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Gait Disorders (gait + disorders)

Distribution by Scientific Domains

Medical Sciences	81%

Selected Abstracts

Dopaminergic and non-dopaminergic pharmacological hypotheses for gait disorders in Parkinson's disease

FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 4 2010
David Devos
Abstract Gait disorders form one component of the axial disorders observed in Parkinson's disease (PD). Indeed, short steps with a forward-leaning stance are diagnostic criteria for PD in the early stages of the condition. Gait disorders also represent a major source of therapeutic failure in the advanced stages of PD (with the appearance of freezing of gait and falls) because they do not respond optimally to the two hand late-stage therapeutics , levodopa and electrical subthalamic nucleus (STN) stimulation. The late onset of doparesistance in these disorders may be linked to propagation of neurodegeneration to structures directly involved in gait control and to non-dopaminergic neurotransmitter systems. The coeruleus locus (a source of noradrenaline) is rapidly and severely affected, leading to a major motor impact. The pedunculopontine nucleus (PPN) and lateral pontine tegmentum (rich in acetylcholine) are both involved in gait. Degenerative damage to the serotoninergic raphe nuclei appears to be less severe, although serotonin-dopamine interactions are numerous and complex. Lastly, dopaminergic depletion leads to glutamatergic hyperactivity of the efferent pathways from the the STN to the PPN. However, the relationships between the various parkinsonian symptoms (and particularly gait disorders) and these pharmacological targets have yet to be fully elucidated. The goal of this review is to develop the various pathophysiological hypotheses published to date, in order to underpin and justify ongoing fundamental research and clinical trials in this disease area. [source]

Clinical effects of deep brain stimulation on gait disorders in Parkinson's disease

EUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2010
R. Wharen
No abstract is available for this article. [source]

Facilitation of corticospinal excitability in the tibialis anterior muscle during robot-assisted passive stepping in humans

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 1 2009
Kiyotaka Kamibayashi
Abstract Although phasic modulation of the corticospinal tract excitability to the lower limb muscles has been observed during normal walking, it is unclear to what extent afferent information induced by walking is related to the modulation. The purpose of this study was to test the corticospinal excitability to the lower limb muscles by using transcranial magnetic stimulation (TMS) and transcranial electrical stimulation of the motor cortex while 13 healthy subjects passively stepped in a robotic driven-gait orthosis. Specifically, to investigate the effect of load-related afferent inputs on the corticospinal excitability during passive stepping, motor evoked potentials (MEPs) in response to the stimulation were compared between two passive stepping conditions: 40% body weight unloading on a treadmill (ground stepping) and 100% body weight unloading in the air (air stepping). In the rectus femoris, biceps femoris and tibialis anterior (TA) muscles, electromyographic activity was not observed throughout the step cycle in either stepping condition. However, the TMS-evoked MEPs of the TA muscle at the early- and late-swing phases as well as at the early-stance phase during ground stepping were significantly larger than those observed during air stepping. The modulation pattern of the transcranial electrical stimulation-evoked MEPs was similar to that of the TMS-evoked MEPs. These results suggest that corticospinal excitability to the TA is facilitated by load-related afferent inputs. Thus, these results might be consistent with the notion that load-related afferent inputs play a significant role during locomotor training for gait disorders. [source]

Dopaminergic and non-dopaminergic pharmacological hypotheses for gait disorders in Parkinson's disease

Psychogenic movement disorders in children: A report of 15 cases and a review of the literature,,

MOVEMENT DISORDERS, Issue 13 2008
Petra Schwingenschuh MD
Abstract Data on psychogenic movement disorders (PMD) in children are scarce, with most existing literature relating to adults only. We report 15 cases with the aim of highlighting the clinical characteristics, risk factors, comorbidity, treatment, outcome, and prognosis of PMD in children. Only 13% of cases had onset before age 10, with the mean age at onset being 12.3 years. Females were predominantly affected (F:M = 4:1). The most common types of movement disorders seen were dystonia (47%), tremor (40%), and gait disorders (13%). Multiple hyperkinetic phenomenologies were observed in many cases. Abrupt onset and precipitation by minor injuries, and stressful life events were commonly reported. Clinical clues on examination suggesting a psychogenic origin were similar to those identified in adults. A distinct feature of PMD in children was the predominant involvement of the dominant limb. The underlying psychiatric diagnosis was conversion disorder in the majority of cases. Time from symptom onset until diagnosis of a PMD varied broadly (between 2 weeks and 5 years). Treatment with cognitive and behavioral therapy and rehabilitation by a multidisciplinary team led to improvement in most cases. However, treatment was much more effective in children with a short time from symptom onset to diagnosis and treatment. © 2008 Movement Disorder Society [source]

The clinical spectrum of freezing of gait in atypical parkinsonism,

MOVEMENT DISORDERS, Issue S2 2008
Stewart A. Factor DO
Abstract Freezing of gait (FOG), commonly seen in advanced Parkinson's disease (PD), has been classified as its fifth cardinal feature. However, its presence frequently leads to a misdiagnosis of PD. FOG is actually more common in atypical parkinsonism (AP): including vascular Parkinsonism (VP), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), dementia with Lewy bodies (DLB), and higher level gait disorders (HLGDs). VP is the result of multiple small vessel infarcts (lacunar state or Binswanger's disease), particularly involving the frontal, parietal, and basal ganglia regions. Approximately 50% have FOG (often referred to as lower body parkinsonism). FOG is also common in neurodegenerative forms of AP, present in 45,57%. Of these, FOG is present in 53% of PSP, 54% MSA, 54% DLB, 25% CBD, and 40% HLGD. It is generally seen in the late stages. There are two syndromes closely associated with AP that are dominated by FOG; pure akinesia (PA) and primary progressive freezing gait (PPFG). PA is characterized by akinesia of gait (including FOG), writing, and speech. Tremor, rigidity, dementia, and response to levodopa are notably absent. PPFG is defined by early FOG (often the initial feature) that progresses to include postural instability. It is accompanied by bradykinesia, rigidity, postural tremor, dementia, and levodopa unresponsiveness. Both syndromes are heterogeneous but PSP seems to be the most common cause. CBD and DLB can also present as PPFG. FOG is a common feature of AP and although typically occurring late in disease may also be an early symptom. © 2008 Movement Disorder Society [source]

Paul Blocq and (psychogenic) astasia abasia

MOVEMENT DISORDERS, Issue 10 2007
Michael S. Okun MD
Abstract The Greek term astasia,abasia literally translates to mean inability to stand and to walk. Although today we would classify the syndrome as a conversion disorder, it was considered a separate disease by Paul Blocq (1860,1896), who described this phenomenon as the inability to maintain an upright posture, despite normal function of the legs in the bed. Paul Blocq's original 1888 articles on astasia abasia were read, partly translated from French to English, and the cases were summarized. A review of a selection of the literature following Blocq's description on astasia abasia was performed. Present day literature was consulted as well. Blocq reviewed what was known about astasia abasia in two papers. Although he was the first to use the combined term astasia abasia, he referred to similar descriptions of Charcot, Richer, Mitchell, Jaccoud, Roméi, and Erlenmeyer. Blocq's contribution was in compiling the experiences and observations of preeminent 19th century neurologists. He recognized that paralysis, jumping, fits, tremor, and bizarre behavior could all be associated with the syndrome. He distinguished the disorder from hysteria. Moreover, he presented a formal delineation of the gait disorder and provided a pathophysiologic concept. Prognosis was considered favorable. Paul Blocq directed attention to psychogenic gait disorders by publishing a small case series on astasia abasia. Today, these case descriptions would be likely considered cases of conversion or psychogenic gait disorder, with or without other conversion/psychogenic movement disorders. © 2007 Movement Disorder Society [source]

Assessing fear of falling: Can a short version of the Activities-specific Balance Confidence scale be useful?

MOVEMENT DISORDERS, Issue 12 2006
Chava Peretz PhD
Abstract We present the process of further validation of the 16-item Activities-specific Balance Confidence scale (ABC-16) and a short version (ABC-6) derived by us, to assess balance confidence and fear of falling (FOF). The ABC-16 was administrated to three groups who were anticipated to have a range of balance confidence: 70 patients with higher level gait disorders (HLGDs), 68 healthy controls, and 19 patients with Parkinson's disease (PD). Item reduction was based on identifying items with the lowest scores (high FOF) among the patients. Internal consistency and discriminative validity were assessed using Cronbach's alpha and logistic regression, respectively. The intraclass correlation (ICC) between the short and long versions was assessed using a mixed model approach, accounting for the difference between the scores of the two versions. Six items were found to reflect the most frightening conditions, especially in the patient groups, and to form the short version (ABC-6). Internal consistency of the ABC-16 and ABC-6 were high in the three groups: Cronbach's alpha was between 0.83 and 0.91 and 0.81 and 0.90, respectively. Compared to the control group, the sensitivity of the ABC-16 was 96% for identification of patients with HLGDs (greatest FOF) and 58% for identification of PDs (moderate FOF), based only on the ABC scores. Similar values were obtained for the short version, i.e., 91% for HLGDs and 53% for PDs. ICCs between the short and the long versions was 0.88 (HLGDs), 0.83 (PDs), and 0.78 (Controls). To conclude, the short version of the ABC has properties analogous to the parent questionnaire and is apparently useful in assessing FOF. © 2006 Movement Disorder Society [source]

Bilateral striopallidodentate calcinosis: Clinical characteristics of patients seen in a registry

MOVEMENT DISORDERS, Issue 2 2001
Bala V. Manyam MD
Abstract Clinical features in bilateral striopallidodentate calcinosis (BSPDC), popularly referred to as Fahr's disease (five autosomal dominant families and eight sporadic cases, n = 38), recruited through a registry, are reported. Applying uniform criteria, cases reported in the literature (n = 61) were combined for detailed analysis. The mean (± S.D.) age of Registry patients was 43 ± 21 and that of literature was 38 ± 17. In combined data set (n = 99), 67 were symptomatic and 32 were asymptomatic. Of the symptomatic, the incidence among men was higher compared with women (45:22). Movement disorders accounted for 55% of the total symptomatic patients. Of the movement disorders, parkinsonism accounted for 57%, chorea 19%, tremor 8%, dystonia 8%, athetosis 5%, and orofacial dyskinesia 3%. Overlap of signs referable to different areas of central nervous system (CNS) was common. Other neurologic manifestations included: cognitive impairment, cerebellar signs, speech disorder, pyramidal signs, psychiatric features, gait disorders, sensory changes, and pain. We measured the total volume of calcification using an Electronic Planimeter and Coordinate Digitizer. Results suggest a significantly greater amount of calcification in symptomatic patients compared to asymptomatic patients. This study suggests that movement disorders are the most common manifestations of BSPDC, and among movement disorders, parkinsonism outnumber others. © 2001 Movement Disorder Society. [source]

Sensitivity Analysis of Human Leg Metabolical Costs

PROCEEDINGS IN APPLIED MATHEMATICS & MECHANICS, Issue 1 2005
Marko Ackermann
The human walking is characterized by skeletal dynamics and muscle excitation patterns minimizing the metabolical energy. This criterion is applied to assess the performance of lower limb prosthetic devices, and to evaluate therapies for patients presenting gait disorders. It is desirable, therefore, to dispose models of the human normal and pathological gaits capable of estimating the metabolical energy expenditure. For the swing phase of normal and pathological gaits a musculoskeletal model of the lower limb is presented to estimate metabolical energy expenditure. The mechanical model has three degrees of freedom and is actuated by eight Hill-type muscle units, and the model for the metabolical costs is adopted from literature. In this paper a combination of inverse and direct dynamics is used, and a sensitivity analysis of the dynamical behavior and the corresponding metabolical costs estimations with respect to parametrized neural excitations is performed. The leg motions are based on experiments in a gait analysis laboratory. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]