Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Clin Neurol Neurosurg. 2020 Oct;197:106083. doi: 10.1016/j.clineuro.2020.106083. Epub 2020 Jul 10.
The symptoms of Parkinson's disease (PD) in many circumstances lead to gait dysfunction which contribute to decreased mobility, reduced quality of life, and increased risk of falling. Dual-task conditions have been shown to amplify gait dysfunction from a spatiotemporal parameter standpoint; however, less is known regarding gait joint kinematics under dual-task conditions in PD, specifically across multiple cognitive domains. The purpose of this project was to systematically characterize lower extremity joint kinematics in individuals with mild-moderate PD under dual-task paradigms across multiple cognitive domains.
Twenty-three individuals with idiopathic Parkinson's disease participated in this observational study evaluating hip, knee, and ankle joint kinematics while walking on a self-paced treadmill under dual-task conditions that taxed memory, attention, verbal fluency, and information processing.
Gait velocity and range of motion at the ankle, knee, and hip decreased (p < 0.05) under all of the dual-task conditions. Hip kinematics were affected to a greater extent than the ankle and knee, with reduction in flexion and extension during all timestamps of the gait cycle (p < 0.05) under all dual-task conditions.
The worsening of gait kinematics under dual-task conditions regardless of the aspect of cognition being challenged suggest that information processing and motor output are unable to withstand dual-task loads without consequence. These study results provide insight for target areas to focus on during therapeutic interventions in order to help minimize gait kinematic decrements observed under dual-task conditions.
帕金森病（PD）的许多症状导致步态功能障碍，从而降低了活动能力、降低了生活质量并增加了跌倒的风险。双任务条件已被证明从时空参数的角度放大了步态功能障碍；然而，在 PD 中，双任务条件下的步态关节运动学知之甚少，特别是在多个认知领域。本项目的目的是系统地描述在多个认知领域的双任务范式下，轻度至中度 PD 个体的下肢关节运动学。
23 名特发性帕金森病患者参与了这项观察性研究，评估了在记忆、注意力、言语流畅性和信息处理等方面受到双重任务影响的自我 paced 跑步机上行走时的脚踝、膝盖和髋关节运动学。
在所有双任务条件下，步态速度和脚踝、膝盖和臀部的运动范围都减小（p<0.05）。髋关节运动学受到的影响大于脚踝和膝盖，在所有双任务条件下，在步态周期的所有时间标记处，髋关节的屈曲和伸展都减少（p<0.05）。
无论认知的哪个方面受到挑战，双任务条件下步态运动学的恶化都表明，信息处理和运动输出在没有后果的情况下无法承受双重任务负荷。这些研究结果为治疗干预中需要关注的目标区域提供了见解，以帮助最大限度地减少在双任务条件下观察到的步态运动学的下降。
