使用可穿戴传感器评估有和无冻结步态的帕金森病患者的稳定性和站立平衡功能极限。
Functional limits of stability and standing balance in people with Parkinson's disease with and without freezing of gait using wearable sensors.
机构信息
Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Rehabilitation Science, Hokkaido University, Sapporo, Hokkaido, Japan.
Department of Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
出版信息
Gait Posture. 2021 Jun;87:123-129. doi: 10.1016/j.gaitpost.2021.04.023. Epub 2021 Apr 19.
BACKGROUND
People with from Parkinson's disease (PD) and freezing of gait (FoG) have more frequent falls compared to those who do not freeze but there is no consensus on which, specific objective measures of postural instability are worse in freezers (PD + FoG) than non-freezers (PD-FoG).
RESEARCH QUESTION
Are functional limits of stability (fLoS) or postural sway during stance measured with wearable inertial sensors different between PD + FoG versus PD-FoG, as well as between PD versus healthy control subjects (HC)?
METHODS
Sixty-four PD subjects with FoG (MDS-UPDRS Part III: 45.9 ± 12.5) and 80 PD subjects without FoG (MDS-UPDRS Part III: 36.2 ± 10.9) were tested Off medication and compared with 79 HC. Balance was quantified with inertial sensors worn on the lumbar spine while performing the following balance tasks: 1) fLoS as defined by the maximum displacement in the forward and backward directions and 2) postural sway area while standing with eyes open on a firm and foam surface. An ANOVA, controlling for disease duration, compared postural control between groups.
RESULTS
PD + FoG had significantly smaller fLoS compared to PD-FoG (p = 0.004) and to healthy controls (p < 0.001). However, PD-FoG showed similar fLoS compared to healthy controls (p = 0.48). Both PD+FoG and PD-FoG showed larger postural sway on a foam surface compared to healthy controls (p = 0.001) but there was no significant difference in postural sway between PD+FoG and PD-FoG.
SIGNIFICANCE
People with PD and FoG showed task-specific, postural impairments with smaller fLoS compared to non-freezers, even when controlling for disease duration. However, individuals with PD with or without FoG had similar difficulties standing quietly on an unreliable surface compared to healthy controls. Wearable inertial sensors can reveal worse fLoS in freezers than non-freezers that may contribute to FoG and help explain their more frequent falls.
背景
与不冻结的帕金森病（PD）和冻结步态（FoG）患者相比，冻结步态的患者更容易跌倒，但对于冻结者（PD+FoG）与非冻结者（PD-FoG）相比，哪种特定的姿势不稳定的客观测量指标更差，尚无共识。
研究问题
在 PD+FoG 与 PD-FoG 以及 PD 与健康对照组（HC）之间，使用可穿戴惯性传感器测量的功能稳定性极限（fLoS）或站立时的姿势摆动是否不同？
方法
对 64 名患有 FoG 的 PD 患者（MDS-UPDRS 第三部分：45.9±12.5）和 80 名无 FoG 的 PD 患者（MDS-UPDRS 第三部分：36.2±10.9）进行测试，并在药物治疗下进行测试，然后与 79 名 HC 进行比较。使用佩戴在腰椎上的惯性传感器来量化平衡，同时进行以下平衡任务：1）定义为向前和向后最大位移的 fLoS，2）在坚固和泡沫表面上睁眼站立时的姿势摆动面积。使用方差分析（ANOVA），控制疾病持续时间，对组间姿势控制进行比较。
结果
与 PD-FoG（p=0.004）和健康对照组（p<0.001）相比，PD+FoG 的 fLoS 明显更小。但是，PD-FoG 与健康对照组的 fLoS 相似（p=0.48）。与健康对照组相比，PD+FoG 和 PD-FoG 在泡沫表面上的姿势摆动都更大（p=0.001），但 PD+FoG 和 PD-FoG 之间的姿势摆动没有差异。
意义
与非冻结者相比，患有 PD 和 FoG 的人表现出特定任务的姿势障碍，fLoS 更小，即使控制了疾病持续时间。然而，患有 PD 且有或没有 FoG 的人在不稳定的表面上安静站立的能力与健康对照组相似。可穿戴惯性传感器可以揭示冻结者比非冻结者的 fLoS 更差，这可能导致 FoG，并有助于解释他们更频繁的跌倒。
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