Spildooren Joke, Vercruysse Sarah, Heremans Elke, Galna Brook, Verheyden Geert, Vervoort Griet, Nieuwboer Alice
Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Belgium (S.J., V.S., H.E., V.G., V.G., N.A.); Rehabilitation Sciences and Physiotherapy, Hasselt University, Belgium (S.J.); and Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Newcastle Upon Tyne, United Kingdom (G.B.).
J Neurol Phys Ther. 2017 Apr;41(2):129-135. doi: 10.1097/NPT.0000000000000178.
Individuals with Parkinson disease exhibit decreased axial head-pelvis rotation. Consequently, they turn more en bloc than healthy controls, which may contribute to freezing during turning. We wanted to understand the influence of auditory cueing and an attentional strategy on turning and how this related to freezing of gait (FOG).
Fifteen participants with Parkinson disease and FOG were asked to turn 180° during baseline condition, unilateral cueing, and an attentional strategy prompting to start the turn with head rotation first. FOG occurrence, axial rotation, center of mass (COM) deviation, knee-flexion amplitude, and total turn velocity were measured using 3D motion analysis while off-medication. Normal reference values were obtained from 14 age-matched controls.
Thirty-nine FOG episodes occurred in 5 participants. FOG occurred in 52.8% of baseline trials compared with 34.6% of trials using the head-first strategy, and 3.8% of the auditory cueing trials. During the head first strategy, the initiation of head, trunk, and pelvic rotation as well as the head-pelvis separation resembled turning patterns of healthy controls, but the COM shift to the inside of the turn was exaggerated. By contrast, during cueing, turning became more en bloc, with decreased head-pelvis separation and knee-flexion amplitude.
Cueing reduced FOG but did not correct axial movement deficits. The head-first strategy improved head-pelvis dissociation but had only limited effects on FOG. These results suggest that axial and COM deviation impairments are not directly related to FOG but may rather indicate a compensatory mechanism. Cueing reinforced the en-bloc movement and might as such help prevent FOG by triggering an alternative neural mechanism for movement generation.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A163).
帕金森病患者表现出轴向头盆旋转减少。因此，他们比健康对照者更多地以整体转动，这可能导致转身时冻结现象。我们想了解听觉提示和注意力策略对转身的影响以及这与步态冻结（FOG）的关系。
15名患有帕金森病和步态冻结的参与者被要求在基线状态、单侧提示以及注意力策略（提示先通过头部旋转开始转身）下进行180°转身。在未服药状态下，使用三维运动分析测量步态冻结的发生情况、轴向旋转、重心（COM）偏移、膝关节屈曲幅度和总转身速度。从14名年龄匹配的对照者中获取正常参考值。
5名参与者发生了39次步态冻结事件。在基线试验中，52.8%出现了步态冻结，而在使用头部优先策略的试验中为34.6%，在听觉提示试验中为3.8%。在头部优先策略期间，头部、躯干和骨盆旋转的起始以及头盆分离类似于健康对照者的转身模式，但重心向转身内侧的偏移被夸大。相比之下，在提示期间，转身变得更像整体转动，头盆分离和膝关节屈曲幅度减小。
提示减少了步态冻结，但未纠正轴向运动缺陷。头部优先策略改善了头盆分离，但对步态冻结的影响有限。这些结果表明，轴向和重心偏移障碍与步态冻结没有直接关系，而可能表明一种代偿机制。提示增强了整体运动，可能通过触发替代的运动产生神经机制来帮助预防步态冻结。可查看视频摘要以获取作者更多见解（见视频，补充数字内容1，http://links.lww.com/JNPT/A163）。
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