Highlights
- •We evaluated the APDM® Mobility Lab in Parkinson's disease.
- •We employed a statistical method to reduce the variables of interest.
- •We found a set of 20 variables that differentiate PD from controls.
- •Another set of 20 variables correlates with symptom severity.
- •This device may be useful for objectively tracking disease progression.
Abstract
Objective
To assess the suitability of instrumented gait and balance measures for diagnosis
and estimation of disease severity in PD.
Methods
Each subject performed iTUG (instrumented Timed-Up-and-Go) and iSway (instrumented
Sway) using the APDM® Mobility Lab. MDS-UPDRS parts II and III, a postural instability and gait disorder
(PIGD) score, the mobility subscale of the PDQ-39, and Hoehn & Yahr stage were measured
in the PD cohort. Two sets of gait and balance variables were defined by high correlation
with diagnosis or disease severity and were evaluated using multiple linear and logistic
regressions, ROC analyses, and t-tests.
Results
135 PD subjects and 66 age-matched controls were evaluated in this prospective cohort
study. We found that both iTUG and iSway variables differentiated PD subjects from
controls (area under the ROC curve was 0.82 and 0.75 respectively) and correlated
with all PD severity measures (R2 ranging from 0.18 to 0.61). Objective exam-based scores correlated more strongly
with iTUG than iSway. The chosen set of iTUG variables was abnormal in very mild disease.
Age and gender influenced gait and balance parameters and were therefore controlled
in all analyses.
Interpretation
Our study identified sets of iTUG and iSway variables which correlate with PD severity
measures and differentiate PD subjects from controls. These gait and balance measures
could potentially serve as markers of PD progression and are under evaluation for
this purpose in the ongoing NIH Parkinson Disease Biomarker Program.
Keywords
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 Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effect of thalamic stimulation on gait in Parkinson disease.Arch Neurol. 1996; 53: 898-903
- The influence of Nordic Walking training on sit-to-stand transfer in Parkinson patients.Gait Posture. 2011; 34: 234-238
- Improved asymmetry of gait in Parkinson's disease with DBS: gait and postural instability in Parkinson's disease treated with bilateral deep brain stimulation in the subthalamic nucleus.Mov Disord. 2009; 24: 590-597
- Effects of subthalamic nucleus stimulation and levodopa treatment on gait abnormalities in Parkinson disease.Arch Neurol. 2003; 60: 80-84
- Gait variability: methods, modeling and meaning.J Neuroeng Rehabil. 2005; 2: 1-9
- The efficacy of quantitative gait analysis by the GAITRite system in evaluation of Parkinsonian bradykinesia.Parkinsonism Relat Disord. 2006; 12: 438-442
- Assistive devices alter gait patterns in Parkinson disease: advantages of the four-wheeled walker.Gait Posture. 2013; 38: 20-24
- The impact of attentional, auditory, and combined cues on walking during single and cognitive dual tasks in Parkinson disease.Gait Posture. 2011; 33: 478-483
- Gait coordination in Parkinson disease: effects of step length and cadence manipulations.Gait Posture. 2013; 38: 340-344
- Validity of the GAITRite walkway system for the measurement of averaged and individual step parameters of gait.Gait Posture. 2005; 22: 317-321
- Correlation of Parkinson disease severity and 18F-DTBZ positron emission tomography.JAMA Neurol. 2014; 71: 758-766
- Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices.J Athl Train. 2011; 46: 600-606
- Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest).Clin Neurol Neurosurg. 2013; 115: 1626-1631
- Computerized posturography analysis of progressive supranuclear palsy: a case-control comparison with Parkinson's disease and healthy controls.Arch Neurol. 2000; 57: 1464-1469
- Impaired step up/over in persons with Parkinson's disease.Adapt Phys Activ Q. 2010; 27: 87-95
- Mobility lab to assess balance and gait with synchronized body-worn sensors.J Bioeng Biomed Sci. 2012; S1: 1-5
- Postural sway as a marker of progression in Parkinson's disease: a pilot longitudinal study.Gait Posture. 2012; 36: 471-476
- ISway: a sensitive, valid and reliable measure of postural control.J Neuroeng Rehabil. 2012; 9: 59
- iTUG, a sensitive and reliable measure of mobility.IEEE Trans Neural Syst Rehabil Eng. 2010; 18: 303-310
- Analyzing 180 degrees turns using an inertial system reveals early signs of progression of Parkinson's disease.Conf Proc IEEE Eng Med Biol Soc. 2009; 2009: 224-227
- The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease.J Neurol Neurosurg Psychiatry. 2010; 81: 171-176
- Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.J Neurol Neurosurg Psychiatry. 1992; 55: 181-184
- PDQ-39: a review of the development, validation and application of a Parkinson's disease quality of life questionnaire and its associated measures.J Neurol. 1998; 245: S10-S14
- Mobile posturography: posturographic analysis of daily-life mobility.Otol Neurotol. 2013; 34: 288-297
- Postural sway and effect of levodopa in early Parkinson's disease.Can J Neurol Sci. 2008; 35: 65-68
- Effect of dopaminergic medication on postural sway in advanced Parkinson's disease.Front Neurol. 2013; 4: 202
Article info
Publication history
Published online: July 19, 2014
Accepted:
July 11,
2014
Received in revised form:
July 8,
2014
Received:
May 14,
2014
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
