Bengevoord A, Vervoort G, Spildooren J, Heremans E, Vandenberghe W, Bloem B R, Nieuwboer A
KU Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
KU Leuven, Department of Rehabilitation Sciences, Heverlee, Belgium.
Gait Posture. 2016 Jan;43:54-9. doi: 10.1016/j.gaitpost.2015.10.021. Epub 2015 Nov 1.
Despite the strong relationship between freezing of gait (FOG) and turning in Parkinson's disease (PD), few studies have addressed specific postural characteristics during turning that might contribute to freezing.
Thirty participants with PD (16 freezers, 14 non-freezers) (all tested OFF medication) and 14 healthy controls walked 5 meters and turned 180° in a 3D gait laboratory. COM behavior was analyzed during four turning quadrants of 40° between 10° and 170° pelvic rotation and during 40° before actual FOG episodes. These pre-FOG segments were compared with similar turning sections in turns of freezers without FOG. Outcome parameters were turn time, COM distance, COM velocity, step width and the medial- and anterior COM position.
Turn time was increased in freezers compared to non-freezers (p=.000). No differences were found regarding COM distance and velocity during turning quadrants between groups and between freezers' pre-FOG segments and similar turning segments without FOG. Medial COM deviation was reduced in PD patients compared to controls (p=.004), but no differences were found between freezers and non-freezers. In turns with freezing, turn time increased (p=.005) and step width decreased (p=.025) pre-FOG. Freezers also showed a less medial (p=.020) and more anterior (p=.016) COM position pre-FOG compared to turning sections without FOG.
Our results revealed no subgroup differences in COM behavior during uninterrupted turning. However, we found a reduced medial deviation, a forward COM shift and a decreased step width in freezers just before FOG episodes. These abnormalities may play a causal role, as they could hamper stability and fluent weight shifting necessary for continued stepping during turning.
尽管帕金森病（PD）患者的冻结步态（FOG）与转身之间存在密切关系，但很少有研究探讨转身过程中可能导致冻结的特定姿势特征。
30名PD患者（16名冻结步态者，14名非冻结步态者）（均在未服药状态下接受测试）和14名健康对照者在三维步态实验室中行走5米并转身180°。在骨盆旋转10°至170°之间的四个40°转身象限以及实际FOG发作前40°期间分析重心（COM）行为。将这些FOG发作前的片段与无FOG的冻结步态者转身时的类似转身部分进行比较。结果参数包括转身时间、COM距离、COM速度、步宽以及COM的内侧和前方位置。
与非冻结步态者相比，冻结步态者的转身时间增加（p = 0.000）。在各群组之间以及冻结步态者的FOG发作前片段与无FOG的类似转身片段之间，转身象限期间的COM距离和速度未发现差异。与对照组相比，PD患者的COM内侧偏差减小（p = 0.004），但冻结步态者与非冻结步态者之间未发现差异。在伴有冻结的转身中，FOG发作前转身时间增加（p = 0.005）且步宽减小（p = 0.025）。与无FOG的转身部分相比，冻结步态者在FOG发作前还表现出COM位置更外侧（p = 0.020）和更靠前（p = 0.016）。
我们的结果显示在不间断转身过程中COM行为无亚组差异。然而，我们发现冻结步态者在FOG发作前内侧偏差减小、COM向前移位以及步宽减小。这些异常情况可能起因果作用，因为它们可能会妨碍转身过程中继续行走所需的稳定性和流畅的体重转移。
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