Article

Gait and balance disturbances in Parkinson's disease (PD) can be debilitating and
may lead to increased fall risk. Deep brain stimulation (DBS) is a treatment
option once therapeutic benefits from medication are limited due to motor
fluctuations and dyskinesia. Optimizing DBS parameters for gait and balance can
be significantly more challenging than for other PD motor symptoms. Furthermore,
inter-rater reliability of the standard clinical PD assessment scale, Unified
Parkinson's Disease Rating Scale (UPDRS), may introduce bias and washout
important features of gait and balance that may respond differently to PD
therapies. Study objectives were to evaluate clinician UPDRS gait and balance
scoring inter-rater reliability, UPDRS sensitivity to different aspects of gait
and balance, and how kinematic features extracted from motion sensor data respond
to stimulation. Forty-two subjects diagnosed with PD were recruited with varying
degrees of gait and balance impairment. All subjects had been prescribed
dopaminergic medication, and 20 subjects had previously undergone DBS surgery.
Subjects performed seven items of the gait and balance subset of the UPDRS while
wearing motion sensors on the sternum and each heel and thigh. Inter-rater
reliability varied by UPDRS item. Correlation coefficients between at least one
kinematic feature and corresponding UPDRS scores were greater than 0.75 for six
of the seven items. Kinematic features improved (p<0.05) from DBS-OFF to DBS-ON
for three UPDRS items. Despite achieving high correlations with the UPDRS,
evaluating individual kinematic features may help address inter-rater reliability
issues and rater bias associated with focusing on different aspects of a motor
task.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS