Panzer V P, Hallett M
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
Clin Biomech (Bristol). 1990 May;5(2):73-80. doi: 10.1016/0268-0033(90)90041-4.
In order to evaluate the usefulness of biomechanical measures in the clinical assessment of Parkinson's disease, we studied the kinematics of upright stance in a patient with evident fluctuations in clinical state (ON-OFF), which allowed us to optimize experimental control. We determined the total amount of movement and the variability of whole body and body segment kinematics in the vertical, anterior-posterior (A-P), and medial-lateral planes. The total excursion parameter (TEX) represented the co-ordinate path over a 20 s period, and the movement variability parameter (VAR) was calculated based on the standard deviation about the quadratic fit to this path. Discriminant analysis was employed to assess the ability of these parameters to discriminate the patient's clinical state, and statistical reduction of the number of measures was accomplished with a stepwise selection procedure. Measures of shoulder A-P movement and the vertical motion of the centre of gravity (COG) were selected for inclusion in both discriminant functions. The VAR function included only four measures (vertical COG and A-P head, shoulder, and hip), while the TEX function required six measures to discriminate the clinical state. Results obtained with the VAR function were superior to those obtained with TEX, and VAR discriminated the OFF state, a common characteristic of Parkinson's disease, especially well. The results are promising, as the measures appear sensitive to the patient's clinical state even though fluctuation of symptoms was reduced in the latter part of the study by various treatments.
为了评估生物力学测量在帕金森病临床评估中的作用，我们研究了一名临床状态明显波动（开-关期）患者的直立姿势运动学，这使我们能够优化实验控制。我们确定了垂直、前后（A-P）和内外侧平面上全身及身体节段运动学的总运动量和变异性。总偏移参数（TEX）代表20秒内的坐标路径，运动变异性参数（VAR）基于对该路径二次拟合的标准差计算得出。采用判别分析来评估这些参数区分患者临床状态的能力，并通过逐步选择程序对测量指标数量进行统计简化。判别函数中均纳入了肩部A-P运动和重心（COG）垂直运动的测量指标。VAR函数仅包含四项测量指标（垂直COG以及A-P方向的头部、肩部和髋部），而TEX函数需要六项测量指标来区分临床状态。VAR函数得到的结果优于TEX函数，且VAR对帕金森病的常见特征——关期的区分效果尤其好。这些结果很有前景，因为尽管在研究后期通过各种治疗使症状波动有所减轻，但这些测量指标似乎仍对患者的临床状态敏感。
