Speech and gait abnormalities in motor subtypes of de-novo Parkinson's disease.

AIM: To investigate the presence and relationship of temporal speech and gait parameters in patients with postural instability/gait disorder (PIGD) and tremor-dominant (TD) motor subtypes of Parkinson's disease (PD). METHODS: Speech samples and instrumented walkway system assessments were acquired from a total of 60 de-novo PD patients (40 in TD and 20 in PIGD subtype) and 40 matched healthy controls. Objective acoustic vocal assessment of seven distinct speech timing dimensions was related to instrumental gait measures including velocity, cadence, and stride length. RESULTS: Compared to controls, PIGD subtype showed greater consonant timing abnormalities by prolonged voice onset time (VOT) while also shorter stride length during both normal walking and dual task, while decreased velocity and cadence only during dual task. Speaking rate was faster in PIGD than TD subtype. In PIGD subtype, prolonged VOT correlated with slower gait velocity (r = -0.56, p = 0.01) and shorter stride length (r = -0.59, p = 0.008) during normal walking, whereas relationships were also found between decreased cadence in dual task and irregular alternating motion rates (r = -0.48, p = 0.04) and prolonged pauses (r = -0.50, p = 0.03). No correlation between speech and gait was detected in TD subtype. CONCLUSION: Our findings suggest that speech and gait rhythm disorder share similar underlying pathomechanisms specific for PIGD subtype.

Effect of Robot-Assisted Gait Training on Selective Voluntary Motor Control in Ambulatory Children with Cerebral Palsy.

This pilot study investigated the efficacy of a four week robot-assisted gait training in twelve children with spastic diparesis. Short-term results and a 3-month follow-up showed statistically significantly increased selective motor control, walking farther distances, gross motor score, and decreased joint contractures.

Evaluation of Postural Stability Differences in the Elderly Through Recurrent Analysis.

Measuring the center of pressure (CoP) for a subject positioned on a force plate is one of the most commonly used tools to investigate balance. Several studies have proven a significant degradation of the body's stability after the age of 60. The conclusions, however, are based on a limited number of indicators and without systematic nonlinear analysis methods being used to evaluate the progression of CoP parameter values. Neither the change in CoP movement in subjects over 60 years of age nor the considerations of their body mass index (BMI) has been systematically evaluated by nonlinear methods so far. This study is based on one of the frequent methods for nonlinear evaluation - the Recurrent Quantification analysis. This article discusses the applicability of this method with regards to the evaluation of changes in postural stability of subjects over 60 years of age. Postural stability changes were evaluated using CoP motion and tested by the nonlinear method. For this research purpose, a group of 103 elderly women were selected and divided into age-respective groups of 60-69 years and 70-79 years old. Each age group was further divided into a subgroup of normal and overweight subjects according to their BMI. The following recurrent analysis parameters were employed in the evaluation of CoP motion in medial-lateral and anterior-posterior directions: determinism (DET), laminarity (LAM) and trapping time (TT). The results of the Wilcoxon test revealed a statistically significant difference between the values in parameters for the different age groups of overweight subjects almost in all the cases. Conversely, statistically significant differences between age groups rarely occurred in a subgroup of subjects with a normal BMI.

Agreement between the GAITRite® System and the Wearable Sensor BTS G-Walk® for measurement of gait parameters in healthy adults and Parkinson's disease patients.

BACKGROUND: Nowadays, the most widely used types of wearable sensors in gait analysis are inertial sensors. The aim of the study was to assess the agreement between two different systems for measuring gait parameters (inertial sensor vs. electronic walkway) on healthy control subjects (HC) and patients with Parkinson's disease (PD). METHODS: Forty healthy volunteers (26 men, 14 women, mean age 58.7 ± 7.7 years) participated in the study and 24 PD patients (19 men, five women, mean age 62.7 ± 9.8 years). Each participant walked across an electronic walkway, GAITRite, with embedded pressure sensors at their preferred walking speed. Concurrently a G-Walk sensor was attached with a semi-elastic belt to the L5 spinal segment of the subject. Walking speed, cadence, stride duration, stride length, stance, swing, single support and double support phase values were compared between both systems. RESULTS: The Passing-Bablock regression slope line manifested the values closest to 1.00 for cadence and stride duration (0.99 ≤ 1.00) in both groups. The slope of other parameters varied between 0.26 (double support duration in PD) and 1.74 (duration of single support for HC). The mean square error confirmed the best fit of the regression line for speed, stride duration and stride length. The y-intercepts showed higher systematic error in PD than HC for speed, stance, swing, and single support phases. CONCLUSIONS: The final results of this study indicate that the G-Walk system can be used for evaluating the gait characteristics of the healthy subjects as well as the PD patients. However, the duration of the gait cycle phases should be used with caution due to the presence of a systematic error.

Effect of Robot-Assisted Gait Training on Selective Voluntary Motor Control in Ambulatory Children with Cerebral Palsy.

This pilot study investigated the efficacy of a four week robot-assisted gait training in twelve childrenwith spastic diparesis. Short-term results and a 3-month follow-up showed statistically significantly increased selective motor control, walking farther distances, gross motor score, and decreased joint contractures.

Extended Timed Up & Go test: Is walking forward and returning back to the chair equivalent gait?

The Timed Up & Go test (TUG) is functional test and is a part of routine clinical examinations. The instrumented Timed Up & Go test enables its segmentation to sub-tasks: sit-to-stand, walking forward, turning, walking back, stand-to-sit, and consequently the computation of task-specific parameters and sub-tasks separately. However, there are no data on whether walking forward parameters differ from the walking back parameters. This study tested the differences between walking forward and walking back in the TUG extended to 10 m for 17 spatio-temporal gait parameters. All parameters were obtained from a GAITRite® pressure sensitive walkway (CIR Systems, Inc.). The differences were assessed for healthy controls and Parkinson's disease (PD) patients. None of investigated parameters exhibited a difference between both gait subtasks for healthy subjects group. Five parameters of interest, namely velocity, step length, stride length, stride velocity, and the proportion of the double support phase with respect to gait cycle duration, showed a statistically significant difference between gait for walking forward and walking back in PD patients. Therefore, we recommend a separate assessment for walking forward and walking back rather than averaging both gaits together.

Evaluation of the effect of heel lift on postural stability and symmetry of muscle activity.

BACKGROUND: Although a leg length inequality (LLI) has the effect on the performed movement, more complex indices for the evaluation of kinematic variables of postural stability and a symmetry of a muscle activity during standing in subjects with the LLI were never used before. OBJECTIVE: The objective is to present appropriate parameters for an evaluation of kinematic variables of postural stability and muscle activity during standing, i.e. to consider EMG signals, in patients with LLI. METHODS: New indices are offered, such as a sway velocity (i.e. the mCTSIB method) and a modified symmetry index (SI), for a quantitative evaluation of EMG signals. The set of data for evaluating the effect of a heel lift was measured on patients with the LLI and healthy volunteers. RESULTS: Prior to the heel lift application, significant statistic differences were found between the mCTSIB of patients and the CG. These differences were no longer statistically significant after the heel lift was applied. As for the SI, the lowest values were found in the CG, while the greatest values were collected among patients before applying the heel lift. CONCLUSIONS: The results point out the benefits of using the newly applied indices in patients with the LLI. Both methods may become useful tools for the evaluation of the physical state of patients with the LLI in a medical practice.