality, test-retest reliability, and internal reliability were examined. Convergent and divergent validities were assessed by correlating FOG-Q with UPDRS, BDI, and PDQ-39. Comparisons between FOG-Q item 3 and UPDRS item 14 were also made. Principal component analysis indicated that FOG-Q measures a single dimension. Test-retest reliability and internal reliability of FOG-Q score was high. FOG-Q was best correlated to items of the UPDRS relating to walking, general motor issues, and mobility. Correlations between baseline and endpoint suggested that FOG-Q item 3 is at least as reliable as UPDRS item 14. At baseline, 85.9% of patients were identified as "Freezers" using FOG-Q item 3 (> or =1) and 44.1% using UPDRS item 14 (> or =1) (P < 0.001). FOG-Q was a reliable tool for the assessment of treatment intervention. FOG-Q item 3 was effective as a screening question for the presence of FOG.
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We present a clinimetric assessment of the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The MDS-UDPRS Task Force revised and expanded the UPDRS using recommendations from a published critique. The MDS-UPDRS has four parts, namely, I: Non-motor Experiences of Daily Living; II: Motor Experiences of Daily Living; III: Motor Examination; IV: Motor Complications. Twenty questions are completed by the patient/caregiver. Item-specific instructions and an appendix of complementary additional scales are provided. Movement disorder specialists and study coordinators administered the UPDRS (55 items) and MDS-UPDRS (65 items) to 877 English speaking (78% non-Latino Caucasian) patients with Parkinson's disease from 39 sites. We compared the two scales using correlative techniques and factor analysis. The MDS-UPDRS showed high internal consistency (Cronbach's alpha = 0.79-0.93 across parts) and correlated with the original UPDRS (rho = 0.96). MDS-UPDRS across-part correlations ranged from 0.22 to 0.66. Reliable factor structures for each part were obtained (comparative fit index > 0.90 for each part), which support the use of sum scores for each part in preference to a total score of all parts. The combined clinimetric results of this study support the validity of the MDS-UPDRS for rating PD.
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Patients with Parkinson's disease (PD) have various types of gait disturbance that are thought to result from impairments in motor timing. Gait disturbances are markedly improved with the use of appropriate visual and auditory cues. In this study, patients suffering from mild to moderate PD underwent a structured music therapy session in which they were trained to walk while mentally singing. The patients were trained in 7 progressive tasks, with a final goal of walking while mentally singing. Before and after the training session, they were videotaped. The video was analyzed for time and steps while walking straight paths and while turning. After a single session of training, the time and steps were significantly improved in both situations. Follow-up interviews with the patients indicated that they effectively utilized mental singing while walking in their daily lives. We propose that singing regulates basal ganglia function and allows patients with PD to keep time regularly. The task used in the present study was simple, required no special tools, and could be utilized anytime and anyplace. Thus, walking while mentally singing has potential for improving the gait of individuals with PD.
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The Lewy body is a distinctive neuronal inclusion that is always found in the substantia nigra and other specific brain regions in Parkinson's disease. It is mainly composed of structurally altered neurofilament, and occurs wherever there is excessive loss of neurons. It occurs in some elderly individuals and rarely in other degenerative diseases of the central nervous system. In 273 brains of patients dying from disorders other than Parkinson's disease, the age-specific prevalence of Lewy bodies increased from 3.8% to 12.8% between the sixth and ninth decades. Associated pathological findings suggest that these cases of incidental Lewy body disease are presymptomatic cases of Parkinson's disease, and confirm the importance of age (time) in the evolution of the disease. In view of the common and widespread occurrence of this disorder we propose that endogenous mechanisms operating in early life may be more important than environmental agents in the pathogenesis of Lewy bodies and Parkinson's disease.
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Gait and gait related activities in patients with Parkinson's disease (PD) can be improved with rhythmic auditory cueing (e.g. a metronome). In the context of a large European study, a portable prototype cueing device was developed to provide an alternative for rhythmic auditory cueing: rhythmic somatosensory cueing (RSC, a miniature vibrating cylinder attached to the wrist). We investigated whether PD patients could adapt their walking pattern using RSC under conditions of changing walking speed and the presence of potentially distracting visual flow while walking on a treadmill. A total of 17 patients with PD participated (mean age 63.4+/-10.3 years; Hoehn-Yahr score 2.5+/-0.9, mean Unified Parkinson's Disease Rating Scale score 49.8+/-13.7, mean disease duration 7.7+/-5.1 years). They performed systematic walking speed manipulations under 4 conditions in a random order: (1) no cue, no visual flow, (2) no cue, visual flow, (3) cue, no visual flow and (4) cue, visual flow. Visual flow in the form of a virtual corridor that moved at the current walking speed was projected on a 2 x 2 m rear-projection screen. The cueing rhythm was set at -10% of preferred stride frequency at each speed. Stride frequency was assessed using peaks in the trajectories of thigh sagittal plane segmental angles. Walking with RSC resulted in lower stride frequencies, and thus larger step lengths (p-values <0.05), regardless of walking speed. The presence of visual flow did not impair the use of RSC, as evidenced by the lack of differences between conditions 3 and 4 (p>0.05). Rhythmic somatosensory cueing may be a viable alternative for auditory cueing and is robust to changes in walking speed and visual distractors.