帕金森病冻结步态患者在转弯时足触地方式的可变性增加。
Increased foot strike variability during turning in Parkinson's disease patients with freezing of gait.
机构信息
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
出版信息
Gait Posture. 2022 Feb;92:321-327. doi: 10.1016/j.gaitpost.2021.12.012. Epub 2021 Dec 10.
BACKGROUND
Turning is a common trigger for freezing episodes in patients with Parkinson's disease (PD). Freezing during turning can lead to falls and fractures and decreased quality of life.
RESEARCH QUESTION
Does foot-strike contact variability also increase during turning, as previously reported in straight gait in PD patients with Freezing of Gait (FOG)?
METHODS
Subjects were instructed to walk on a gait mat, making "normal pivot" (180°) turns at each end. ProtoKinetics Movement Analysis Software (PKMAS) software was used for analysis. Video recordings and foot-pressure-prints were studied to identify and define turn segments. Spatiotemporal gait and turn measures were then determined only for the turn segments. A movement disorders neurologist determined clinical freezes.
RESULTS
100 subjects (28 controls, 38 noFOG and 34 FOG) were included. Compared to non-freezers (noFOG), FOG subjects had a smaller foot-strike during turning (a measure of completeness of foot contact with the mat) and increased foot-strike variability. FOG subjects also had a shorter stride-length, slower stride-velocity, and greater swing phase time and percentage during turns. After adjusting for turn direction, inner/outer leg dynamics showed heavier inner leg footsteps in FOG subjects. 38% of FOG subjects experienced freezes during turning. 69% of freezes occurred during the middle third of the turn. Turn-freezers had more severe spatiotemporal gait deficits.
SIGNIFICANCE
Developing targeted therapies to retrain subjects to plant their whole foot on the ground with more consistency could help decrease episodes of freezing of gait.
背景
转身是帕金森病（PD）患者冻结发作的常见诱因。转身时冻结可导致跌倒和骨折，降低生活质量。
研究问题
在以前报道的 PD 伴冻结步态（FOG）患者直走时，转身过程中足部触地接触的可变性是否也会增加？
方法
要求受试者在步态垫上行走，在每端进行“正常枢轴”（180°）转弯。使用 ProtoKinetics 运动分析软件（PKMAS）进行分析。录像和足底压力印被用来识别和定义转弯段。然后仅对转弯段确定时空步态和转弯测量值。运动障碍神经科医生确定了临床冻结。
结果
纳入了 100 名受试者（28 名对照，38 名无 FOG 和 34 名 FOG）。与非冻结者（无 FOG）相比，FOG 受试者在转弯时足部触地（接触垫的足部完整性的度量）较小，且足部触地的可变性增加。FOG 受试者的步长也较短，步速较慢，转弯时摆动相时间和百分比更大。在调整转弯方向后，内外腿动力学显示 FOG 受试者的内腿脚步更重。38%的 FOG 受试者在转弯时经历了冻结。69%的冻结发生在转弯的中间三分之一。转弯冻结者的时空步态缺陷更严重。
意义
开发针对训练受试者用更一致的方式将整个脚放在地面上的靶向治疗方法可能有助于减少冻结步态发作的次数。
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