Patera M, Zampogna A, Pietrosanti L, Asci F, Falletti M, Pinola G, Bianchini E, Di Lazzaro G, Rosati V, Grillo P, Giannini F, Fattapposta F, Costantini G, Pisani A, Saggio G, Suppa Antonio
Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
IRCCS Neuromed, Pozzilli (IS), Italy.
J Neuroeng Rehabil. 2025 Mar 4;22(1):47. doi: 10.1186/s12984-025-01589-w.
Reduced arm swing movements during gait are an early motor manifestation of Parkinson's disease (PD). The clinical evolution, response to L-Dopa and pathophysiological underpinning of abnormal arm swing movements in PD remain largely unclear. By using a network of wearable sensors, this study objectively assesses arm swing movements during gait in PD patients across different disease stages and therapeutic conditions.
Twenty healthy subjects (HS) and 40 PD patients, including 20 early-stage and 20 mid-advanced subjects, underwent a 6-m Timed Up and Go test while monitored through a network of wearable inertial sensors. Arm swing movements were objectively evaluated in both hemibodies and different upper limb joints (shoulder and elbow), using specific time-domain (range of motion and velocity) and frequency-domain measures (harmonics and total harmonic distortion). To assess the effects of L-Dopa, patients under chronic dopaminergic therapy were randomly examined when OFF and ON therapy. Finally, clinical-behavioral correlations were investigated, primarily focusing on the relationship between arm swing movements and cardinal L-Dopa-responsive motor signs, including bradykinesia and rigidity.
Compared to HS, the whole group of PD patients showed reduced range of motion and velocity, alongside increased asymmetry of arm swing movements during gait. Additionally, a distinct increase in total harmonic distortion was found in patients. The kinematic changes were prominent in the early stage of the disease and progressively worsened owing to the involvement of the less affected hemibody. The time- and frequency-domain abnormalities were comparable in the two joints (i.e., shoulder and elbow). In the subgroup of patients under chronic dopaminergic treatment, L-Dopa restored patterns of arm swing movements. Finally, the kinematic alterations in arm swing movements during gait correlated with the clinical severity of bradykinesia and rigidity.
Arm swing movements during gait in PD are characterized by narrow, slow, and irregular patterns. As the disease progresses, arm swing movements deteriorate also in the less affected hemibody, without any joint specificity. The positive response to L-Dopa along with the significant correlation between kinematics and bradykinesia/rigidity scores points to the involvement of dopaminergic pathways in the pathophysiology of abnormal arm swing movements in PD.
步态中手臂摆动减少是帕金森病（PD）的早期运动表现。帕金森病中异常手臂摆动的临床演变、对左旋多巴的反应以及病理生理学基础仍不清楚。本研究通过使用可穿戴传感器网络，客观评估不同疾病阶段和治疗条件下帕金森病患者步态中的手臂摆动。
20名健康受试者（HS）和40名帕金森病患者，包括20名早期患者和20名中晚期患者，在通过可穿戴惯性传感器网络监测的情况下，进行了6米计时起立行走测试。使用特定的时域（运动范围和速度）和频域测量（谐波和总谐波失真），对双上肢和不同上肢关节（肩部和肘部）的手臂摆动进行客观评估。为了评估左旋多巴的效果，对接受慢性多巴胺能治疗的患者在停药和服药时进行随机检查。最后，研究临床行为相关性，主要关注手臂摆动与主要的左旋多巴反应性运动体征（包括运动迟缓及僵硬）之间的关系。
与健康受试者相比，帕金森病患者整体在步态中表现出运动范围和速度降低，同时手臂摆动的不对称性增加。此外，患者的总谐波失真明显增加。运动学变化在疾病早期较为突出，且由于未受影响较轻的半侧身体受累而逐渐恶化。两个关节（即肩部和肘部）的时域和频域异常情况相当。在接受慢性多巴胺能治疗的患者亚组中，左旋多巴恢复了手臂摆动模式。最后，步态中手臂摆动的运动学改变与运动迟缓及僵硬的临床严重程度相关。
帕金森病患者步态中的手臂摆动特点是幅度小、速度慢且不规则。随着疾病进展，未受影响较轻的半侧身体的手臂摆动也会恶化，且无关节特异性。对左旋多巴的阳性反应以及运动学与运动迟缓/僵硬评分之间的显著相关性表明多巴胺能通路参与了帕金森病异常手臂摆动的病理生理学过程。
