Barbic Franca, Galli Manuela, Dalla Vecchia Laura, Canesi Margherita, Cimolin Veronica, Porta Alberto, Bari Vlasta, Cerri Gabriella, Dipaola Franca, Bassani Tito, Cozzolino Domenico, Pezzoli Gianni, Furlan Raffaello
Internal Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Neuroscience Research Association, Milan, Italy;
J Appl Physiol (1985). 2014 Mar 1;116(5):495-503. doi: 10.1152/japplphysiol.01160.2013. Epub 2014 Jan 16.
Motor impairment in Parkinson's disease (PD) is partly due to defective central processing of lower limb afferents. Concomitant alterations in cardiovascular autonomic control leading to orthostatic hypotension may worsen motor ability. We evaluated whether mechanical activation of feet sensory afferents could improve gait and modify the response of cardiovascular autonomic control to stressors in 16 patients (age 66 ± 2 yr) with idiopathic PD (Hoehn & Yhar scale 2-3) on their usual therapy. Eight subjects (group A) were randomized to undergo skin pressure (0.58 ± 0.04 kg/mm(2)) stimulation at the hallux tip and first metatarsal joint (effective stimulation; ES) of both feet. Eight remaining patients (group B) underwent sham stimulation (SS) followed by ES. Three-dimensional movement analysis provided quantitative indexes of movement disability before (baseline) and 24 h after ES and SS. Spectral analysis of heart rate and blood pressure variability provided markers of cardiac sympatho-vagal (LF/HF) and vascular sympathetic (LFSAP) modulations. Markers were measured at rest and during 75° head-up tilt, before and 24 h after ES and SS. After ES, step length and gait velocity increased, upright rotation velocity was enhanced, and step number was decreased. After ES, LFSAP declined. The increase in LF/HF and LFSAP induced by tilt was greater than before feet stimulation. No changes in gait and autonomic parameters were observed after SS. Twenty-four hours after ES, patients with PD showed improved gait and increased cardiac and vascular sympathetic modulation during upright position compared with baseline. Conversely, SS was ineffective on both movement and autonomic parameters, indicating a site specificity effect of the stimulation.
帕金森病（PD）中的运动障碍部分归因于下肢传入神经的中枢处理缺陷。心血管自主控制的伴随改变导致体位性低血压，可能会使运动能力恶化。我们评估了在16例（年龄66±2岁）接受常规治疗的特发性PD患者（Hoehn & Yahr分级2 - 3级）中，足部感觉传入神经的机械激活是否能改善步态，并改变心血管自主控制对应激源的反应。8名受试者（A组）被随机分配接受双脚拇趾尖和第一跖趾关节处的皮肤压力（0.58±0.04 kg/mm(2)）刺激（有效刺激；ES）。其余8名患者（B组）先接受假刺激（SS），然后接受ES。三维运动分析提供了ES和SS前（基线）以及24小时后运动障碍的定量指标。心率和血压变异性的频谱分析提供了心脏交感 - 迷走（LF/HF）和血管交感（LFSAP）调制的标志物。在ES和SS前以及后24小时，在静息状态和75°头高位倾斜期间测量标志物。ES后，步长和步态速度增加，直立旋转速度提高，步数减少。ES后，LFSAP下降。倾斜引起的LF/HF和LFSAP增加大于足部刺激前。SS后未观察到步态和自主参数的变化。ES后24小时，与基线相比，PD患者在直立位时步态改善，心脏和血管交感调制增加。相反，SS对运动和自主参数均无效，表明刺激具有部位特异性效应。
