Yuri Kwon

Analysis of Viscoelastic Properties of Wrist Joint for Quantification of Parkinsonian Rigidity

This study aims to analyze viscoelastic properties of the wrist in patients with Parkinsons disease (PD) in comparison with the clinical score of severity. Forty-five patients with PD and 12 healthy volunteers participated in this study. Severity of rigidity at the wrist was rated by a neurologist just before the experiment. Wrist joint torque resistive to the imposed movement was measured. Three different models, (identical in structure, only different in the number of parameters for extension and flexion phases) were used in identification of viscoelastic properties: 1) one damping constant and one spring constant throughout all phases, 2) two damping constants for each phase and one spring constant throughout all phases, and 3) two damping constants and two spring constants for each phase. Normalized work and impulse suggested in the literature were also calculated. Spring constants of different models and phases showed comparable correlation with rigidity score ( r=0.68-0.73). In terms of the correlation of damping constant with clinical rigidity score, model 1 ( r = 0.90) was better than models 2 and 3 ( r=0.59 - 0.71). These results suggest that the clinical rigidity score is better represented by the mean viscosity during both flexion and extension. In models with two dampers (model 2 and 3), the damping constant was greater during extension than flexion in patients ( p <; 0.001), in contrast that there was no phase difference in normal subjects. This suggests that in contrast with normal subjects, phase-dependent viscosity may be an inherent feature of PD. Although work and impulse were correlated with clinical rigidity score ( r = 0.11 - 0.84), they could not represent the phase-dependent rigidity inherent in PD. In conclusion, the viscosity of model 1 would be appropriate for quantification of clinical ratings of rigidity and that of model 2 for distinction of PD and also for investigation of phase-dependent characteristics in parkinsonian rigidity.

Age–sex differences in the hip abductor muscle properties

Aim:  Elderly women are reported to have worse postural balance in the mediolateral direction than elderly men, which may be related to hip lateral muscle properties. The purpose of this study was to investigate the effects of sex, age and their interactions on hip abductor muscle properties.

Analysis of lower limb bradykinesia in Parkinson's disease patients.

Aim:  Bradykinesia of the lower limb is an important limiting factor of the quality of life in parkinsonian patients. This study aims to develop quantitative measures of bradykinesia and to investigate the possible dissociation of amplitude and velocity measures and their dependence on movement direction during toe‐tapping.

Quantitative evaluation of parkinsonian rigidity during intra-operative deep brain stimulation

This study aims at the quantification of fine change in parkinsonian rigidity at the wrist during deep brain stimulation (DBS) using a portable measurement system and objective mechanical measures. The rigidity of fourteen limbs was evaluated during DBS surgery. The resistive torque to imposed movement was measured for every setting where a reduction in rigidity was perceived by a neurologist. Quantitative mechanical measures derived from experimental data included viscoelastic properties, work, impulse and mechanical impedance. Most mechanical measures could discriminate the optimal setting from baseline (electrode at stereotactic initial position without electrical stimulation) and the highest significance was achieved by viscous damping constant (p<0.001). Spearman correlation coefficients between mechanical measures and clinical score for multiple settings (averaged for 14 limbs) were 0.51-0.77 and the best correlation was shown for viscosity (ρ=0.77 ± 0.22). The results suggest that intraoperative quantification of rigidity during DBS surgery is possible with the suggested system and measures, which would be helpful for the adjustment of electrode position and stimulation parameters.

Feet distance and static postural balance: Implication on the role of natural stance

The purpose of this study was to investigate 1) the effect of feet distance on static postural balance and 2) the location of natural feet distance and its possible role in the relationship of feet distance and postural balance. Static balance tests were performed on a force platform for 100 s with six different feet distances (0, 5, 10, 15, 20, 25 cm). Measures of postural balance included mean amplitude of horizontal ground reaction force (GRF) as well as the mean distance and velocity of the center of pressure (COP). All measures were discomposed into anterioposterior and mediolateral directions. ANOVA and post-hoc comparison were performed for all measures with feet distance as an independent factor. Also measured was the feet distance at the natural stance preferred by each subject. All measures significantly varied with feet distance (p<0.001). Mean distance of COP showed monotonic decrease with feet distance. Mean amplitude of horizontal GRF as well as mean velocity of COP showed U-shaped pattern (decrease followed by increase) with the minimum at the feet distance of 15 cm or 20 cm, near which the natural feet distance of 16.5 (SD 3.8) cm was located. COP is regarded to be an approximation of the center of mass (hence the resultant performance of postural control) in an inverted pendulum model with the horizontal GRF ignored. On the other hand, horizontal GRF is the direct cause of horizontal acceleration of a center of mass. The present result on horizontal GRF shows that the effort of postural control is minimized around the feet distance of natural standing and implies why the natural stance is preferred.

Age-gender differences in the reaction times of ankle muscles.

Reaction times of the hip abductor were reported to be longer in elderly women than in elderly men, and this was suggested to be related to mediolateral balance performance. The aim of the present study was to investigate the effects of age and gender on the reaction performance of ankle muscles, which have predominant roles in anterioposterior balance control.

A practical method for the detection of freezing of gait in patients with Parkinson’s disease

Purpose Freezing of gait (FOG), increasing the fall risk and limiting the quality of life, is common at the advanced stage of Parkinson’s disease, typically in old ages. A simple and unobtrusive FOG detection system with a small calculation load would make a fast presentation of on-demand cueing possible. The purpose of this study was to find a practical FOG detection system. Patients and methods A sole-mounted sensor system was developed for an unobtrusive measurement of acceleration during gait. Twenty patients with Parkinson’s disease participated in this study. A simple and fast time-domain method for the FOG detection was suggested and compared with the conventional frequency-domain method. The parameters used in the FOG detection were optimized for each patient. Results The calculation load was 1,154 times less in the time-domain method than the conventional method, and the FOG detection performance was comparable between the two domains (P=0.79) and depended on the window length (P<0.01) and dimension of sensor information (P=0.03). Conclusion A minimally constraining sole-mounted sensor system was developed, and the suggested time-domain method showed comparable FOG detection performance to that of the conventional frequency-domain method. Three-dimensional sensor information and 3–4-second window length were desirable. The suggested system is expected to have more practical clinical applications.

Comparison of Reaction Times of Ankle Joint Muscles in the Elderly Men and Women

Abstract: Elderly women are reported to have greater risk of falls. The purpose of this paper was to investigate thepossible gender differences in the reaction performance of ankle joint muscles, which have dominant role in the controlof sagittal plane balance. Twenty-six elderly men and women with comparable mean age participated in this study.Reaction times to the audible beeps were measured in the tibialis anterior muscle and gastrocnemius muscle. Reactiontime variables included premotor time, electromechanical delay and total reaction time. Gender difference in each reac-tion time was investigated by independent t-test. In both muscles, premotor time was longer in men but the elec-tromechanical delay was longer in women (p < 0.05). Resulting total reaction time was longer in men in tibialis anteriormuscle (p < 0.01) and it tended to be longer in men also in gastrocnemius muscle (p = 0.25). The results demonstratesthat the overall reaction performances of elderly women is better than or comparable to those of elderly men in anklejoint muscles. This suggests that the reaction performance of ankle muscles is hardly the cause of the greater riskof falls in elderly women. Key words: Reaction time, Ankle joint, Gender difference, Risk of falls

Age-gender differences in the postural sway during squat and stand-up movement.

Incidence of falling among elderly female has been reported to be much higher than that of elderly male. Although the gender differences in the elderly were reported for the static postural sway, there has been no investigation of the gender difference for the dynamic postural sway. This study investigates how age and gender affect the postural sway during dynamic squat and stand-up movement. 124 subjects (62 subjects for each of young and elderly) performed consecutive squat and stand-up movement, 2 times in one session, and 2 sessions per subject. Center of pressure (COP) was measured using force platform during the test. Outcome measures included peak-to-peak sways of the COP (COP sway) in the sagittal plane (anteroposterior) and frontal plane (mediolateral) and also those normalized by body height. Two-way ANOVA and post-hoc comparisons were performed for the outcome measures with the independent factors of age and gender. All outcome measures, excluding mediolateral COP sway, showed significant interaction of age and gender (p<0.05). Post-hoc test revealed that only female showed increase in COP sway with age. When normalized by height, increase in COP sways (both directions) with age significant only in women resulted in greater sways in elderly female than elderly male. This may be related to the greater fall rate of elderly female than that of elderly men while performing dynamic activities.

Age Difference in the Cephalad Attenuation of Upper Body Accelerations During Fast Speed Walking

Abstract - The purpose of this study was to investigate possible age differences in the attenuation of acceleration in the upper body (from pelvis through shoulder to head) during fast walking. Thirty young and 29 elderly subjects participated in this study. Wireless acceleration sensors were attached on head, shoulder, and pelvis. Subjects performed two trials of fast walking on a treadmill, where the fast speed was defined as 1.5 times of the comfortable speed. Root-mean-squared (RMS) accelerations of each axis were compared with age group and sensor position as independent factors. In the AP direction, the pelvis acceleration was greater in the young and the shoulder-to-head attenuation was also greater in the young (p<0.001), so that the head acceleration was comparable between age groups (p=0.581). In the ML direction, the pelvis acceleration was greater in the young and also the pelvis-to-shoulder attenuation was greater in the young (p<0.001), so that the head acceleration was greater in the elderly group (p<0.001). Insufficient attenuation ML acceleration in the elderly resulting in the greater acceleration in the head may deteriorate the balance control which utilize feedback signals from the sensory organs in head, e.g., vestibular and visual systems. Key Words : Gait speed, Attenuation coefficients, Acceleration, Age†Corresponding Author : Dept. of Research Institute of Biomedical Engineering, Konkuk University, Choonju, 380-701, KoreaE-mail : gmeom@kku.ac.kr* Dept. of Biomedical Engineering, Konkuk Univerity, Choonju, Korea Received : November 3, 2015; Accepted : December 15, 2015