Novak Peter, Novak Vera
Department of Neurology, Boston University School of Medicine, 715 Albany Street, C315, Boston, MA 02118, USA.
J Neuroeng Rehabil. 2006 May 4;3:9. doi: 10.1186/1743-0003-3-9.
Previous studies have suggested that impaired proprioceptive processing in the striatum may contribute to abnormal gait in Parkinson's disease (PD).
This pilot study assessed the effects of enhanced proprioceptive feedback using step-synchronized vibration stimulation of the soles (S-VS) on gait in PD. S-VS was used in 8 PD subjects (3 women and 5 men, age range 44-79 years, on medication) and 8 age-matched healthy subjects (5 women and 3 men). PD subjects had mild or moderate gait impairment associated with abnormal balance, but they did not have gait freezing. Three vibratory devices (VDs) were embedded in elastic insoles (one below the heel and two below the forefoot areas) inserted into the shoes. Each VD operates independently and has a pressure switch that activates the underlying vibratory actuator. The VD delivered the 70-Hz suprathreshold vibration pulse upon touch by the heel or forefoot, and the vibration pulse was deactivated upon respective push-offs. Six-minute hallway walking was studied with and without S-VS. Gait characteristics were measured using the force-sensitive foot switches. The primary outcome was the stride variability expressed as a coefficient of variation (CV), a measure of gait steadiness. Secondary outcome measures were walking distance and speed, stride length and duration, cadence, stance, swing and double support duration, and respective CVs (if applicable).
The walking speed (p < 0.04) and the CV of the stride interval (p < 0.02) differed between the groups and S-VS conditions. In the PD group, S-VS decreased stride variability (p < 0.002), increased walking speed (p < 0.0001), stride duration (p < 0.01), stride length (p < 0.0002), and cadence (p < 0.03). In the control group, S-VS decreased stride variability (p < 0.006) and increased gait speed (p < 0.03), but other locomotion parameters were not significantly altered.
Augmented sensory feedback improves parkinsonian gait steadiness in the short-term setting. Because the suprathreshold stimulation prevented blinding of subjects, the learning effect and increased attention can be a confounding factor underlying results. Long-term studies are needed to establish the clinical value of the S-VS.
先前的研究表明，纹状体中本体感觉处理受损可能导致帕金森病（PD）患者步态异常。
这项初步研究评估了使用足底同步振动刺激（S-VS）增强本体感觉反馈对PD患者步态的影响。8名PD患者（3名女性和5名男性，年龄范围44-79岁，正在服药）和8名年龄匹配的健康受试者（5名女性和3名男性）参与了研究。PD患者存在与平衡异常相关的轻度或中度步态障碍，但无步态冻结现象。三个振动装置（VDs）嵌入弹性鞋垫（一个在足跟下方，两个在前脚掌区域下方），并插入鞋子中。每个VD独立运行，有一个压力开关，可激活下方的振动执行器。足跟或前脚掌触碰时，VD会发出70赫兹的阈上振动脉冲，推离时振动脉冲关闭。研究了有和没有S-VS情况下的6分钟走廊行走。使用力敏脚踏开关测量步态特征。主要结果是步幅变异性，用变异系数（CV）表示，是步态稳定性的一个指标。次要结果指标包括行走距离和速度、步幅长度和持续时间、步频、站立、摆动和双支撑持续时间，以及各自的CV（如适用）。
两组在行走速度（p < 0.04）和步幅间隔的CV（p < 0.02）方面以及S-VS条件之间存在差异。在PD组中，S-VS降低了步幅变异性（p < 0.002），提高了行走速度（p < 0.0001）、步幅持续时间（p < 0.01）、步幅长度（p < 0.0002）和步频（p < 0.03）。在对照组中，S-VS降低了步幅变异性（p < 0.006），提高了步态速度（p < 0.03），但其他运动参数没有显著改变。
在短期情况下，增强的感觉反馈可改善帕金森病患者的步态稳定性。由于阈上刺激避免了受试者的盲目性，学习效应和注意力增加可能是结果的一个混杂因素。需要进行长期研究以确定S-VS的临床价值。
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