Valentina Dilda

Attentional set-shifting deficits correlate with the severity of freezing of gait in Parkinson's disease.

Freezing of gait (FOG) is a poorly understood symptom of Parkinson’s disease (PD) during which a patient suffers an abrupt cessation of walking [1]. Whilst little consensus exists regarding the mechanisms underlying FOG [2], there is considerable evidence that additional cognitive demand whilst walking represents a significant trigger in the pathophysiology of FOG [2]. In addition, the severity of self-reported FOG has been correlated with a selective deficit in attentional set-shifting [3]. Taken together, these findings suggest a degree of commonality between corticostriatal networks serving attention and the pathophysiology of FOG. However, no study has directly linked clinical measures of FOG severity during walking with diminished executive function, in particular the ability to rapidly switch between tasks. In this study we hypothesized that impaired behavioral performance on cognitive testing should correlate with objective measures of actual freezing events whilst walking.

Effects of Galvanic vestibular stimulation on cognitive function

Although imaging studies suggest activation of cortical areas by vestibular input, there is little evidence of an adverse effect of non-veridical vestibular input on cognitive function. To test the hypothesis that degraded vestibular afferent input adversely affects cognition, we compared performance on a cognitive test battery in a group undergoing suprathreshold bilateral bipolar Galvanic vestibular stimulation (GVS) with a control group receiving no GVS or subthreshold stimulation. The battery consisted of six cognitive tests as follows: reaction time, dual tasking, Stroop, mental rotation, perspective-taking and matching-to-sample, as well as a simple visuomotor (manual tracking) task. Subjects performed the test battery before, during and after suprathreshold GVS exposure or subthreshold stimulation. Suprathreshold GVS significantly increased error rate for the match-to-sample and perspective-taking tasks relative to the subthreshold group, demonstrating a negative effect of non-veridical vestibular input in these specific cognitive tasks. Reaction time, dual tasking, mental rotation and manual tracking were unaffected by GVS exposure. The adverse effect of suprathreshold GVS on perspective taking but not mental rotation is consistent with imaging studies, which have demonstrated that egocentric mental transformations (perspective taking) occur primarily in cortical areas that receive vestibular input (the parietal–temporal junction and superior parietal lobule), whereas object-based transformations (mental rotation) occur in the frontoparietal region. The increased error rate during the match-to-sample task is likely due to interference with hippocampal processing related to spatial memory, as suggested by imaging studies on vestibular patients.

Validation of 24-hour ambulatory gait assessment in Parkinson's disease with simultaneous video observation

BackgroundParkinsons disease (PD) is a neurodegenerative disorder resulting in motor disturbances that can impact normal gait. Although PD initially responds well to pharmacological treatment, as the disease progresses efficacy often fluctuates over the course of the day, and clinical management would benefit from long-term objective measures of gait. We have previously described a small device worn on the shank that uses acceleration and angular velocity sensors to calculate stride length and identify freezing of gait in PD patients. In this study we extend validation of the gait monitor to 24-h using simultaneous video observation of PD patients.MethodsA sleep laboratory was adapted to perform 24-hr video monitoring of patients while wearing the device. Continuous video monitoring of a sleep lab, hallway, kitchen and conference room was performed using a 4-camera security system and recorded to hard disk. Subjects (3) wore the gait monitor on the left shank (just above the ankle) for a 24-h period beginning around 5 pm in the evening. Accuracy of stride length measures were assessed at the beginning and end of the 24-h epoch. Two independent observers rated the video logs to identify when subjects were walking or lying down.ResultsThe mean error in stride length at the start of recording was 0.05 m (SD 0) and at the conclusion of the 24 h epoch was 0.06 m (SD 0.026). There was full agreement between observer coding of the video logs and the output from the gait monitor software; that is, for every video observation of the subject walking there was a corresponding pulse in the monitor data that indicated gait.ConclusionsThe accuracy of ambulatory stride length measurement was maintained over the 24-h period, and there was 100% agreement between the autonomous detection of locomotion by the gait monitor and video observation.

Central Adaptation to Repeated Galvanic Vestibular Stimulation: Implications for Pre-Flight Astronaut Training

Healthy subjects (N = 10) were exposed to 10-min cumulative pseudorandom bilateral bipolar Galvanic vestibular stimulation (GVS) on a weekly basis for 12 weeks (120 min total exposure). During each trial subjects performed computerized dynamic posturography and eye movements were measured using digital video-oculography. Follow up tests were conducted 6 weeks and 6 months after the 12-week adaptation period. Postural performance was significantly impaired during GVS at first exposure, but recovered to baseline over a period of 7–8 weeks (70–80 min GVS exposure). This postural recovery was maintained 6 months after adaptation. In contrast, the roll vestibulo-ocular reflex response to GVS was not attenuated by repeated exposure. This suggests that GVS adaptation did not occur at the vestibular end-organs or involve changes in low-level (brainstem-mediated) vestibulo-ocular or vestibulo-spinal reflexes. Faced with unreliable vestibular input, the cerebellum reweighted sensory input to emphasize veridical extra-vestibular information, such as somatosensation, vision and visceral stretch receptors, to regain postural function. After a period of recovery subjects exhibited dual adaption and the ability to rapidly switch between the perturbed (GVS) and natural vestibular state for up to 6 months.

Tolerance to extended galvanic vestibular stimulation: optimal exposure for astronaut training.

BACKGROUND We have developed an analogue of postflight sensorimotor dysfunction in astronauts using pseudorandom galvanic vestibular stimulation (GVS). To date there has been no study of the effects of extended GVS on human subjects and our aim was to determine optimal exposure for astronaut training based on tolerance to intermittent and continuous galvanic stimulation. METHODS There were 60 subjects who were exposed to a total of 10.5 min of intermittent GVS at a peak current of 3.5 mA or 5 mA. A subset of 24 subjects who tolerated the intermittent stimulus were subsequently exposed to 20-min continuous stimulation at 3.5 mA or 5 mA. RESULTS During intermittent GVS the large majority of subjects (78.3%) reported no or at most mild motion sickness symptoms, 13.3% reported moderate symptoms, and 8.3% experienced severe nausea and requested termination of the stimulus. During 20-min continuous exposure, 83.3% of subjects reported no or at most mild motion sickness symptoms and 16.7% (all in the 5-mA group) experienced severe nausea. CONCLUSION Based on these results, we propose two basic modes of GVS application to minimize the incidence of motion sickness: intermittent high (5 mA) amplitude, suited to simulation of intensive operator tasks requiring a high-fidelity analogue of postflight sensorimotor dysfunction such as landing or docking maneuvers; and continuous low (3.5 mA) amplitude stimulation, for longer simulation scenarios such as extra vehicular activity. Our results suggest that neither mode of stimulation would induce motion sickness in the large majority of subjects for up to 20 min exposure.

Temporal Characteristics of High-Frequency Lower-Limb Oscillation during Freezing of Gait in Parkinson's Disease.

A cardinal feature of freezing of gait (FOG) is high frequency (3–8 Hz) oscillation of the legs, and this study aimed to quantify the temporal pattern of lower-body motion prior to and during FOG. Acceleration data was obtained from sensors attached to the back, thighs, shanks, and feet in 14 Parkinsons disease patients performing timed-up-and-go tasks, and clinical assessment of FOG was performed by two experienced raters from video. A total of 23 isolated FOG events, defined as occurring at least 5 s after gait initiation and with no preceding FOG, were identified from the clinical ratings. The corresponding accelerometer records were analyzed within a 4 s window centered at the clinical onset of freezing. FOG-related high-frequency oscillation (an increase in power in the 3–8 Hz band >3 SD from baseline) followed a distal to proximal onset pattern, appearing at the feet, shanks, thighs, and then back over a period of 250 ms. Peak power tended to decrease as the focus of oscillation moved from feet to back. There was a consistent delay (mean 872 ms) between the onset of high frequency oscillation at the feet and clinical onset of FOG. We infer that FOG is characterized by high frequency oscillation at the feet, which progresses proximally and is mechanically damped at the torso.

Pre-adaptation to noisy Galvanic vestibular stimulation is associated with enhanced sensorimotor performance in novel vestibular environments

Performance on a visuomotor task in the presence of novel vestibular stimulation was assessed in nine healthy subjects. Four subjects had previously been adapted to 120 min exposure to noisy Galvanic vestibular stimulation (GVS) over 12 weekly sessions of 10 min; the remaining five subjects had never experienced GVS. Subjects were seated in a flight simulator and asked to null the roll motion of a visual bar presented on a screen using a joystick. Both the visual bar and the simulator cabin were moving in roll with a pseudorandom (sum of sines) waveform that were uncorrelated. The cross correlation coefficient, which ranges from 1 (identical waveforms) to 0 (unrelated waveforms), was calculated for the ideal (perfect nulling of bar motion) and actual joystick input waveform for each subject. The cross correlation coefficient for the GVS-adapted group (0.90 [SD 0.04]) was significantly higher (t[8] = 3.162; p = 0.013) than the control group (0.82 [SD 0.04]), suggesting that prior adaptation to GVS was associated with an enhanced ability to perform the visuomotor task in the presence of novel vestibular noise.