Palmisano Chiara, Beccaria Laura, Haufe Stefan, Volkmann Jens, Pezzoli Gianni, Isaias Ioannis U
Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany.
Uncertainty, Inverse Modeling and Machine Learning Group, Faculty IV Electrical Engineering and Computer Science, Technical University of Berlin, 10623 Berlin, Germany.
Bioengineering (Basel). 2022 Nov 2;9(11):639. doi: 10.3390/bioengineering9110639.
Freezing of gait (FOG) is a sudden episodic inability to produce effective stepping despite the intention to walk. It typically occurs during gait initiation (GI) or modulation and may lead to falls. We studied the anticipatory postural adjustments (imbalance, unloading, and stepping phase) at GI in 23 patients with Parkinson's disease (PD) and FOG (PDF), 20 patients with PD and no previous history of FOG (PDNF), and 23 healthy controls (HCs). Patients performed the task when off dopaminergic medications. The center of pressure (CoP) displacement and velocity during imbalance showed significant impairment in both PDNF and PDF, more prominent in the latter patients. Several measurements were specifically impaired in PDF patients, especially the CoP displacement along the anteroposterior axis during unloading. The pattern of segmental center of mass (SCoM) movements did not show differences between groups. The standing postural profile preceding GI did not correlate with outcome measurements. We have shown impaired motor programming at GI in Parkinsonian patients. The more prominent deterioration of unloading in PDF patients might suggest impaired processing and integration of somatosensory information subserving GI. The unaltered temporal movement sequencing of SCoM might indicate some compensatory cerebellar mechanisms triggering time-locked models of body mechanics in PD.
冻结步态（FOG）是一种尽管有行走意图但突然发作的无法产生有效步幅的情况。它通常发生在步态起始（GI）或调节过程中，可能导致跌倒。我们研究了23例帕金森病（PD）合并冻结步态（PDF）患者、20例无冻结步态既往史的PD患者（PDNF）和23名健康对照者（HCs）在GI时的预期姿势调整（失衡、卸载和步幅阶段）。患者在停用多巴胺能药物时执行该任务。失衡期间的压力中心（CoP）位移和速度在PDNF和PDF患者中均显示出显著受损，在后者中更为突出。PDF患者的几项测量指标尤其受损，特别是卸载期间沿前后轴的CoP位移。节段质心（SCoM）运动模式在各组之间未显示出差异。GI之前的站立姿势概况与结果测量指标无关。我们已经证明帕金森病患者在GI时存在运动编程受损。PDF患者卸载功能更明显的恶化可能表明服务于GI的体感信息的处理和整合受损。SCoM未改变的时间运动序列可能表明一些补偿性小脑机制触发了PD中身体力学的时间锁定模型。
