Obstacle Avoidance Increases Asymmetry of Crossing Step in Individuals With Parkinson's Disease and Neurologically Healthy Individuals

The authors' aim was to investigate gait asymmetry of crossing step during obstacle avoidance while walking in people with Parkinson's disease (PD) under and without the effects of dopaminergic medication. Thirteen individuals with PD and 13 neurologically healthy individuals performed 5 trials of unobstructed gait and 10 trials of obstacle crossing during gait (5 trials with each leg) and spatiotemporal parameters were analyzed. Obstacle crossing increased step duration of the crossing step for the most-affected or nondominant limb compared to the crossing step with the least-affected or dominant limb. Individuals with PD without the effects of medication increased step duration for the step with the least-affected limb compared to the step with the most-affected limb during obstacle crossing.     

Motor planning in Parkinson’s disease patients experiencing freezing of gait: The influence of cognitive load when approaching obstacles

Freezing of gait (FOG) in Parkinson’s disease (PD) is typically assumed to be a pure motor deficit, although it is important to consider how an abrupt loss of gait automaticity might be associated with an overloaded central resource capacity. If resource capacity limits are a factor underlying FOG, then obstacle crossing may be particularly sensitive to dual task effects in eliciting FOG. Participants performed a dual task (auditory digit monitoring) in order to increase cognitive load during obstacle crossing. Forty-two non-demented participants (14 PD patients with FOG, 13 PD who do not freeze, and 14 age-matched healthy control participants) were required to walk and step over a horizontal obstacle set at 15% of the participants’ height. Kinematic data were split into two phases of their approach: early (farthest away from the obstacle), and late (just prior to the obstacle). Interestingly, step length variability and step time variability increased when PD patients with FOG performed the dual task, but only in the late phase prior to the obstacle (i.e. when closest to the obstacle). Additionally, immediately after crossing, freezers landed the lead foot abnormally close to the obstacle regardless of dual task condition, and also contacted the obstacle more frequently (planning errors). Strength of the dual task effect was associated with low general cognitive status, declined executive function, and inappropriate spatial planning, but only in the PD-FOG group. This study is the first to demonstrate that cognitive load differentially impacts planning of the final steps needed to avoid an obstacle in PD patients with freezing, but not non-freezers or healthy controls, suggesting specific neural networks associated with FOG behaviours.     

When an Object Appears Unexpectedly: Object Circumvention in Adults

Obstacles often appear unexpectedly in our pathway and these require us to make immediate adjustments. Despite how regularly we encounter such situations only few studies have considered how we adjust to unexpected obstacles in the pathway that require us to walk around them. The authors considered how adults adjust to the possibility of an obstacle appearing and then also how foot placement is adjusted to circumvent an obstacle. Fifteen healthy adults walked down an 11-m walkway, initially they were told this was a clear pathway and nothing in the environment would change (no gate), they then performed a series of trials in which a gate may (gate close) or may not (gate open) partially obstruct their pathway. The authors found that mediolateral trunk velocity and acceleration was significantly increased when there was the possibility of an obstacle but before the obstacle appeared. This demonstrates an adaptive walking strategy that seems to enable healthy young adults to successfully circumvent obstacles. The authors also categorized foot placement adjustments and found that adults favored making shorter and wider steps away from the obstacle. They suggest this combination of adjustments allows participants to maintain stability while successfully circumventing the obstacle.     

The starting distance of obstacle circumvention did not affect intersegmental coordination in individuals with Parkinson's disease

BackgroundObstacle circumvention is a challenging task in Parkinson's disease (PD). Body segments adjustments, such as changing the direction of the trunk, followed by a change in the direction of the head, and modifications in the positioning of the feet, are necessary to circumvent an obstacle during walking. For that, individuals need to identify the distance to the obstacle, its characteristics (such as its dimension), and perform well-coordinated movements. However, PD is characterized by rigidity, which may be increased in the axial axis and compromise the task execution. Also, worsening sensory integration in PD may increase the time to perform these body segments adjustments, thus impairing the movement coordination when starting obstacle circumvention near to the obstacle.AimTo determine if the starting distance (1.5 m, 3 m, or 5 m) from the obstacle could modify the intersegmental coordination (specifically, the coordination between head, trunk, and pelvis) during the obstacle circumvention steps in individuals with PD.MethodsFourteen individuals with a diagnosis of idiopathic PD and 15 neurologically healthy individuals (CG) from the community were included in this study. The participants were evaluated in three different gait conditions, according to the starting distance from the obstacle: 1.5 m, 3 m, and 5 m away from the obstacle. Vector coding technique was employed to establish the coupling between head, trunk, and pelvis in the steps immediately before and during obstacle circumvention. Three-way ANOVA's (group, distance, and step) were calculated with the level of significance at p < 0.05.ResultsFor all couplings of coordination, there were no effects of distance. However, significant main effects of group and steps (p < 0.05) were found for all couplings with different patterns of coordination: head/pelvis (group: in-phase and anti-phase variables; steps: anti-phase variable), head/trunk (group: trunk variable; steps: in-phase and anti-phase variables) and trunk/pelvis (group: anti-phase; steps: trunk and pelvis). Finally, only head/trunk coupling showed an interaction between group*steps. Individuals with PD showed 7.95% lower head movement (p < 0.024) and 14.85% greater trunk movement than CG (p < 0.002). Also, individuals with PD performed 17.56% greater head movement in the step before the circumvention compared to the step during circumvention (p < 0.044).ConclusionThe starting distance from the obstacle did not influence the pattern of axial intersegmental coordination in both groups. However, how these segments interact in the preparation and during the obstacle circumvention are opposite in individuals with PD. While on the previous step to obstacle circumvention, the head movement was greater than the trunk, during the obstacle circumvention step, individuals with PD rotated the trunk more.     

Emotional state affects gait initiation in individuals with Parkinson’s disease

The purpose of the present study was to determine the impact of manipulating emotional state on gait initiation in persons with Parkinson’s disease (PD) and healthy older adults. Following the presentation of pictures that are known to elicit specific emotional responses, participants initiated gait and continued to walk for several steps at their normal pace. Reaction time, the displacement and velocity of the center of pressure (COP) trajectory during the preparatory postural adjustments, and length and velocity of the first two steps were measured. Analysis of the gait initiation measures revealed that exposure to (1) threatening pictures, relative to all other pictures, speeded the initiation of gait for PD patients and healthy older adults; (2) approach-oriented emotional pictures (erotic and happy people), relative to withdrawal-oriented pictures, facilitated the anticipatory postural adjustments of gait initiation for PD patients and healthy older adults, as evidenced by greater displacement and velocity of the COP movement; and (3) emotional pictures modulated gait initiation parameters in PD patients to the same degree as in healthy older adults. Collectively, these findings hold significant implications for understanding the circuitry underlying the manner by which emotions modulate movement and for the development of emotion-based interventions designed to maximize improvements in gait initiation for individuals with PD.     

Use of the gait deviation index for the evaluation of patients with Parkinson's disease

The authors aimed to determine whether the Gait Deviation Index (GDI) could be feasible to characterize gait in patients with Parkinson's disease (PD) and evaluate outcomes of levodopa treatment. Twenty-two PD participants were evaluated with clinical examination and 3-D quantitative gait analysis (GDI was calculated from gait analysis) in 2 states (OFF and ON) after taking levodopa. Twenty age-matched healthy participants (CG) were included as controls. The GDI value in the OFF state was 83.4 ± 11.5 (statistically different from CG) while clinical scales demonstrated a moderate-severe gait impairment of these patients. Significant improvements are evident from clinical scores and by GDI values in the ON state. The mean GDI for the ON state (GDI(ON): 87.9 ± 10.4) was significantly higher than in for the OFF state (GDI(OFF): 83.4 ± 11.5), indicating a global gait improvement after the treatment. The results show that GDI has lower value as an indicator of pathology in PD patients than in quantifying the effects of levodopa treatment in PD state.     

Saccade-Stepping Interactions Revise the Motor Plan for Obstacle Avoidance

The authors used a stimulus-response compatibility paradigm to assess the effect of changing the estimated time to obstacle contact. A limb-selection cue was presented in different phases of gait to young (n = 5) and to older (n = 4) adults while they were moving toward a foam obstacle in the walking path. A downward saccade was initiated after the cue; the saccade typically occurred during the stance phase of the target limb (the foot cued to lead the step over the obstacle). The mean saccade-step latency after the cue was on the order of ?500 ms in both young and elderly participants. On reaching the obstacle, both groups generated an upward saccade approximately ?300 ms before target footlift in both groups. Saccades following the limb-selection cue appeared to direct the gaze toward footfall targets just beyond the obstacle, whereas saccades generated just before obstacle footlift moved the gaze to the forward-looking direction. The elderly had significantly longer saccade-trailing-footlift latencies and prolonged gaze-fixation times than did the younger adults. Transient disruptions in optical flow appeared to be necessary for successful obstacle-avoidance behavior when there was an unexpected change in the estimated time to obstacle contact.     

“Posture first”: Interaction between posture and locomotion in people with low back pain during unexpectedly cued modification of gait initiation motor command

The ability to adapt anticipatory postural adjustments (APAs) in response to perturbations during single-joint movements is altered in people with chronic low back pain (LBP), but a comprehensive analysis during functional motor tasks is still missing. This study aimed to compare APAs and stepping characteristics during gait initiation between people with LBP and healthy controls, both in normal (without cue occurrence) condition and when an unexpected visual cue required to switch the stepping limb. Fourteen individuals with LPB and 10 healthy controls performed gait initiation in normal and switch conditions. The postural responses were evaluated through the analysis of center of pressure, propulsive ground reaction forces, trunk and whole-body kinematics, and activation onsets of leg and back muscles. During normal gait initiation, participants with LBP exhibited similar APAs and stepping characteristics to healthy controls. In the switch condition, individuals with LBP were characterized by greater mediolateral postural stability but decreased forward body motion and propulsion before stepping. The thorax motion was associated with forward propulsion parameters in both task conditions in people with LBP but not healthy controls. No between-group differences were found in muscle activation onsets. The results suggest that postural stability is prioritized over forward locomotion in individuals with LBP. Furthermore, the condition-invariant coupling between thorax and whole-body forward propulsion in LBP suggests an adaptation in the functional use of the thorax within the postural strategy, even in poor balance conditions.     

Distraction Affects the Performance of Obstacle Avoidance During Walking

In this study, dual-task interference in obstacle-avoidance tasks during human walking was examined. Ten healthy young adults participated in the experiment. While they were walking on a treadmill, an obstacle suddenly fell on the treadmill in front of their left leg during either midswing, early stance, or late stance of the ipsilateral leg. Participants were instructed to avoid the obstacle, both as a single task and while they were concurrently performing a cognitive secondary task (dual task). Rates of failure, avoidance strategy, and a number of kinematic parameters were studied under both task conditions. When only a short response time was available, rates of failure on the avoidance task were larger during the dual task than during the single task. Smaller crossing swing velocities were found during the dual task as compared with those observed in the single task. The difference in crossing swing velocities was attributable to increased stiffness of the crossing swing limb. The results of the present study indicated that divided attention affects young and healthy individuals' obstacle-avoidance performance during walking.     

The effect of dopaminergic medication on conflict adaptation in Parkinson's disease

Parkinson's disease (PD) is a neurological disorder associated primarily with motor symptoms such as tremor, slowness of movement, and difficulties with gait and balance. Most patients take dopaminergic medication to improve their motor functions. Previous studies reported indications that such medication can impair higher cognitive functions (cf. dopamine overdose hypothesis). In the present study, we examined the effect of medication status on conflict adaptation. PD patients performed a Stroop task in which we manipulated the proportion of congruent and incongruent items, thereby allowing us to explore conflict adaptation. The use of mouse movements allowed us to examine the action dynamics of conflict adaptation in PD, and their sensitivity to dopaminergic medication. Each patient performed the same task twice: once without making changes to their regular medication regime, and once after overnight withdrawal from their medication. Results showed that medication improved mouse movements and alleviated motor symptoms. Moreover, patients' mouse movements were modulated as a function of the proportion congruency manipulation, revealing conflict adaptation in PD, which was unaffected by medication status. The present study extends earlier work on conflict adaptation in PD where reduced transient (trial-by-trial) conflict adaptation was observed ON compared to OFF medication (Duthoo et al., 2013, Neuropsychology, 27, 556). Our findings suggest that more sustained cognitive control processes may not be sensitive to dopamine overdose effects.     

Evidence of Incomplete Motor Programming in Parkinson's Disease

One of the essential questions regarding movement deficits in Parkinson's disease (PD) is whether they stem from impaired selecting and switching among movements, impaired use of predictive information to prepare movement, or impaired execution of movement. PD subjects (n = 9) and age-matched control subjects (n = 8) performed a cued, sequential-response RT task. The cue provided either no information, accurate information, or inaccurate information about the upcoming response. PD subjects used predictive information to prepare and to switch among movement sequences normally, but second and third key press latencies were prolonged in comparison with the first key press latency. In Experiments 2 and 3, the effects of choice set and sequence length on key press latencies were examined. These results provide evidence that PD subjects initiate movement before the entire response sequence is prepared. PD does not impair motor programming or execution processes themselves but impairs the smooth coordination of those processes.     

The Discriminating Properties of an Optoelectronic Movement Analysis Method in Patients With Parkinsonism

Several partly overlapping diseases have Parkinsonism as a symptom and tools that may differentiate between these disorders would be helpful. The authors evaluated the discriminating properties of the objective automated posturo-locomotor-manual (PLM) L-DOPA test in regard to health, and the movement disorders Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). A PLM test–retest procedure was performed in healthy controls (n = 37) and results were compared with PLM L-DOPA tests performed by 132 patients with Parkinsonism in intermediate to advanced stages (56 PD, 53 MSA, 23 PSP). The movement time (MT) for the standardized movement and its different components was measured. The discriminating abilities of individual, or combinations of, test variables were determined by forward stepwise multiple logistic regression and evaluated with receiver-operating characteristic (ROC) analysis. Each PLM variable separated healthy persons from patients with Parkinsonism before administration of L-DOPA (area under the curve (AUC) = 0.94–0.99, p <.001 for any separate variable). A combination of (MT_off – MT_on)/MT_off and MT_on had the highest ability to separate patients with PD from patients with atypical Parkinsonism (area under the curve = 0.91, p <.001). The PLM test discriminates between healthy controls and patients with Parkinsonism, and between patients with Parkinson's disease and patients with atypical Parkinsonism.

[Supplementary material is available for this article. Go to the publisher's online edition of Journal of Motor Behavior for the following free supplemental resource: supplementary data.]     

Upper limb movement analysis during gait in multiple sclerosis patients

PurposeGait disorders in multiple sclerosis (MS) are well studied; however, no previous study has described upper limb movements during gait. However, upper limb movements have an important role during locomotion and can be altered in MS patients due to direct MS lesions or mechanisms of compensation. The aim of this study was to describe the arm movements during gait in a population of MS patients with low disability compared with a healthy control group.MethodsIn this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7 ± 9.6 years, female: 40%) with relapsing-remitting MS with low disability (mean EDSS: 2 ± 1) and 25 healthy age-matched controls using a 3-dimension gait analysis.ResultsMS patients walked slower, with increased mean elbow flexion and decreased amplitude of elbow flexion (ROM) compared to the control group, whereas shoulder and hand movements were similar to controls. These differences were not explained by age or disability.ConclusionUpper limb alterations in movement during gait in MS patients with low disability can be characterized by an increase in mean elbow flexion and a decrease in amplitude (ROM) for elbow flexion/extension. This upper limb movement pattern should be considered as a new component of gait disorders in MS and may reflect subtle motor deficits or the use of compensatory mechanisms.     

Obstacle Crossing Differences Between Blind and Blindfolded Subjects After Haptic Exploration

Little is known about the ability of blind people to cross obstacles after they have explored haptically their size and position. Long-term absence of vision may affect spatial cognition in the blind while their extensive experience with the use of haptic information for guidance may lead to compensation strategies. Seven blind and 7 sighted participants (with vision available and blindfolded) walked along a flat pathway and crossed an obstacle after a haptic exploration. Blind and blindfolded subjects used different strategies to cross the obstacle. After the first 20 trials the blindfolded subjects reduced the distance between the foot and the obstacle at the toe-off instant, while the blind behaved as the subjects with full vision. Blind and blindfolded participants showed larger foot clearance than participants with vision. At foot landing the hip was more behind the foot in the blindfolded condition, while there were no differences between the blind and the vision conditions. For several parameters of the obstacle crossing task, blind people were more similar to subjects with full vision indicating that the blind subjects were able to compensate for the lack of vision.     

Effects of aging on whole body and segmental control while obstacle crossing under impaired sensory conditions

The ability to safely negotiate obstacles is an important component of independent mobility, requiring adaptive locomotor responses to maintain dynamic balance. This study examined the effects of aging and visual–vestibular interactions on whole-body and segmental control during obstacle crossing. Twelve young and 15 older adults walked along a straight pathway and stepped over one obstacle placed in their path. The task was completed under 4 conditions which included intact or blurred vision, and intact or perturbed vestibular information using galvanic vestibular stimulation (GVS). Global task performance significantly increased under suboptimal vision conditions. Vision also significantly influenced medial–lateral center of mass displacement, irrespective of age and GVS. Older adults demonstrated significantly greater trunk pitch and head roll angles under suboptimal vision conditions. Similar to whole-body control, no GVS effect was found for any measures of segmental control. The results indicate a significant reliance on visual but not vestibular information for locomotor control during obstacle crossing. The lack of differences in GVS effects suggests that vestibular information is not up-regulated for obstacle avoidance. This is not differentially affected by aging. In older adults, insufficient visual input appears to affect ability to minimize anterior–posterior trunk movement despite a slower obstacle crossing time and walking speed. Combined with larger medial–lateral deviation of the body COM with insufficient visual information, the older adults may be at a greater risk for imbalance or inability to recover from a possible trip when stepping over an obstacle.     

Prospective dynamic balance control during the swing phase of walking: Stability boundaries and time-to-contact analysis

This study examined the prospective control of the swing phase in young healthy adults while walking at preferred speed over unobstructed ground and during obstacle clearance. Three aspects of swing were examined: (1) the relation of the body Center of Mass (CoM) to the stability boundaries at the base of support; (2) a dynamic time-to-contact analysis of the CoM and swing foot to these boundaries; and (3) the role of head movements in the prospective control of gait and field of view assessment. The time-to-contact analysis of CoM and swing foot showed less stable swing dynamics in the trail foot compared to the lead foot in the approach to the unstable equilibrium, with the CoM leading the swing foot and crossing the anterior stability boundary before the swing foot. Compensations in temporal coupling occurred in the trail limb during the late swing phase. Time-to-contact analysis of head movement showed stronger prospective control of the lead foot, while fixation of the field of view occurred earlier in swing and was closer to the body in the obstacle condition compared to unobstructed walking. The dynamic time-to-contact analysis offers a new approach to assessing the unstable swing phase of walking in different populations.     

Effects of age on the visuo-locomotor control used to circumvent a virtual pedestrian with different limb movements

It is known that young adults (YA) circumvent pedestrians differently than inanimate obstacles and that limb movements of the pedestrian influence minimum clearance for predictable pedestrian paths. Although older adults (OA) use more cautious strategies for general pedestrian avoidance compared to YA, how pedestrian movements influence circumvention by OAs is unknown. The aim of this study was to understand how limb movements of a pedestrian with an initially unpredictable trajectory affect circumvention control in younger vs older healthy adults. Fourteen YA and 14 OA (> 70 years) were immersed in a virtual shopping mall and instructed to circumvent a virtual pedestrian (VP) approaching with either normal locomotor movements, upper limbs fixed, lower limbs fixed, or both upper and lower limbs fixed. Onset distance for trajectory deviation, minimum clearance, walking speed, body segment yaw angles and gaze behaviour were analysed. When the VP lacked local limb movements, both age groups initiated their trajectory deviations farther away, but significantly more so for OA. Minimal clearance was unchanged across conditions and similar for both age groups. OA walked slower, produced smaller head and trunk yaw, and visually focused on the VP for a greater percentage of time. Thus, lack of limb movements of another pedestrian resulted in more cautious circumvention control and OA needed more time to process visual information with greater visual attention focused on the VP. Age-related changes could translate to a greater risk of falls in OA populations with reduced balance and mobility that could limit community ambulation.     

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

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.     

Are there common walking gait characteristics in patients diagnosed with late-onset Pompe disease?

Late-onset Pompe disease (LOPD) is a rare disease, defined as a progressive accumulation of lysosomal glycogen resulting in muscle weakness and respiratory problems. Anecdotally, individuals often have difficulties walking, yet, there is no three-dimensional data supporting these claims. We aimed to assess walking patterns in individuals with LOPD and compare with healthy individuals. Kinematic, kinetic and spatiotemporal data were compared during walking at a self-selected speed between individuals with LOPD (n = 12) and healthy controls (n = 12). Gait profile scores and movement analysis profiles were also determined to indicate gait quality. In comparison with healthy individuals, the LOPD group demonstrated greater thoracic sway (96%), hip adduction angles (56%) and pelvic range of motion (77%) and reduced hip extensor moments (36%). Greater group variance for the LOPD group were also observed. Individuals with LOPD had a slower (15%) walking speed and reduced cadence (7%). Gait profile scores were 37% greater in the LOPD group compared to the healthy group. Proximal muscular weakness associated with LOPD disease is likely to have resulted in a myopathic gait pattern, slower selected walking speeds and deviations in gait patterns. Although individuals with LOPD presented with some common characteristics, greater variability in gait patterns is likely to be a result of wide variability in phenotype spectrum observed with LOPD. This is the first study to examine walking in individuals with LOPD using instrumented gait analysis and provides an understanding of LOPD on walking function which can help orientate physiotherapy treatment for individuals with LOPD.     

How obstructing is an obstacle? The influence of starting posture on obstacle avoidance

The introduction of non-target objects into a workspace leads to temporal and spatial adjustments of reaching trajectories towards a target. Currently, there are two different explanations for this phenomenon: the non-target objects are considered as either physical obstacles to which we maintain a preferred distance (see Tresilian, 1998) or as distractors that interfere with movement planning (see Tipper, Howard, & Jackson, 1997). These components are difficult to disentangle, however. Our aim was to determine the unique contribution of the avoidance of a physical obstacle to the adjustments of reaching trajectories. In this study, we manipulate the degree of physical obstruction by non-target objects while keeping the a priori visual layout of the workspace more or less constant. This is achieved by placing participants in different starting postures with respect to the orientation of their limb segments. Participants reach towards and grasp target objects with non-targets present in the workspace in a frontal and a lateral starting posture. In the frontal conditions participants showed larger movements away from the non-target on the ipsilateral side of the workspace than in the lateral conditions. The results provide evidence for the interpretation that non-targets influence the movement trajectory partly because they are 'obstructing'.