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P073 Navigating through doorways with Parkinson's disease
S94
Abstracts of the 17th Annual Meeting of ESMAC, Poster Presentations / Gait & Posture 28S (2008) S49–S118
linear best fits between static joint angle positions are calculated (Table 2). Discussion: The performance of isolated joint movements often by far is not as ideal as naively assumed. In the abduction above 90º, typically the arm also moves out of the frontal plane and the thorax is tilted. The clinical perception therefore is not a 3D joint position but clearly a projection angle to which we found the best agreement. References [1] Moore M.L., 1949, Phys Ther Rev. 29, 256–264. [2] Klopcar N. et. al., 2006 Clin Biomech (Bristol, Avon), 21, S1, S20S26. [3] Rettig O, et. al., 2003, Gait Posture, 18(Suppl 2), s94 (Abstract). [4] Rettig O, et. al., 2005, Gait Posture, 22S, s19 (Abstract). [5] Rettig O. et. al., 2007, Gait Posture, 26S, s35 (Abstract).
P073 Navigating through doorways with Parkinson’s disease S. D’Souza1 , J. Smith2 , J. Harris2 , D. Ewins1 . 1 Centre for Biomedical Engineering, University of Surrey; 2 School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom Summary/Conclusions: This study aims at investigating the effect of certain environmental features on gait in people with Parkinson’s disease (PD) such as walking through doorways and the use of visual cues. The results collected so far suggest that the side of the brain most affected influences speed and veering, and that use of a target while appearing to increase veering, can reduce hesitation and central deviation in passing through a doorway. Introduction: Many people with PD have problems navigating through doorways or cluttered environments. Studies have been conducted to investigate the effect of visually salient cues [1][2] and inhibitory environmental effects [3] on PD gait. However, there has been no systematic variation of these features, or measures of how well patients could navigate in or around these features. In this study, we have investigated the inhibitory effects of doorway widths on PD gait in terms of slowing and veering of walking trajectories. In addition, we have examined the effects of a target marker to determine whether inhibitory effects of visual clutter are even stronger in the absence of an explicit target. Patients/Materials and Methods: 15 patients with right sided Parkinson’s (RPD), 10 with left sided Parkinson’s (LPD) and 15 control subjects of matching age and sex were recorded using a ProReflex motion analysis system (Qualisys AB, Gothenburg, Sweden) as they walked a distance of 10 m over a linoleum covered walkway into an artificial doorway having a neutral surround. The doorwidth was varied over four common values (0.76, 0.84, 0.92, 1.00 m). A centrally aligned target marker was placed 3 m beyond the doorway at eye level. Trials were recorded while subjects walked at their normal pace through the doorway. The processed data were analyzed for speed over a series of 1 m distance bins along the walkway, veering from the centre of the walkway and deviation from centre of the doorway. Results: As shown in the table below, controls did not walk in a straight line from start point to the middle of the doorway but veered to the right by 18 mm and 12.6 mm (without and with target respectively) so that their path is curved. Using this trend as a reference, the RPDs veered towards the left of the control group
while the LPDs veered even more toward the right. The position of veering of the LPD group was 0.5 m closer to the doorway as compared to the other 2 groups. Values below are expressed as mean (SD), and left veering indicated by (left). While passing through the doorway, the RPDs had a greater deviation towards the left while the opposite was true for the LPDs. For all gait conditions, controls had the highest speed whereas the average speed of RPDs was higher than that of LPDs resulting in three separate speed bands. The presence of a target improved the speed of walking while reducing hesitation at the doorway. Discussion: The findings so far suggest that both patient groups show strong veering and consequent central deviation at the doorway in the direction opposite to the side of severity of their motor symptoms. The target increased peak veering but helped the patient group align themselves better while passing through the doorway. References [1] Azulay J-P et al. Brain 1999, 122, 111–120. [2] Lewis GN et al. Brain 2000 123, 2077–2090. [3] Nieuwboer A et al. Movement Disorders 2001, 16, 1066–1075.
P074 Multilevel, high dose botulinum toxin type a treatment in ambulatory children with cerebral palsy. M. Bonikowski, K. Sakławska, Ł. Gra˛bczewski. Movement Analysis Laboratory Zag´orze, Mazovian Neuropsychiatric and Rehabilitation Centre for Children and Youth Zag´orze n, Warsaw, Poland Summary: As it was established the main purpose of this study was to investigate a short-term outcome and effectiveness of BTX-A used in the high dose multilevel treatment of CP children. Conclusions: Multi-level treatment seems to improve ROM, the gait pattern and function of children with CP. Functional improvement depends on gait pattern before the treatment and age of a patient. Introduction: Botulinum toxin type A (BTX-A) reduces spasticity through partial denervation of the injected muscle. Multilevel BTX-A injections using high doses, have been successfully administered by prof. G. Molenaers [1] from University Hospital Pellenberg, Belgium, and prof. J. Becher [2] from VU Medisch Centrum Amsterdam for a few years. Patients/Materials and Methods: 60 children with bilateral spastic CP were treated. The children’s age varied from 3 to 10 years. The observation period lasted for at least 56 weeks. The injections were carried out with general anesthesia. BTX-A Botox used was of standard dilution of 50j/ml/NaCl in average dose of 20j/kg of body weight. Maximal doses reached 6j/kg for muscle group. Following muscles were treated: iliopsoas, rectus femoris, medial hamstrings, gastrocnemius, soleus, tibialis posterior. In cases of fixed contractures serial casts were applied for period of 2 to 4 weeks. All patients used AFO or GRAFO orthoses for walking. For assessment of the results passive ROM (range of motion) were used, as well as measurement of dynamic component (Tardieu test) and gait analysis using SYBAR 2.0 system (Noldus Holand). Gait function was assessed with 8-point gait independence scale. Results: In all the patients’ cases ROM improvements were affirmed as soon as 2 weeks after injections, as well as
Abstracts of the 17th Annual Meeting of ESMAC, Poster Presentations / Gait & Posture 28S (2008) S49–S118
linear best fits between static joint angle positions are calculated (Table 2). Discussion: The performance of isolated joint movements often by far is not as ideal as naively assumed. In the abduction above 90º, typically the arm also moves out of the frontal plane and the thorax is tilted. The clinical perception therefore is not a 3D joint position but clearly a projection angle to which we found the best agreement. References [1] Moore M.L., 1949, Phys Ther Rev. 29, 256–264. [2] Klopcar N. et. al., 2006 Clin Biomech (Bristol, Avon), 21, S1, S20S26. [3] Rettig O, et. al., 2003, Gait Posture, 18(Suppl 2), s94 (Abstract). [4] Rettig O, et. al., 2005, Gait Posture, 22S, s19 (Abstract). [5] Rettig O. et. al., 2007, Gait Posture, 26S, s35 (Abstract).
P073 Navigating through doorways with Parkinson’s disease S. D’Souza1 , J. Smith2 , J. Harris2 , D. Ewins1 . 1 Centre for Biomedical Engineering, University of Surrey; 2 School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom Summary/Conclusions: This study aims at investigating the effect of certain environmental features on gait in people with Parkinson’s disease (PD) such as walking through doorways and the use of visual cues. The results collected so far suggest that the side of the brain most affected influences speed and veering, and that use of a target while appearing to increase veering, can reduce hesitation and central deviation in passing through a doorway. Introduction: Many people with PD have problems navigating through doorways or cluttered environments. Studies have been conducted to investigate the effect of visually salient cues [1][2] and inhibitory environmental effects [3] on PD gait. However, there has been no systematic variation of these features, or measures of how well patients could navigate in or around these features. In this study, we have investigated the inhibitory effects of doorway widths on PD gait in terms of slowing and veering of walking trajectories. In addition, we have examined the effects of a target marker to determine whether inhibitory effects of visual clutter are even stronger in the absence of an explicit target. Patients/Materials and Methods: 15 patients with right sided Parkinson’s (RPD), 10 with left sided Parkinson’s (LPD) and 15 control subjects of matching age and sex were recorded using a ProReflex motion analysis system (Qualisys AB, Gothenburg, Sweden) as they walked a distance of 10 m over a linoleum covered walkway into an artificial doorway having a neutral surround. The doorwidth was varied over four common values (0.76, 0.84, 0.92, 1.00 m). A centrally aligned target marker was placed 3 m beyond the doorway at eye level. Trials were recorded while subjects walked at their normal pace through the doorway. The processed data were analyzed for speed over a series of 1 m distance bins along the walkway, veering from the centre of the walkway and deviation from centre of the doorway. Results: As shown in the table below, controls did not walk in a straight line from start point to the middle of the doorway but veered to the right by 18 mm and 12.6 mm (without and with target respectively) so that their path is curved. Using this trend as a reference, the RPDs veered towards the left of the control group
while the LPDs veered even more toward the right. The position of veering of the LPD group was 0.5 m closer to the doorway as compared to the other 2 groups. Values below are expressed as mean (SD), and left veering indicated by (left). While passing through the doorway, the RPDs had a greater deviation towards the left while the opposite was true for the LPDs. For all gait conditions, controls had the highest speed whereas the average speed of RPDs was higher than that of LPDs resulting in three separate speed bands. The presence of a target improved the speed of walking while reducing hesitation at the doorway. Discussion: The findings so far suggest that both patient groups show strong veering and consequent central deviation at the doorway in the direction opposite to the side of severity of their motor symptoms. The target increased peak veering but helped the patient group align themselves better while passing through the doorway. References [1] Azulay J-P et al. Brain 1999, 122, 111–120. [2] Lewis GN et al. Brain 2000 123, 2077–2090. [3] Nieuwboer A et al. Movement Disorders 2001, 16, 1066–1075.
P074 Multilevel, high dose botulinum toxin type a treatment in ambulatory children with cerebral palsy. M. Bonikowski, K. Sakławska, Ł. Gra˛bczewski. Movement Analysis Laboratory Zag´orze, Mazovian Neuropsychiatric and Rehabilitation Centre for Children and Youth Zag´orze n, Warsaw, Poland Summary: As it was established the main purpose of this study was to investigate a short-term outcome and effectiveness of BTX-A used in the high dose multilevel treatment of CP children. Conclusions: Multi-level treatment seems to improve ROM, the gait pattern and function of children with CP. Functional improvement depends on gait pattern before the treatment and age of a patient. Introduction: Botulinum toxin type A (BTX-A) reduces spasticity through partial denervation of the injected muscle. Multilevel BTX-A injections using high doses, have been successfully administered by prof. G. Molenaers [1] from University Hospital Pellenberg, Belgium, and prof. J. Becher [2] from VU Medisch Centrum Amsterdam for a few years. Patients/Materials and Methods: 60 children with bilateral spastic CP were treated. The children’s age varied from 3 to 10 years. The observation period lasted for at least 56 weeks. The injections were carried out with general anesthesia. BTX-A Botox used was of standard dilution of 50j/ml/NaCl in average dose of 20j/kg of body weight. Maximal doses reached 6j/kg for muscle group. Following muscles were treated: iliopsoas, rectus femoris, medial hamstrings, gastrocnemius, soleus, tibialis posterior. In cases of fixed contractures serial casts were applied for period of 2 to 4 weeks. All patients used AFO or GRAFO orthoses for walking. For assessment of the results passive ROM (range of motion) were used, as well as measurement of dynamic component (Tardieu test) and gait analysis using SYBAR 2.0 system (Noldus Holand). Gait function was assessed with 8-point gait independence scale. Results: In all the patients’ cases ROM improvements were affirmed as soon as 2 weeks after injections, as well as