Carolina de Oliveira Souza

Listenmee and Listenmee smartphone application: synchronizing walking to rhythmic auditory cues to improve gait in Parkinson's disease.

Evidence supports the use of rhythmic external auditory signals to improve gait in PD patients (Arias & Cudeiro, 2008; Kenyon & Thaut, 2000; McIntosh, Rice & Thaut, 1994; McIntosh et al., 1997; Morris, Iansek, & Matyas, 1994; Thaut, McIntosh, & Rice, 1997; Suteerawattananon, Morris, Etnyre, Jankovic, & Protas , 2004; Willems, Nieuwboer, Chavert, & Desloovere, 2006). However, few prototypes are available for daily use, and to our knowledge, none utilize a smartphone application allowing individualized sounds and cadence. Therefore, we analyzed the effects on gait of Listenmee®, an intelligent glasses system with a portable auditory device, and present its smartphone application, the Listenmee app®, offering over 100 different sounds and an adjustable metronome to individualize the cueing rate as well as its smartwatch with accelerometer to detect magnitude and direction of the proper acceleration, track calorie count, sleep patterns, steps count and daily distances. The present study included patients with idiopathic PD presented gait disturbances including freezing. Auditory rhythmic cues were delivered through Listenmee®. Performance was analyzed in a motion and gait analysis laboratory. The results revealed significant improvements in gait performance over three major dependent variables: walking speed in 38.1%, cadence in 28.1% and stride length in 44.5%. Our findings suggest that auditory cueing through Listenmee® may significantly enhance gait performance. Further studies are needed to elucidate the potential role and maximize the benefits of these portable devices.

Influence of Educational Status on Executive Function and Functional Balance in Individuals with Parkinson Disease

Objective:This study investigated whether educational status influenced how people with Parkinson disease (PD) performed on Parts A, B, and DELTA of the Trail Making Test (TMT) and on the Berg Balance Scale (BBS). Background:Recent studies have shown that educational status may influence cognitive and motor test performance. Methods:We gave the TMT and the BBS to assess executive function and functional balance in 28 people with PD (Hoehn and Yahr score between 2 and 3) and 30 healthy elderly people. Participants reported their number of years of formal education. We divided each group of participants by educational status: low (4 to 10 years of education) or high (≥11 years). Results:In both the PD (P=0.018) and control (P=0.003) groups, participants with low educational status performed worse on the TMT Part B than did those with high educational status. Within the PD group, the less-educated participants scored worse on the BBS than did the more educated (P<0.001); this difference was not significant between the more- and less-educated controls (P=0.976). Conclusions:Whether or not they had PD, less-educated people performed worse than more-educated people on the TMT Part B. Educational status affected executive function, but PD status did not. Among individuals with PD, educational status influenced functional balance.

Spinal cord stimulation improves gait in patients with Parkinson's disease previously treated with deep brain stimulation

Deep brain stimulation and levodopatherapy ameliorate motor manifestations in Parkinsons disease, but their effects on axial signs are not sustained in the long term.

The competition with a concurrent cognitive task affects posturographic measures in patients with Parkinson disease

OBJECTIVES To estimate the impact of a sensory-motor- cognitive task on postural balance, in Parkinson disease patients (Hoehn and Yahr 2-3) and to investigate possible relationships between posturography and functional balance clinical scales. METHOD Parkinson disease patients (n = 40) and healthy controls (n = 27) were evaluated with fluency tests, Berg Balance scale, Mini Best test and static posturography on the conditions eyes open, eyes closed and dual-task (simultaneous balance and fluency tasks). RESULTS Posturographic data showed that Parkinson disease patients performed worse than controls in all evaluations. In general, balance on dual-task was significantly poorer than balance with eyes closed. Posturographic data were weakly correlated to clinical balance scales. CONCLUSION In clinical practice, Parkinson disease patients are commonly assessed with eyes closed, to sensitize balance. Our study showed that adding a cognitive task is even more effective. Static posturographic data should be carefully overgeneralized to infer functional balance impairments.

An fMRI-compatible force measurement system for the evaluation of the neural correlates of step initiation

Knowledge of brain correlates of postural control is limited by the technical difficulties in performing controlled experiments with currently available neuroimaging methods. Here we present a system that allows the measurement of anticipatory postural adjustment of human legs to be synchronized with the acquisition of functional magnetic resonance imaging data. The device is composed of Magnetic Resonance Imaging (MRI) compatible force sensors able to measure the level of force applied by both feet. We tested the device in a group of healthy young subjects and a group of elderly subjects with Parkinson’s disease using an event-related functional MRI (fMRI) experiment design. In both groups the postural behavior inside the magnetic resonance was correlated to the behavior during gait initiation outside the scanner. The system did not produce noticeable imaging artifacts in the data. Healthy young people showed brain activation patterns coherent with movement planning. Parkinson’s disease patients demonstrated an altered pattern of activation within the motor circuitry. We concluded that this force measurement system is able to index both normal and abnormal preparation for gait initiation within an fMRI experiment.

Gait, posture and cognition in Parkinson's disease

Gait disorders and postural instability are the leading causes of falls and disability in Parkinsons disease (PD). Cognition plays an important role in postural control and may interfere with gait and posture assessment and treatment. It is important to recognize gait, posture and balance dysfunctions by choosing proper assessment tools for PD. Patients at higher risk of falling must be referred for rehabilitation as early as possible, because antiparkinsonian drugs and surgery do not improve gait and posture in PD.

Combined auditory and visual cueing provided by eyeglasses influence gait performance in Parkinson Disease patients submitted to deep brain stimulation: a pilot study

Background: Auditory-visual cueing using portable cueing devices has been effective for gait training in rehabilitation programs with Parkinson patients. However, it is possible that some gait problems arise due to interference from chronic high frequency stimulation with the gait and balance neural networks in patients with Parkinson Disease. Thus, it should be useful to test whether advanced Parkinson Disease patients experiencing gait problems (despite the treatment with medication and high frequency deep brain stimulation) would benefit from therapy using cueing. Methods: Eyeglasses combining auditory-visual cueing were used with 18 patients with advanced Parkinson Disease and treated with medication and deep brain stimulation. Patients were assessed using the Dynamic Gait Index, Timed Up and Go and Six-Minute Walking Test and performance was measured with and without the cueing (with and without eyeglasses on). Results: One way ANOVA on the performance measures indicated that Dynamic Gait Index and Six-Minute Walking Test significantly improved in the cued condition. Since cueing was task specific, and Timed Up and Go includes subtasks such sitting and standing, the combined auditory-visual cueing did not improve performance on such tasks. Conversely, the combined cueing may have worked as distractors during these subtasks. Conclusion: Combined auditory-visual cueing provided by this wearable technology may have practical applicability in rehabilitation therapy. It provided additional benefits on gait in patients with advanced Parkinson Disease with deep brain stimulation in the subthalamic nucleus.

Effects of modified Restricted Environmental Stimulation Therapy on relaxation, heart rate, blood pressure and flexibility

Background : Restricted Environmental Stimulation Therapy (REST) promotes physiological and behavioral changes that reduce the deleterious effects of stress. However, it requires expensive equipment and is accessible to a limited number of professionals and patients. We aimed to evaluate the physiological and behavioral effects of modified REST (mREST) in healthy young women. Method: Twenty-one healthy young women (20-25 yrs) participated. mREST consists of positioning the patient floating in the pool with 32 o C for about 15 minutes, for twelve sessions, with blindfolded and wearing earplugs. The evaluation was performed before and after the intervention. The analysis of the state of relaxation was investigated by a questionnaire and the self-reports were categorized. Measures of heart rate and blood pressure were used as indicators of the cardiovascular response. Flexibility, measured by the finger-to-floor test, was used as an indicator of muscle relaxation. Results : Heart rate and blood pressure significantly decreased while flexibility and relaxation increased after the sessions (p<0.001 for all comparisons). Self-reports of relaxation were consistent with the blood pressure measures and indicated that the participants showed states of relaxation associated with the decrease of blood pressure and the increase of flexibility (p<0.001 for all comparisons). Conclusion : Healthy women undergoing mREST reported relaxation, with effects on muscular and cardiovascular systems. mREST is a simple, practical and affordable option for therapy in the aquatic environment.

Effects of spinal cord stimulation on postural control in Parkinson's disease patients with freezing of gait

Freezing of gait (FoG) in Parkinson’s disease (PD) is an incapacitating transient phenomenon, followed by continuous postural disorders. Spinal cord stimulation (SCS) is a promising intervention for FoG in patients with PD, however, its effects on distinct domains of postural control is not well known. The aim of this study is to assess the effects of SCS on FoG and distinct domains of postural control. Four patients with FoG were implanted with SCS systems in the upper thoracic spine. Anticipatory postural adjustment (APA), reactive postural responses, gait and FoG were biomechanically assessed. In general, the results showed that SCS improved FoG and APA. However, SCS failed to improve reactive postural responses. SCS seems to influence cortical motor circuits, involving the supplementary motor area. On the other hand, reactive posture control to external perturbation that mainly relies on neuronal circuitries involving the brainstem and spinal cord, is less influenced by SCS.

Relationship Between Posturography, Clinical Balance and Executive Function in Parkinson´s Disease

ABSTRACT This study aimed to evaluate the relationship between posturography, clinical balance, and executive function tests in Parkinson´s disease (PD). Seventy-one people participated in the study. Static posturography evaluated the center of pressure fluctuations in quiet standing and dynamic posturography assessed sit-to-stand, tandem walk, and step over an obstacle. Functional balance was evaluated by Berg Balance Scale, MiniBESTest, and Timed Up and Go test. Executive function was assessed by Trail Making Test (TMT) and semantic verbal fluency test. Step over obstacle measures (percentage of body weight transfer and movement time) were moderately correlated to Timed Up and Go, part B of TMT and semantic verbal fluency (r > 0.40; p < 0.05 in all relationships). Stepping over an obstacle assesses the responses to internal perturbations. Participants with shorter movement times and higher percentage of body weight transfer (higher lift up index) on this task were also faster in Timed Up and Go, part B of TMT, and semantic verbal fluency. All these tasks require executive function (problem solving, sequencing, shifting attention), which is affected by PD and contribute to postural assessment.