Elisa Pelosin1,2, Cecilia Cerulli1, Carla Ogliastro1,2, Giovanna Lagravinese1, Laura Mori1,2, Gaia Bonassi3, Anat Mirelman4,5, Jeffrey M Hausdorff4,6,7, Giovanni Abbruzzese1,2, Roberta Marchese2, Laura Avanzino2,3. 1. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Italy. 2. Ospedale Policlinico San Martino, IRCSS, Genova, Italy. 3. Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Italy. 4. Center for the Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Israel. 5. Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel. 6. Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel. 7. Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Abstract
BACKGROUND: Falls are frequent in Parkinson's disease and aging. Impairments in the cholinergic-mediated attentional supervision of gait may contribute to increased fall risk, especially when obstacles challenge gait. Interventions combining motor-cognitive approaches have been shown to improve motor performance, cognitive skills, and falls number. Here, we hypothesized that an intervention simulating an attention-demanding walking condition could affect not only complex gait performance and fall risk but also short-latency afferent inhibition (SAI), as a marker of cholinergic activity. METHODS:Thirty-nine participants at falls risk (24 Parkinson's disease participants and 15 older adults) were recruited in a randomized controlled trial. Participants were assigned to treadmill training or treadmill training with non-immersive virtual reality intervention and trained three times a week for 6 weeks. SAI, a transcranial magnetic stimulation paradigm, was used to assess cholinergic activity. Gait kinematics was measured during usual walking and while negotiating physical obstacles. Transcranial magnetic stimulation and gait assessments were performed pre, post, and 6 months post-intervention. RESULTS:Treadmill training combined with non-immersive virtual reality induced an increase in inhibition of the SAI protocol on cortical excitability, improved obstacle negotiation performance, and induced a reduction of the number of falls compared with treadmill training. Furthermore, the more SAI increased after training, the more the obstacle negotiation performance improved and fall rate decreased. CONCLUSIONS: We provide evidence that an innovative rehabilitation approach targeting cognitive components of complex motor actions can induce changes in cortical cholinergic activity, as indexed by SAI, thereby enabling functional gait improvements.
RCT Entities:
BACKGROUND: Falls are frequent in Parkinson's disease and aging. Impairments in the cholinergic-mediated attentional supervision of gait may contribute to increased fall risk, especially when obstacles challenge gait. Interventions combining motor-cognitive approaches have been shown to improve motor performance, cognitive skills, and falls number. Here, we hypothesized that an intervention simulating an attention-demanding walking condition could affect not only complex gait performance and fall risk but also short-latency afferent inhibition (SAI), as a marker of cholinergic activity. METHODS: Thirty-nine participants at falls risk (24 Parkinson's diseaseparticipants and 15 older adults) were recruited in a randomized controlled trial. Participants were assigned to treadmill training or treadmill training with non-immersive virtual reality intervention and trained three times a week for 6 weeks. SAI, a transcranial magnetic stimulation paradigm, was used to assess cholinergic activity. Gait kinematics was measured during usual walking and while negotiating physical obstacles. Transcranial magnetic stimulation and gait assessments were performed pre, post, and 6 months post-intervention. RESULTS: Treadmill training combined with non-immersive virtual reality induced an increase in inhibition of the SAI protocol on cortical excitability, improved obstacle negotiation performance, and induced a reduction of the number of falls compared with treadmill training. Furthermore, the more SAI increased after training, the more the obstacle negotiation performance improved and fall rate decreased. CONCLUSIONS: We provide evidence that an innovative rehabilitation approach targeting cognitive components of complex motor actions can induce changes in cortical cholinergic activity, as indexed by SAI, thereby enabling functional gait improvements.
Authors: Natalie E Allen; Colleen G Canning; Lorena Rosa S Almeida; Bastiaan R Bloem; Samyra Hj Keus; Niklas Löfgren; Alice Nieuwboer; Geert Saf Verheyden; Tiê P Yamato; Catherine Sherrington Journal: Cochrane Database Syst Rev Date: 2022-06-06
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Authors: Letizia Pezzi; Andrea Di Matteo; Roberta Insabella; Sara Mastrogiacomo; Carlo Baldari; Victor Machado Reiss; Teresa Paolucci Journal: Parkinsons Dis Date: 2022-09-16
Authors: Elisa Pelosin; Chiara Ponte; Martina Putzolu; Giovanna Lagravinese; Jeffrey M Hausdorff; Alice Nieuwboer; Pieter Ginis; Lynn Rochester; Lisa Alcock; Bastiaan R Bloem; Freek Nieuwhof; Andrea Cereatti; Ugo Della Croce; Anat Mirelman; Laura Avanzino Journal: Front Aging Neurosci Date: 2022-01-05 Impact factor: 5.750
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