Thumm Pablo Cornejo, Maidan Inbal, Brozgol Marina, Shustak Shiran, Gazit Eran, Shema Shiratzki Shirley, Bernad-Elazari Hagar, Beck Yoav, Giladi Nir, Hausdorff Jeffrey M, Mirelman Anat
Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.
Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Gait Posture. 2018 May;62:384-387. doi: 10.1016/j.gaitpost.2018.03.041. Epub 2018 Mar 28.
Among patients with Parkinson's disease (PD), gait is typically disturbed and less automatic. These gait changes are associated with impaired rhythmicity and increased prefrontal activation, presumably in an attempt to compensate for reduced automaticity.
We investigated whether during treadmill walking, when the pace is determined and fixed, prefrontal activation in patients with PD is lower, as compared to over-ground walking.
Twenty patients with PD (age: 69.8 ± 6.5 yrs.; MoCA: 26.9 ± 2.4; disease duration: 7.9 ± 4.2 yrs) walked at a self-selected walking speed over-ground and on a treadmill. A wireless functional near infrared spectroscopy (fNIRS) system measured prefrontal lobe activation, i.e., oxygenated hemoglobin (Hb02) in the pre-frontal area. Gait was evaluated using 3D-accelerometers attached to the lower back and ankles (Opal™, APDM). Dynamic gait stability was assessed using the maximum Lyapunov exponent to investigate automaticity of the walking pattern.
Hb02 was lower during treadmill walking than during over-ground walking (p = 0.001). Gait stability was greater on the treadmill, compared to over-ground walking, in both the anteroposterior and medio-lateral axes (p < 0.001).
These findings support the notion that when gait is externally paced, prefrontal lobe activation is reduced in patients with PD, perhaps reflecting a reduced need for compensatory cognitive mechanisms.
在帕金森病（PD）患者中，步态通常会受到干扰且自动化程度降低。这些步态变化与节律受损和前额叶激活增加有关，推测这是为了补偿自动化程度的降低。
我们研究了在跑步机上行走时，当步速被确定并固定时，与地面行走相比，PD患者的前额叶激活是否更低。
20名PD患者（年龄：69.8±6.5岁；蒙特利尔认知评估量表[MoCA]：26.9±2.4；病程：7.9±4.2年）以自选速度在地面和跑步机上行走。一个无线功能近红外光谱（fNIRS）系统测量前额叶激活，即前额叶区域的氧合血红蛋白（Hb02）。使用连接到下背部和脚踝的3D加速度计（Opal™，APDM）评估步态。使用最大Lyapunov指数评估动态步态稳定性，以研究行走模式的自动化程度。
与地面行走相比，跑步机行走期间Hb02更低（p = 0.001）。与地面行走相比，跑步机上在前后轴和内外侧轴上的步态稳定性更高（p < 0.001）。
这些发现支持了这样一种观点，即当步态由外部设定步速时，PD患者的前额叶激活会降低，这可能反映出对代偿性认知机制的需求减少。
