Vitório Rodrigo, Lirani-Silva Ellen, Baptista André Macari, Barbieri Fabio Augusto, dos Santos Paulo Cezar Rocha, Teixeira-Arroyo Claudia, Gobbi Lilian Teresa Bucken
UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil.
UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil.
Gait Posture. 2014;40(1):266-9. doi: 10.1016/j.gaitpost.2014.03.003. Epub 2014 Mar 12.
The current study evaluated the effects of disease severity on the control of obstacle crossing in people with idiopathic Parkinson's disease (PD). Forty-five subjects participated in the study, including 15 patients with mild PD (classified as stage 1 to 1.5 of the Hoehn and Yahr Rating Scale), 15 patients with moderate PD (classified as stage 2 to 3 of the Hoehn and Yahr Rating Scale), and 15 neurologically healthy individuals. Groups were matched by sex, age, body mass, and body height. The obstacle crossing task required participants to walk along a pathway and step over an obstacle (half of the knee height, positioned in the middle of the pathway). Patients were tested in a typically medicated state. Kinematic data were recorded using an optoelectronic tridimensional system. The outcome measures included spatiotemporal measures of obstacle avoidance. There were no significant differences between patients with mild PD and healthy individuals. Patients with moderate PD exhibited shorter distances for leading toe clearance and leading foot placement after the obstacle than did healthy individuals. Patients with moderate PD tended to exhibit a lower leading horizontal mean velocity during obstacle crossing than did healthy individuals. We found significant negative relationships between obstacle crossing measures and disease severity (score on the motor section of the Unified Parkinson's Disease Rating Scale). These findings suggest that disease severity affects locomotor behavior during obstacle crossing in PD. Specifically, obstacle avoidance was not affected in the early stages of PD; however, bradykinesia and hypometria influenced obstacle crossing in patients with moderate PD.
本研究评估了疾病严重程度对特发性帕金森病（PD）患者跨越障碍物控制能力的影响。45名受试者参与了该研究，其中包括15名轻度PD患者（根据Hoehn和Yahr评定量表分类为1至1.5期）、15名中度PD患者（根据Hoehn和Yahr评定量表分类为2至3期）以及15名神经功能正常的个体。各组在性别、年龄、体重和身高方面进行了匹配。跨越障碍物任务要求参与者沿着一条路径行走并跨过一个障碍物（障碍物高度为膝盖高度的一半，位于路径中间）。患者在通常服药状态下接受测试。使用光电三维系统记录运动学数据。结果测量包括避障的时空测量。轻度PD患者与健康个体之间无显著差异。中度PD患者在越过障碍物后，前导脚趾离地间隙和前导脚放置的距离比健康个体短。中度PD患者在跨越障碍物时前导水平平均速度往往低于健康个体。我们发现跨越障碍物测量与疾病严重程度（统一帕金森病评定量表运动部分得分）之间存在显著负相关。这些发现表明疾病严重程度会影响PD患者跨越障碍物时的运动行为。具体而言，在PD早期避障不受影响；然而，运动迟缓及动作幅度减小影响了中度PD患者的跨越障碍物能力。
