Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
Gait Posture. 2012 Jan;35(1):116-20. doi: 10.1016/j.gaitpost.2011.08.020. Epub 2011 Sep 29.
The reduction of arm swing during gait is a frequent phenomenon in patients with early Parkinson's disease (PD). However, the objective quantification of this clinical sign using treadmill-based gait analysis has not been systematically evaluated so far. We simultaneously measured ultrasound based limb kinematics and spatiotemporal gait parameters during treadmill walking at different speeds in 21 early PD patients in Hoehn and Yahr (HY) stage I, 19 patients with bilateral PD in HY stage II and 25 age-matched controls. Both PD groups showed a highly significant reduction of the arm swing amplitude on the more affected body side (MAS). Decomposing total arm swing resulted in a bilateral decrease of arm retroversion in both PD groups, whereas anteversion was normal on the less affected side of the HY I cohort. Early stage patients exhibited a highly significant, almost threefold increase of the arm swing asymmetry index (I(A)) compared with controls. Reduced retroversion on the MAS and increased arm swing I(A) were the independent variables with the closest association to disease status in a multivariate logistic regression analysis. We conclude that ultrasound based motion analysis during treadmill walking allows reliable investigation of asymmetric arm movements in early PD patients which attenuate with ongoing disease. Impaired active arm retroversion seems to be the earliest sign of upper extremity dysfunction in parkinsonian gait. The measurement of limb kinematics during treadmill gait can broaden our methodological line-up for the analysis of complex motor programs in movement disorders.
在早期帕金森病（PD）患者中，行走时手臂摆动减少是一种常见现象。然而，迄今为止，尚未系统评估使用跑步机步态分析对这种临床体征进行客观量化。我们同时测量了 21 名早期 PD 患者（Hoehn 和 Yahr [HY] 1 期）、19 名双侧 PD 患者（HY 2 期）和 25 名年龄匹配的对照组在不同速度下在跑步机上行走时的超声肢体运动学和时空步态参数。两组 PD 患者在受影响较大的身体侧（MAS）手臂摆动幅度均显著降低。分解总手臂摆动导致两组患者的手臂后旋双侧减少，而 HY I 队列受影响较小的一侧则为前旋正常。早期患者与对照组相比，手臂摆动不对称指数（I(A)）显著增加近三倍。在多变量逻辑回归分析中，MAS 上的旋转减少和手臂摆动 I(A)增加是与疾病状态最密切相关的独立变量。我们得出结论，跑步机行走时的超声运动分析可可靠地研究早期 PD 患者的不对称手臂运动，这些运动随疾病的发展而减弱。主动手臂后旋受损似乎是帕金森步态中上肢功能障碍的最早迹象。在跑步机步态中测量肢体运动学可以拓宽我们在运动障碍中分析复杂运动程序的方法。
