Xanthopoulos P, Heilman K M, Drago V, Pardalos P, Foster P S, Skidmore F M
Department of Industrial and Systems Engineering, University of Florida, College of Engineering, Gainesville, FL 32610-0236, USA.
Neurosci Lett. 2008 Dec 19;448(1):105-9. doi: 10.1016/j.neulet.2008.10.032. Epub 2008 Oct 15.
BACKGROUND/OBJECTIVES: When performing activity associated with walking, the amount of walking a person does often will depend on their plans. This study was designed to evaluate the relationship between motor planning and ambulatory persistence in participants with Parkinson's disease (PD) and to see if ambulatory persistence was related to the ability to perform activities of daily living (ADL).
20 individuals with idiopathic PD were recruited to perform the Trail making Test (a test of motor planning) and to wear a step activity monitor for 48h. The measurement of persistence of an ambulatory event consisted of the number of steps taken during an event and an ambulatory event was defined as continuous ambulation (taking step) without pausing for 3 or more seconds. The resumption of taking step (ambulation) after 3 or more seconds counted as a new ambulatory event. UPDRS-motor and ADL scale were also obtained.
The cumulative percentage of the total ambulatory events at each number of steps was plotted for each subject which when plotted could be described as a sigmoid curve. We found that this sigmoidal curve defined by the equation y=x(n)/(k(n)+x(n)), fit the data well, where k represents a constant specific to each subject, x represents the number of steps during each ambulatory event, and y represents the projected percentage of movement events containing x number of steps or less. (Root Mean Square Error (RMSE)=0.02, R(2)=0.98). Trail making test part A was highly associated with the constant k (R=-0.74, p<0.001). The constant k was also highly associated with the UPDRS ADL subscale (R=-0.81, p=0.0001). A forward bivariate regression model including Part A of the Trail making test, and the UPDRS-ADL subscale predicted 66% of the variability of the constant k. The overall number of steps taken per day, and the UPDRS motor subscale did not contribute to the model.
Defective motor planning in Parkinson's disease as measured by poor performance on a Trail making test is associated with a measurable alteration in ambulatory persistence, and altered ambulatory persistence, quantified by our proposed model parameter, correlates highly with the UPDRS ADL score. Thus, cognitive-motor planning defects might be a major source of disability in PD. We suggest that in future clinical practice gait tests can be used in order to quantify short-term planning ability in neurodegenerative diseases.
背景/目的：在进行与行走相关的活动时，一个人行走的步数通常取决于他们的计划。本研究旨在评估帕金森病（PD）患者的运动计划与行走持续性之间的关系，并观察行走持续性是否与日常生活活动（ADL）能力相关。
招募20名特发性PD患者进行连线测验（一项运动计划测试），并佩戴步数活动监测器48小时。行走事件持续性的测量包括事件期间所走的步数，行走事件定义为连续行走（迈步）且不间断3秒或更长时间。3秒或更长时间后重新开始迈步（行走）计为一个新的行走事件。同时还获取了统一帕金森病评定量表（UPDRS）的运动和ADL量表。
为每个受试者绘制了每个步数下行走事件总数的累积百分比，绘制后可描述为S形曲线。我们发现由方程y = x(n)/(k(n)+x(n))定义的这条S形曲线与数据拟合良好，其中k代表每个受试者特有的常数，x代表每个行走事件中的步数，y代表包含x步或更少步数的运动事件的预计百分比。（均方根误差（RMSE）=0.02，R(2)=0.98）。连线测验A部分与常数k高度相关（R = -0.74，p < 0.001）。常数k也与UPDRS的ADL子量表高度相关（R = -0.81，p = 0.0001）。一个包含连线测验A部分和UPDRS-ADL子量表的向前双变量回归模型预测了常数k变异性的66%。每天的总步数以及UPDRS运动子量表对模型没有贡献。
通过连线测验表现不佳所衡量的帕金森病运动计划缺陷与行走持续性的可测量改变相关，并且通过我们提出的模型参数量化的行走持续性改变与UPDRS ADL评分高度相关。因此，认知运动计划缺陷可能是PD患者残疾的主要来源。我们建议在未来的临床实践中可以使用步态测试来量化神经退行性疾病中的短期计划能力。
