The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Jeffery J Summers - One of the best experts on this subject based on the ideXlab platform.
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workshop: executive summary
2002Co-Authors: Meg E Morris, Thomas A Matyas, Robert Iansek, Jeffery J SummersAbstract:Results of our previous studies have shown that the slow, Shuffling Gait of Parkinson's disease patients is due to an inability to generate appropriate stride length and that cadence control is intact and is used as a compensatory mechanism. The reason for the reduced stride length is unclear, although deficient internal cue production or inadequate contribution to cortical motor set by the basal ganglia are two possible explanations. In this study we have examined the latter possibility by comparing the long-lasting effects of visual cues in improving stride length with that of attentional strategies. Computerized stride analysis was used to measure the spatial (distance) and temporal (timing) parameters of the walking pattern in a total of 54 subjects in three separate studies. In each study Parkinson's disease subjects were trained for 20 min by repeated 10 m walks set at control stride length (determined from control subjects matched for age, sex and height), using either visual floo
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stride length regulation in parkinson s disease normalization strategies and underlying mechanisms
Brain, 1996Co-Authors: Meg E Morris, Thomas A Matyas, Robert Iansek, Jeffery J SummersAbstract:Summary Results of our previous studies have shown that the slow, Shuffling Gait of Parkinson's disease patients is due to an inability to generate appropriate stride length and that cadence control is intact and is used as a compensatory mechanism. The reason for the reduced stride length is unclear, although deficient internal cue production or inadequate contribution to cortical motor set by the basal ganglia are two possible explanations. In this study we have examined the latter possibility by comparing the long-lasting effects of visual cues in improving stride length with that of attentional strategies. Computerized stride analysis was used to measure the spatial (distance) and temporal (timing) parameters of the walking pattern in a total of 54 subjects in three separate studies. In each study Parkinson's disease subjects were trained for 20 min by repeated 10 m walks set at control stride length (determined from control subjects matched for age, sex and height), using either visual floor
Juergen Winkler - One of the best experts on this subject based on the ideXlab platform.
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Wearable sensors objectively measure Gait parameters in Parkinson's disease.
PloS one, 2017Co-Authors: Johannes C. M. Schlachetzki, Jens Barth, Franz Marxreiter, Julia Gossler, Zacharias Kohl, Samuel Reinfelder, Heiko Gassner, Kamiar Aminian, Bjoern M. Eskofier, Juergen WinklerAbstract:Distinct Gait characteristics like short steps and Shuffling Gait are prototypical signs commonly observed in Parkinson's disease. Routinely assessed by observation through clinicians, Gait is rated as part of categorical clinical scores. There is an increasing need to provide quantitative measurements of Gait, e.g. to provide detailed information about disease progression. Recently, we developed a wearable sensor-based Gait analysis system as diagnostic tool that objectively assesses Gait parameter in Parkinson's disease without the need of having a specialized Gait laboratory. This system consists of inertial sensor units attached laterally to both shoes. The computed target of measures are spatiotemporal Gait parameters including stride length and time, stance phase time, heel-strike and toe-off angle, toe clearance, and inter-stride variation from Gait sequences. To translate this prototype into medical care, we conducted a cross-sectional study including 190 Parkinson's disease patients and 101 age-matched controls and measured Gait characteristics during a 4x10 meter walk at the subjects' preferred speed. To determine intraindividual changes in Gait, we monitored the Gait characteristics of 63 patients longitudinally. Cross-sectional analysis revealed distinct spatiotemporal Gait parameter differences reflecting typical Parkinson's disease Gait characteristics including short steps, Shuffling Gait, and postural instability specific for different disease stages and levels of motor impairment. The longitudinal analysis revealed that Gait parameters were sensitive to changes by mirroring the progressive nature of Parkinson's disease and corresponded to physician ratings. Taken together, we successfully show that wearable sensor-based Gait analysis reaches clinical applicability providing a high biomechanical resolution for Gait impairment in Parkinson's disease. These data demonstrate the feasibility and applicability of objective wearable sensor-based Gait measurement in Parkinson's disease reaching high technological readiness levels for both, large scale clinical studies and individual patient care.
Marcos Baabor - One of the best experts on this subject based on the ideXlab platform.
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Deep Brain Stimulation Surgery for Parkinson Disease Coexisting With Communicating Hydrocephalus: A Case Report
Frontiers in neurology, 2018Co-Authors: Carlos Guevara, Jose De Grazia, Pedro F. Vázquez, Pablo Baabor, Cristian Garrido, Melissa Martinez, Jaime Fuentes, Fabian Piedimonte, Marcos BaaborAbstract:We report a successful bilateral globus pallidus internus-deep brain stimulation (GPi-DBS) for a Parkinson disease (PD) patient with idiopathic normal pressure hydrocephalus (INPH) and an unusually long anterior commissure-posterior commissure (AC-PC) line. A 54-year-old man presented with a history of 3 months of severe Shuffling Gait, rigidity, slow movements of the left side limbs, and difficulty managing finances. A brain MRI revealed marked ventriculomegaly (Evans index = 0.42). The patient was diagnosed with INPH and a ventriculoperitoneal shunt was placed. Cognitive impairment improved, but walking disturbances, slowness, and rigidity persisted. Then treatment with levodopa was added, and the patient experienced a sustained improvement. He was diagnosed with PD. After 7 years, the patient developed Gait freezing and severe levodopa-induced dyskinesia. The patient underwent bilateral GPi-DBS. We used MRI/CT fusion techniques for anatomical indirect targeting. Indirect targeting is based on standardized stereotactic atlas and on a formula-derived method based on AC-PC landmarks. The AC-PC line was 40 mm (the usual length is between 19 and 32 mm). Intraoperative microelectrode recording was a non-expendable test, but multiple recordings were avoided to reduce the surgical risk of ventricular involvement. There was a 71% decrease in the UPDRS III score during the on-stimulation state (28 to 8). The patient's dyskinesias resolved dramatically with a UdysRS of 15 (88% improvement) during the on-stimulation condition. The observed motor benefits and the improvement of his daily activities have persisted 6 months after surgery. Deep brain stimulation surgery in PD with ventriculomegaly is a challenge. This procedure can result in a greater chance of breaching the ventricle, with risks of intraventricular hemorrhage and migration of cerebrospinal fluid into the brain parenchyma with target displacement. Furthermore, clinical judgment is paramount when recent onset of Shuffling Gait coexists with ventriculomegaly because the most common dilemma is differentiating between PD and INPH. For these reasons, neurologists and surgeons may refuse to operate on PD patients with ventriculomegaly. However, DBS should be considered for PD patients with motor complications when responsiveness to levodopa is demonstrated, even in the context of marked ventriculomegaly.
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Video_1_Deep Brain Stimulation Surgery for Parkinson Disease Coexisting With Communicating Hydrocephalus: A Case Report.MP4
2018Co-Authors: Carlos Guevara, Jose De Grazia, Pablo Baabor, Cristian Garrido, Melissa Martinez, Jaime Fuentes, Fabian Piedimonte, Pedro Vazquez, Marcos BaaborAbstract:We report a successful bilateral globus pallidus internus-deep brain stimulation (GPi-DBS) for a Parkinson disease (PD) patient with idiopathic normal pressure hydrocephalus (INPH) and an unusually long anterior commissure-posterior commissure (AC-PC) line. A 54-year-old man presented with a history of 3 months of severe Shuffling Gait, rigidity, slow movements of the left side limbs, and difficulty managing finances. A brain MRI revealed marked ventriculomegaly (Evans index = 0.42). The patient was diagnosed with INPH and a ventriculoperitoneal shunt was placed. Cognitive impairment improved, but walking disturbances, slowness, and rigidity persisted. Then treatment with levodopa was added, and the patient experienced a sustained improvement. He was diagnosed with PD. After 7 years, the patient developed Gait freezing and severe levodopa-induced dyskinesia. The patient underwent bilateral GPi-DBS. We used MRI/CT fusion techniques for anatomical indirect targeting. Indirect targeting is based on standardized stereotactic atlas and on a formula—derived method based on AC-PC landmarks. The AC-PC line was 40 mm (the usual length is between 19 and 32 mm). Intraoperative microelectrode recording was a non-expendable test, but multiple recordings were avoided to reduce the surgical risk of ventricular involvement. There was a 71% decrease in the UPDRS III score during the on-stimulation state (28 to 8). The patient's dyskinesias resolved dramatically with a UdysRS of 15 (88% improvement) during the on-stimulation condition. The observed motor benefits and the improvement of his daily activities have persisted 6 months after surgery. Deep brain stimulation surgery in PD with ventriculomegaly is a challenge. This procedure can result in a greater chance of breaching the ventricle, with risks of intraventricular hemorrhage and migration of cerebrospinal fluid into the brain parenchyma with target displacement. Furthermore, clinical judgment is paramount when recent onset of Shuffling Gait coexists with ventriculomegaly because the most common dilemma is differentiating between PD and INPH. For these reasons, neurologists and surgeons may refuse to operate on PD patients with ventriculomegaly. However, DBS should be considered for PD patients with motor complications when responsiveness to levodopa is demonstrated, even in the context of marked ventriculomegaly.
Meg E Morris - One of the best experts on this subject based on the ideXlab platform.
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workshop: executive summary
2002Co-Authors: Meg E Morris, Thomas A Matyas, Robert Iansek, Jeffery J SummersAbstract:Results of our previous studies have shown that the slow, Shuffling Gait of Parkinson's disease patients is due to an inability to generate appropriate stride length and that cadence control is intact and is used as a compensatory mechanism. The reason for the reduced stride length is unclear, although deficient internal cue production or inadequate contribution to cortical motor set by the basal ganglia are two possible explanations. In this study we have examined the latter possibility by comparing the long-lasting effects of visual cues in improving stride length with that of attentional strategies. Computerized stride analysis was used to measure the spatial (distance) and temporal (timing) parameters of the walking pattern in a total of 54 subjects in three separate studies. In each study Parkinson's disease subjects were trained for 20 min by repeated 10 m walks set at control stride length (determined from control subjects matched for age, sex and height), using either visual floo
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The biomechanics and motor control of Gait in Parkinson disease.
Clinical biomechanics (Bristol Avon), 2001Co-Authors: Meg E Morris, Frances Huxham, Jennifer L. Mcginley, Karen J Dodd, Robert IansekAbstract:Parkinson disease is a progressive neurological condition characterised by hypokinesia (reduced movement), akinesia (absent movement), tremor, rigidity and postural instability. These movement disorders are associated with a slow short-stepped, Shuffling Gait pattern. Analysis of the biomechanics of Gait in response to medication, visual cues, attentional strategies and neurosurgery provides insight into the nature of the motor control deficit in Parkinson disease and the efficacy of current therapeutic interventions. In this article we supplement a critical evaluation of the Parkinson disease Gait literature with two case examples. The first case describes the kinematic Gait response of an individual with Parkinson disease to visual cues in the "off" phase of the levodopa medication cycle. The second case investigates the biomechanics and motor control of turning during walking in a patient with Parkinson disease compared with elderly and young control subjects. The results are interpreted in light of the need for Gait analysis to investigate complex functional walking tasks rather than confining assessment to straight line walking, which has been the trend to date.
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stride length regulation in parkinson s disease normalization strategies and underlying mechanisms
Brain, 1996Co-Authors: Meg E Morris, Thomas A Matyas, Robert Iansek, Jeffery J SummersAbstract:Summary Results of our previous studies have shown that the slow, Shuffling Gait of Parkinson's disease patients is due to an inability to generate appropriate stride length and that cadence control is intact and is used as a compensatory mechanism. The reason for the reduced stride length is unclear, although deficient internal cue production or inadequate contribution to cortical motor set by the basal ganglia are two possible explanations. In this study we have examined the latter possibility by comparing the long-lasting effects of visual cues in improving stride length with that of attentional strategies. Computerized stride analysis was used to measure the spatial (distance) and temporal (timing) parameters of the walking pattern in a total of 54 subjects in three separate studies. In each study Parkinson's disease subjects were trained for 20 min by repeated 10 m walks set at control stride length (determined from control subjects matched for age, sex and height), using either visual floor
Abdul Hamid Alraiyes - One of the best experts on this subject based on the ideXlab platform.
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Unusual presentation of sarcoidosis—involving testis, spinal cord and the brain
QJM : monthly journal of the Association of Physicians, 2012Co-Authors: M. C. Alraies, R. Desai, Abdul Hamid AlraiyesAbstract:A 37-year-old African American man with history of HTN presented with 3 months history of bilateral leg weakness, headaches, urinary retention and impotence. Initially he started to have headaches. A few weeks later he started complaining of bilateral leg numbness from the umbilicus area to the toes. On presentation his vitals were stable. He had normal cardiopulmonary and abdominal exam. The patient had decreased strength in both lower extremities (3/5 in both legs), with decreased light touch and painful sensation in both lower extremities. He had a wide-based Shuffling Gait. He was found to have a 1 cm firm lesion in the left testis. MRI spine showed numerous nodules in the dura, involving the cervical region and the cauda equine (Figures 1 and 2). Many of these lesions were also intramedullary. …
