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Dopaminergic and non-dopaminergic gait components assessed by instrumented timed up and go test in Parkinson’s disease

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

The timed up and go test (TUG) is a widely used clinical test for the evaluation of balance and mobility. An instrumented version of TUG (iTUG) has been proposed to provide quantitative information on TUG performances. Here, we hypothesized that l-dopa may differently influence gait parameters recorded by a portable inertial sensor. To test this idea, we evaluated iTUG test in patients with Parkinson’s disease (PD), both in l-dopa OFF and ON state. Twenty-eight PD patients performed the iTUG. Subjects were instructed to perform the task both in practical “OFF” and “ON” state. The system differentiated the test in six phases, recording phase durations, three-axial accelerations, average and peak angular speeds during turning. In all patients, sit-to-stand vertical and medio-lateral accelerations together with turning phase duration and angular speeds improved after l-dopa administration, while sit-to-stand and stand-to-sit phases antero-posterior accelerations were less responsive. In PD, l-dopa modulates iTUG in different ways, mostly improving the turning phases and less acting on postural controls during the sit-to-stand and stand-to-sit phases. Our results suggest different involvement of dopaminergic mechanisms on gait as assessed by iTUG. This is important for those aspects which are not improved by pharmacological therapy.

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References

  • Blin O, Ferrandez AM, Pailhous J et al (1991) Dopa-sensitive and dopa-resistant gait parameters in Parkinson’s disease. J Neurol Sci 103:51–54

    Article  CAS  PubMed  Google Scholar 

  • Bowes SG, Clark PK, Leeman AL et al (1990) Determinants of gait in the elderly parkinsonian on maintenance levodopa/carbidopa therapy. Br J Clin Pharmacol 30:13–24

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bryant MS, Rintala DH, Hou JG et al (2011) Gait variability in Parkinson’s disease: influence of walking speed and dopaminergic treatment. Neurol Res 33:959–964

    Article  PubMed  PubMed Central  Google Scholar 

  • Burleigh-Jacobs A, Horak FB, Nutt JG et al (1997) Step initiation in Parkinson’s disease: influence of levodopa and external sensory triggers. Mov Disord 12:206–215

    Article  CAS  PubMed  Google Scholar 

  • Chastan N, Westby GW, Yelnik J et al (2009) Effects of nigral stimulation on locomotion and postural stability in patients with Parkinson’s disease. Brain 132:172–184

    Article  CAS  PubMed  Google Scholar 

  • Curtze C, Nutt JG, Carlson-Kuhta P et al (2015) Levodopa is a double-edged Sword for balance and gait in people with Parkinson’s disease. Mov Disord 30:1361–1370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Curtze C, Nutt JG, Carlson-Kuhta P et al (2016) Objective gait and balance impairments relate to balance confidence and perceived mobility in people with Parkinson disease. Phys Ther 96:1734–1743

    Article  PubMed  PubMed Central  Google Scholar 

  • Doan JB, de Bruin N, Pellis SM et al (2013) Obstacle avoidance amongst Parkinson disease patients is challenged in a threatening context. J Neurodegener Dis 2013:787861

    PubMed  PubMed Central  Google Scholar 

  • Duncan RP, Leddy AL, Earhart GM (2011) Five times sit-to-stand test performance in Parkinson’s disease. Arch Phys Med Rehabil 92:1431–1436

    Article  PubMed  PubMed Central  Google Scholar 

  • Fahn S, Elton RL, and the members of the UPDRS development committee (1987) Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M (eds) Recent developments in Parkinson’s disease. Macmillan Healthcare Information, Florham Park, pp 153–163

    Google Scholar 

  • Fasano A, Bloem BR (2013) Gait disorders. Continuum (Minneap. Minn.) 19:1344–1382

    Google Scholar 

  • Fernandes Â, Sousa AS, Couras J et al (2015) Influence of dual-task on sit-to-stand-to-sit postural control in Parkinson’s disease. Med Eng Phys 37:1070–1075

    Article  PubMed  Google Scholar 

  • Franzen E, Paquette C, Gurfinkel VS et al (2009) Reduced performance in balance, walking and turning tasks is associated with increased neck tone in Parkinson’s disease. Exp Neurol 219:430–438

    Article  PubMed  PubMed Central  Google Scholar 

  • Fregni F, Boggio PS, Bermpohl F et al (2006) Immediate placebo effect in Parkinson’s disease—is the subjective relief accompanied by objective improvement? Eur Neurol 56:222–229

    Article  PubMed  Google Scholar 

  • Goetz CG, Tilley BC, Shaftman SR et al (2008) Movement Disorder Society UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170

    Article  PubMed  Google Scholar 

  • Greene BR, O’Donovan A, Romero-Ortuno R et al (2010) Quantitative falls risk assessment using the timed up and go test. IEEE Trans Biomed Eng 57:2918–2926

    Article  PubMed  Google Scholar 

  • Hausdorff JM (2009) Gait dynamics in Parkinson’s disease: common and distinct behavior among stride length, gait variability, and fractal-like scaling. Chaos 19:026113

    Article  PubMed  PubMed Central  Google Scholar 

  • Hughes AJ, Daniel SE, Kilford L et al (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Inkster LM, Eng JJ (2004) Postural control during a sit-to-stand task in individuals with mild Parkinson’s disease. Exp Brain Res 154:33–38

    Article  PubMed  Google Scholar 

  • Jacobs JV, Nutt JG, Carlson-Kuhta P et al (2009) Knee trembling during freezing of gait represents multiple anticipatory postural adjustments. Exp Neurol 215:334–341

    Article  PubMed  Google Scholar 

  • Jankovic J (2008) Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 79:368–376

    Article  CAS  PubMed  Google Scholar 

  • Jankovic J, McDermott M, Carter J et al (1990) Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology 40:1529–1534

    Article  CAS  PubMed  Google Scholar 

  • Kleiner A, Galli M, Gaglione M et al (2015) The parkinsonian gait spatiotemporal parameters quantified by a single inertial sensor before and after automated mechanical peripheral stimulation treatment. Parkinsons Dis 2015:390512

    PubMed  PubMed Central  Google Scholar 

  • McNeely ME, Earhart GM (2011) The effects of medication on turning in people with Parkinson disease with and without freezing of gait. J Park Dis 1:259–270

    CAS  Google Scholar 

  • Mirelman A, Weiss A, Buchman AS et al (2014) Association between performance on Timed Up and Go subtasks and mild cognitive impairment: further insights into the links between cognitive and motor function. J Am Geriatr Soc 62:673–678

    Article  PubMed  PubMed Central  Google Scholar 

  • Morris S, Morris ME, Iansek R (2001) Reliability of measurements obtained with the Timed “Up & Go” test in people with Parkinson disease. Phys Ther 81:810–818

    Article  CAS  PubMed  Google Scholar 

  • Munetz MR, Benjamin S (1988) How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry 39:1172–1177

    CAS  PubMed  Google Scholar 

  • Pieruccini-Faria F, Vitorio R, Almeida QJ et al (2013) Evaluating the acute contributions of dopaminergic replacement to gait with obstacles in Parkinson’s disease. J Mot Behav 45:369–380

    Article  CAS  PubMed  Google Scholar 

  • Podsiadlo S, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    Article  CAS  PubMed  Google Scholar 

  • Rocchi L, Chiari L, Mancini M et al (2006) Step initiation in Parkinson’s disease: influence of initial stance conditions. Neurosci Lett 406:128–132

    Article  CAS  PubMed  Google Scholar 

  • Rochester L, Baker K, Nieuwboer A et al (2011) Targeting dopa-sensitive and dopa-resistant gait dysfunction in Parkinson’s disease: selective responses to internal and external cues. Mov Disord 26:430–435

    Article  PubMed  Google Scholar 

  • Salarian A, Horak FB, Zampieri C et al (2010) iTUG, a sensitive and reliable measure of mobility. IEEE Trans Neural Syst Rehabil Eng 18:303–310

    Article  PubMed  PubMed Central  Google Scholar 

  • Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 80:896–903

    CAS  PubMed  Google Scholar 

  • Siriphorn A, Chamonchant D, Boonyong S (2015) The effects of vision on sit-to-stand movement. J Phys Ther Sci 27:83–86

    Article  PubMed  PubMed Central  Google Scholar 

  • Smulders K, Dale ML, Carlson-Kuhta P et al (2016) Pharmacological treatment in Parkinson’s disease: effects on gait. Parkinsonism Relat Disord 31:3–13

    Article  PubMed  PubMed Central  Google Scholar 

  • Sterling NW, Cusumano JP, Shaham N et al (2015) Dopaminergic modulation of arm swing during gait among Parkinson’s disease patients. J Parkinson’s Dis 5:141–150

    CAS  Google Scholar 

  • Suppa A, Kita A, Leodori G et al (2017) l-DOPA and freezing of gait in Parkinson’s disease: objective assessment through a wearable wireless system. Front Neurol 8:406

    Article  PubMed  PubMed Central  Google Scholar 

  • Tomlinson CL, Stowe R, Patel S et al (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25:2649–2653

    Article  PubMed  Google Scholar 

  • van der Burg JC, van Wegen EE, Rietberg MB et al (2006) Postural control of the trunk during unstable sitting in Parkinson’s disease. Parkinsonism Relat Disord 12:492–498

    Article  PubMed  Google Scholar 

  • Wall JC, Bell C, Campbell S et al (2000) The Timed Get-up-and-Go test revisited: measurement of the component tasks. J Rehabil Res Dev 37:109–113

    CAS  PubMed  Google Scholar 

  • Weller C, O’Neill CJ, Charlett A et al (1993) Defining small differences in efficacy between anti-parkinsonian agents using gait analysis: a comparison of two controlled release formulations of levodopa/decarboxylase inhibitor. Br J Clin Pharmacol 35:379–385

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Zampieri C, Salarian A, Carlson-Kuhta P et al (2010) The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson’s disease. J Neurol Neurosurg Psychiatry 81:171–176

    Article  PubMed  Google Scholar 

  • Zampieri C, Salarian A, Carlson-Kuhta P et al (2011) Assessing mobility at home in people with early Parkinson’s disease using an instrumented Timed Up and Go test. Parkinsonism Relat Disord 17:277–280

    Article  PubMed  Google Scholar 

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Author notes

  1. Valeria Dibilio and Alessandra Nicoletti equally contributed to this work.

Authors and Affiliations

  1. Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy

    Valeria Dibilio, Alessandra Nicoletti, Giovanni Mostile, Simona Toscano, Antonina Luca, Loredana Raciti, Giorgia Sciacca, Rosario Vasta, Calogero Edoardo Cicero, Donatella Contrafatto & Mario Zappia

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  1. Valeria Dibilio
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  2. Alessandra Nicoletti
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  3. Giovanni Mostile
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  4. Simona Toscano
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  5. Antonina Luca
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Correspondence to Mario Zappia.

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Dibilio, V., Nicoletti, A., Mostile, G. et al. Dopaminergic and non-dopaminergic gait components assessed by instrumented timed up and go test in Parkinson’s disease. J Neural Transm 124, 1539–1546 (2017). https://doi.org/10.1007/s00702-017-1794-8

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  • DOI: https://doi.org/10.1007/s00702-017-1794-8

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