Balance and gait is impaired in the majority of older people, especially those with age-related, neurological degeneration such as parkinsonism.
We aim to compare the postural and locomotor impairments resulting from two types of parkinsonism, idiopathic Parkinson's disease and Frontal Gait Disorder (also called vascular or lower body parkinsonism) using objective measures of postural control: anticipatory postural adjustments, postural sway in stance, automatic postural responses, locomotor measures of dynamic stability, arm swing, Freezing of Gait (FoG), and stride width. Our underlying hypothesis is that frontal lobe connections with the basal ganglia and brainstem posture/locomotor centers are responsible for postural deficits in both Parkinson's disease and Frontal Gait Disorders. Because of their common frontal cortex control, we predict that postural impairments will be related to executive cognitive impairments in both groups. We will also compare the integrity of brain locomotion circuitry in these patients who have as FoG, small APAs or impaired APRs. We predict that similar postural and locomotor disorders in both types of parkinsonism will share common neural network deficits, providing insight into which neural pathways are related to specific postural systems. We will also determine which postural, cognitive and circuitry impairments predict efficacy of a cognitively-challenging mobility rehabilitation.
The specific aims are: I. To characterize postural and cognitive impairments in patients with Frontal Gait Disorders, compared to idiopathic Parkinson's disease. We hypothesize that postural impairments will be related to executive impairments in both FGD and PD. II. To relate postural and cognitive disorders with deficits in brain posture/locomotor circuitry. We hypothesize that parkinsonian patients, who have similar postural disorders will share common structural postural/locomotor brain circuitry deficits using diffusion tensor imaging. III. To determine which postural, cognitive, and brain posture/locomotor circuitry deficits predict responsiveness to Agility Boot Camp (ABC) rehabilitation. We hypothesize that cognitive, postural, and/or posture/locomotion circuitry impairments at baseline will predict which patients improve with rehabilitation. Specifically, we predict that parkinsonian patients with FoG, executive dysfunction, and reduced white matter tracks from PPN to frontal cortex will show limited rehabilitation efficacy. This project will improve our understanding of the role of the frontal cortex in balance and gait and how cognitive impairments relate to postural disorders with the goal of improving mobility rehabilitation in the elderly.

Public Health Relevance

This is the first study to relate integrity of the brain's postural/locomotor circuits to objective measures of balance and gait disorders in patients with idiopathic Parkinson's disease compared to patients with Frontal Gait Disorders (e.g., vascular parkinsonism). This project will improve our understanding of the role of the frontal cortex in balance and gait and how cognitive impairments relate to postural disorders with the goal of improving mobility rehabilitation in the elderly.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
2R01AG006457-29
Application #
8695001
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Chen, Wen G
Project Start
1989-09-30
Project End
2019-03-31
Budget Start
2014-05-15
Budget End
2015-03-31
Support Year
29
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Oregon Health and Science University
Department
Neurology
Type
Schools of Medicine
DUNS #
City
Portland
State
OR
Country
United States
Zip Code
97239
Cruz, Caio Ferraz; Piemonte, Maria Elisa Pimentel; Okai-Nobrega, LĂ­ria Akie et al. (2018) Parkinson's disease does not alter automatic visual-motor coupling in postural control. Neurosci Lett 686:47-52
Huisinga, Jessie; Mancini, Martina; Veys, Chris et al. (2018) Coherence analysis of trunk and leg acceleration reveals altered postural sway strategy during standing in persons with multiple sclerosis. Hum Mov Sci 58:330-336
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Gilat, Moran; Ehgoetz Martens, Kaylena A; Miranda-DomĂ­nguez, Oscar et al. (2018) Dysfunctional Limbic Circuitry Underlying Freezing of Gait in Parkinson's Disease. Neuroscience 374:119-132
Bonora, Gianluca; Mancini, Martina; Carpinella, Ilaria et al. (2017) Investigation of Anticipatory Postural Adjustments during One-Leg Stance Using Inertial Sensors: Evidence from Subjects with Parkinsonism. Front Neurol 8:361
Van Ooteghem, Karen; Frank, James S; Horak, Fay B (2017) Postural motor learning in Parkinson's disease: The effect of practice on continuous compensatory postural regulation. Gait Posture 57:299-304
Mancini, Martina; Smulders, Katrijn; Cohen, Rajal G et al. (2017) The clinical significance of freezing while turning in Parkinson's disease. Neuroscience 343:222-228
Schlenstedt, Christian; Mancini, Martina; Horak, Fay et al. (2017) Anticipatory Postural Adjustment During Self-Initiated, Cued, and Compensatory Stepping in Healthy Older Adults and Patients With Parkinson Disease. Arch Phys Med Rehabil 98:1316-1324.e1
Dale, Marian L; Horak, Fay B; Wright, W Geoffrey et al. (2017) Impaired perception of surface tilt in progressive supranuclear palsy. PLoS One 12:e0173351

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