帕金森病伴或不伴多巴胺能药物治疗的关节间协调性：一项病例对照研究。
Inter-joint coordination with and without dopaminergic medication in Parkinson's disease: a case-control study.
机构信息
Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Kiel University, Arnold-Heller Str. 3, Kiel, 24105, Germany.
Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria.
出版信息
J Neuroeng Rehabil. 2024 Jul 13;21(1):118. doi: 10.1186/s12984-024-01416-8.
BACKGROUND
How the joints exactly move and interact and how this reflects PD-related gait abnormalities and the response to dopaminergic treatment is poorly understood. A detailed understanding of these kinematics can inform clinical management and treatment decisions. The aim of the study was to investigate the influence of different gait speeds and medication on/off conditions on inter-joint coordination, as well as kinematic differences throughout the whole gait cycle in well characterized pwPD.
METHODS
29 controls and 29 PD patients during medication on, 8 of them also during medication off walked a straight walking path in slow, preferred and fast walking speeds. Gait data was collected using optical motion capture system. Kinematics of the hip and knee and coordinated hip-knee kinematics were evaluated using Statistical Parametric Mapping (SPM) and cyclograms (angle-angle plots). Values derived from cyclograms were compared using repeated-measures ANOVA for within group, and ttest for between group comparisons.
RESULTS
PD gait differed from controls mainly by lower knee range of motion (ROM). Adaptation to gait speed in PD was mainly achieved by increasing hip ROM. Regularity of gait was worse in PD but only during preferred speed. The ratios of different speed cyclograms were smaller in the PD groups. SPM analyses revealed that PD participants had smaller hip and knee angles during the swing phase, and PD participants reached peak hip flexion later than controls. Withdrawal of medication showed an exacerbation of only a few parameters.
CONCLUSIONS
Our findings demonstrate the potential of granular kinematic analyses, including > 1 joint, for disease and treatment monitoring in PD. Our approach can be extended to further mobility-limiting conditions and other joint combinations.
TRIAL REGISTRATION
The study is registered in the German Clinical Trials Register (DRKS00022998, registered on 04 Sep 2020).
背景
关节的具体运动方式及其相互作用方式，以及这如何反映与帕金森病相关的步态异常和对多巴胺能治疗的反应，目前仍知之甚少。对这些运动学的详细了解可以为临床管理和治疗决策提供信息。本研究旨在调查不同步行速度和药物开/关状态对关节间协调性的影响，以及在特征明确的帕金森病患者整个步态周期中的运动学差异。
方法
29 名对照者和 29 名药物开期帕金森病患者（其中 8 名也在药物关期）在慢、快和快三种步行速度下沿着直线行走路径行走。使用光学运动捕捉系统采集步态数据。使用统计参数映射（SPM）和循环图（角度-角度图）评估髋关节和膝关节的运动学以及髋关节-膝关节的协调运动学。使用重复测量方差分析进行组内比较，使用 t 检验进行组间比较，比较循环图得出的数值。
结果
帕金森病步态与对照组的主要区别在于膝关节活动度（ROM）较低。帕金森病患者适应步行速度的主要方式是增加髋关节 ROM。帕金森病患者的步态规律性较差，但仅在中速时如此。PD 组不同速度循环图的比值较小。SPM 分析显示，PD 患者在摆动相时髋关节和膝关节角度较小，且 PD 患者的髋关节屈曲峰值出现时间晚于对照组。停药后仅少数参数恶化。
结论
我们的研究结果表明，包括超过一个关节的精细运动学分析在帕金森病的疾病和治疗监测中具有潜力。我们的方法可以扩展到其他运动受限的疾病和其他关节组合。
试验注册
该研究在德国临床试验注册中心（DRKS00022998）注册，注册日期为 2020 年 9 月 4 日。
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