Barbieri Fabio Augusto, Polastri Paula Favaro, Gobbi Lilian Teresa Bucken, Simieli Lucas, Pereira Vinicius Ignácio Alota, Baptista André Macari, Moretto Gabriel Felipe, Fiorelli Carolina Menezes, Imaizumi Luis Felipe Itikawa, Rodrigues Sérgio Tosi
São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil.
São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil.
Behav Brain Res. 2018 Jul 2;346:105-114. doi: 10.1016/j.bbr.2017.11.032. Epub 2017 Nov 24.
The mechanisms that contribute to gait asymmetry in people with Parkinson's disease (PD) are unclear, mainly during gait with greater environmental demand, such as when an obstacle is circumvented while walking.
The aim of this study was to investigate the effects of obstacle circumvention of the least and most affected side on motor and gaze behavior in people with PD under/without the effects of dopaminergic medication.
Fifteen people with PD and 15 matched-control individuals were instructed to walk along a pathway, at a self-selected velocity, and to circumvent an obstacle, avoiding contact with it. Each participant performed five trials for each side. Kinematic parameters, mediolateral and horizontal body clearance to the obstacle, strategy to circumvent the obstacle, and gaze behavior were calculated. Parameters were grouped according to the side that the obstacle was circumvented and compared by three-way ANOVAs.
Both people with PD and the control group presented asymmetry to circumvent an obstacle during walking, however this was exacerbated in people with PD. Individuals with PD presented safe strategies (largest mediolateral and horizontal body clearance to the obstacle, "lead-out" strategy, and higher number and time of fixations on the obstacle) during obstacle circumvention for the least affected side compared to the most affected side. In addition, positive effects of dopaminergic medication on body clearance, spatial-temporal parameters, and gaze behavior were evidenced only when the obstacle was circumvented to the least affected side.
The obstacle circumvention to the most affected side is risky for people with PD.
帕金森病（PD）患者步态不对称的机制尚不清楚，尤其是在对环境要求较高的步态中，比如行走时绕过障碍物。
本研究旨在调查在有无多巴胺能药物作用的情况下，PD患者绕过障碍物时，受影响最小侧和受影响最大侧绕过障碍物对运动和注视行为的影响。
15名PD患者和15名匹配的对照个体被要求以自选速度沿路径行走，并绕过一个障碍物，避免与之接触。每个参与者每侧进行5次试验。计算运动学参数、身体与障碍物的内外侧和水平间隙、绕过障碍物的策略以及注视行为。参数根据绕过障碍物的一侧进行分组，并通过三因素方差分析进行比较。
PD患者和对照组在行走时绕过障碍物均表现出不对称性，但PD患者更为明显。与受影响最大侧相比，PD患者在绕过受影响最小侧障碍物时采用了安全策略（身体与障碍物的最大内外侧和水平间隙、“引出”策略以及对障碍物的注视次数和时间更多）。此外，仅在绕过受影响最小侧障碍物时，才证明多巴胺能药物对身体间隙、时空参数和注视行为有积极影响。
对于PD患者，绕过受影响最大侧的障碍物存在风险。
