Abstract
Objective
To assess the effects of automated peripheral stimulation (AMPS) in reducing gait
variability of subjects with Parkinson disease (PD) and freezing of gait (FOG) treated
with AMPS and to explore the effects of this treatment on gait during a single task
(walking) and a dual task (walking while attending the word-color Stroop test).
Design
Interventional, double-blinded, placebo-controlled, randomized trial.
Setting
Clinical rehabilitation.
Participants
Thirty subjects were randomized into 2 groups: AMPS (n=15) and AMPS sham (n=15).
Interventions
Both groups received 2 treatment sessions a week for 4 consecutive weeks (totaling
8 treatment sessions). AMPS was applied by using a medical device (Gondola™) and consisted
in mechanical pressure stimulations delivered by metallic actuators on 4 areas of
the feet. Treatment parameters and device configuration were modified for AMPS sham
group.
Main Outcome Measures
Gait analyses were measured at baseline and after the first, fourth, and eighth treatment
sessions.
Results
Interactions among groups and sessions were found for both conditions while off anti-Parkinsonian
medications. AMPS decreased gait variability in subjects with PD and FOG for both
single and dual task conditions.
Conclusions
AMPS is an effective add-on therapy for treating gait variability in patients with
PD and FOG.
Keywords
List of abbreviations:
AMPS (automated peripheral stimulation), FOG (freezing of gait), FOG-Q (Freezing of Gait Questionnaire), H&Y (Hoehn & Yahr Scale), MMSE (Mini Mental State Examination), PD (Parkinson disease)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson’s disease and Huntington’s disease.Mov Disord. 1998; 13: 428-437
- Age-related differences in spatiotemporal markers of gait stability during dual task walking.Gait Posture. 2007; 26: 113-119
- Gait changes in older adults: predictors of falls or indictors of fear.J Am Geriatr Soc. 1997; 45: 313-320
- Relationship between falls and stride length variability in senile dementia of the Alzheimer type.Gerontology. 1996; 42: 108-113
- Increased gait unsteadiness in community-dwelling elderly fallers.Arch Phys Med Rehabil. 1997; 78: 278-283
- Etiology and modification of gait instability in older adults: a randomized controlled trial of exercise.J Appl Physiol. 2001; 90: 2117-2129
- Gait variability and fall risk in community-living older adults: a 1-year prospective study.Arch Phys Med Rehabil. 2001; 82: 1050-1056
- Assessment of dual tasking has no clinical value for fall prediction in Parkinson’s disease.J Neurol. 2012; 259: 1840-1847
- Pathophysiology of somatosensory abnormalities in Parkinson disease.Nat Rev Neurol. 2013; 9: 687-697
- Textured and stimulating insoles for balance and gait impairments in patients with multiple sclerosis and Parkinson’s disease: a systematic review and meta-analysis.Gait Posture. 2017; 51: 132-141
- Literature review of vibrotactile systems addressing freezing of gait in Parkinsonians.in: Marques L. Bernardino A. 2017 IEEE International Conference on Autonomous Robot Systems and Competitions (ICARSC); 26-28 April 2017; Coimbra (Portugal). IEEE, New York2017: 104-109
- Effects of mechanical stimulation of the feet on gait and cardiovascular autonomic control in Parkinson's disease.J Appl Physiol. 2014; 116: 495-503
- Effect of step-synchronized vibration stimulation of soles on gait in Parkinson's disease: a pilot study.J Neuroeng Rehabil. 2006; 3: 9
- Plantar cutaneous sensory stimulation improves single-limb support time and EMG activation patterns among individuals with Parkinson's disease.Parkinsonism Relat Disord. 2009; 15: 697-702
- The Parkinsonian gait spatiotemporal parameters quantified by a single inertial sensor before and after automated mechanical peripheral stimulation treatment.Parkinson’s Dis. 2015; 2015: 390512
- Timed Up and Go test and wearable inertial sensor: a new combining tool to assess change in subject with Parkinson’s disease after automated mechanical peripheral stimulation treatment.International J Engineering Innovative Technology. 2015; 4: 155-163
- Acute modulation of brain connectivity in Parkinson disease after automatic mechanical peripheral stimulation: a pilot study.PLoS One. 2015; 10e0137977
- Long-term effects of automated mechanical peripheral stimulation on gait patterns of patients with Parkinson's disease.Int J Rehabil Res. 2015; 38: 238-245
- The effects of automated mechanical peripheral stimulation in functional mobility and neuroplasticity of subjects with Parkinson's disease: a hierarchical cluster analysis.Gait Posture. 2017; 57: 45-46
Pinto C, Pagnussat AS, Kleiner AFR, et al. Automated mechanical peripheral stimulation improves gait parameters in subjects with Parkinson’s disease and freezing of gait: a randomized clinical trial. Am J Phys Med Rehabil; in press.
- Plantar stimulation in Parkinsonians: from biomarkers to mobility—randomized-controlled trial.Restor Neurol Neurosci. 2018; 36: 195-205
Galli M, Vicidomini C, Kleiner AFR, et al. Peripheral neurostimulation breaks the shuffling step patterns in Parkinsonian gait: a double blind randomized longitudinal study with automated mechanical peripheral stimulation. Eur J Phys Rehabil Med; in press.
- Analyzing gait variability and dual-task interference in patients with Parkinson's disease and freezing by means of the word-color Stroop test.Aging Clin Exp Res. 2018; 30: 1137-1142
- “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Construction of freezing of gait questionnaire for patients with Parkinsonism.Parkinsonism Relat Disord. 2000; 6: 165-170
- Movement disorder society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results.Mov Disord. 2008; 23: 2129-2170
- Parkinsonism: onset, progression, and mortality.Neurology. 1967; 17: 427-442
- The sensitivity of the sole of the foot in patients with Morbus Parkinson.Neurosci Lett. 2003; 346: 173-176
- Three-dimensional lower extremity joint kinetics in normal pediatric gait.J Pediatr Orthop. 1991; 11: 341-349
- Eta squared and partial eta squared as measures of effect size in educational research.Rev Educ Res. 2011; 6: 135-147
- Statistical power analysis for the behavioral sciences.2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
- Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks.Phys Ther. 2002; 82: 888-897
- Interaction of the basal ganglia and supplementary motor area in the elaboration of movement.in: Glencross D.J. Piek J.P. Motor control and sensory-motor integration: issues and directions. Elsevier Science BV, Amsterdam1995: 37-59
- Goal-directed secondary motor tasks: their effects on gait in subjects with Parkinson disease.Arch Phys Med Rehabil. 2000; 81: 110-116
- Does the type of concurrent task affect preferred and cued gait in people with Parkinson’s disease?.Aust J Physiother. 2005; 51: 175-180
- Executive dysfunction and attention contribute to gait interference in off state Parkinson’s disease.Gait Posture. 2010; 31: 169-174
- Effects of cognitive function on gait and dual tasking abilities in patients with Parkinson’s disease suffering from motor response fluctuations.Exp Brain Res. 2011; 208: 169-179
- Attending to the task: interference effects of functional tasks on walking in Parkinson’s disease and the roles of cognition, depression, fatigue, and balance.Arch Phys Med Rehabil. 2004; 85: 1578-1585
- Gait asymmetry in patients with Parkinson’s disease and elderly fallers: when does the bilateral coordination of gait require attention?.Exp Brain Res. 2007; 177: 336-346
- Bilateral coordination of gait and Parkinson’s disease: the effects of dual tasking.J Neurol Neurosurg Psychiatry. 2009; 80: 347-350
- Impaired regulation of stride variability in Parkinson's disease subjects with freezing of gait.Exp Brain Res. 2003; 149: 187-194
- Freezing of gait in Parkinson's disease: the impact of dual-tasking and turning.Mov Disord. 2010; 25: 2563-2570
- Dual-tasking effects on gait variability: the role of aging, falls, and executive function.Mov Disord. 2006; 7: 950-957
- Early, untreated Parkinson’s disease patients show reaction time variability.Neurosci Lett. 2008; 441: 77-80
- The effect of age on variability in gait.J Gerontol. 1984; 39: 662-666
- Variability and motor control.in: Newell K.M. Corcos D.M. Issues in variability and motor control. Human Kinetics, Champaign1993: 1-12
- Human walking and higher-level gait disorders, particularly in the elderly.Neurology. 1993; 43: 268-279
- Predictors of future falls in Parkinson disease.Neurology. 2010; 75: 116-124
- Clinical and physiological assessments for elucidating falls risk in Parkinson's disease.Mov Disord. 2009; 24: 1280-1289
- Sensitivity mapping of the human foot: thresholds at 30 skin locations.Foot Ankle Int. 2009; 30: 986-991
- The plantar sole is a dynamometric map for human balance control.Neuroreport. 1998; 9: 3247-3252
- Foot sole and ankle muscle inputs contribute jointly to human erect posture regulation.J Physiol. 2001; 532: 869-878
- Cutaneous afferents from human plantar sole contribute to body posture awareness.Neuroreport. 2002; 13: 1957-1961
- Effects of changes in plantar sensory feedback on human gait characteristics: a systematic review.Footwear Sci. 2012; 4: 1-22
- Site-specific differences in the association between plantar tactile perception and mobility function in older adults.Front Aging Neurosci. 2014; 6: 68
- The cutaneous sensory system.Neurosci Biobehav Rev. 2010; 34: 148-159
- The effect of changes in foot sensation on plantar pressure and muscle activity.Clin Biomech. 2001; 16: 719-727
- Evidence for strong synaptic coupling between single tactile afferents from the sole of the foot and motoneurons supplying leg muscles.J Neurophysiol. 2005; 94: 3795-3804
Article info
Publication history
Published online: June 11, 2018
Footnotes
A research contract signed on November 11, 2015, is currently active between the Department of Electronics, Information and Bioengineering of Politecnico di Milano (Italy) and Gondola Medical Technologies SA (Switzerland).
Clinical Trial Registration No.: NCT02594540.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
