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      Aspectos biomecânicos da locomoção de pessoas com doença de Parkinson: revisão narrativa Translated title: Aspectos biomecánicos de la locomoción de personas con enfermedad de Parkinson: una revisión Translated title: Biomechanical aspects of locomotion people with Parkinson's disease: review study

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          Abstract

          Resumo A presente revisão narrativa tem por objetivo analisar os aspectos biomecânicos da locomoção e os efeitos de intervenções nos padrões da marcha de pessoas com doença de Parkinson (DP). Fez-se uma pesquisa bibliográfica no banco de dados dos sistemas SciELO e PubMed, com as seguintes palavras: human locomotion, biomechanics, pathologic gait e Parkinson's disease, em periódicos nacionais e internacionais. Concluímos que as principais alterações biomecânicas são nos parâmetros espaçotemporais, como menor comprimento de passada e estabilidade dinâmica, além da baixa ativação muscular nos músculos propulsores, bem como menor velocidade autosselecionada da marcha. Fazem-se necessários protocolos de treinamento de caminhada que considerem esses parâmetros para auxiliar a reabilitação da marcha de pessoas com DP.

          Translated abstract

          Resumen La presente revisión tiene por objetivo analizar los aspectos biomecánicos de la locomoción y los efectos de las intervenciones en los patrones de la marcha en personas con enfermedad de Parkinson (EP). Se realizó una investigación bibliográfica en las bases de datos SciELO y PubMed, utilizando las siguientes palabras:human locomotion, biomechanics, pathologic gait y Parkinson's disease, en revistas nacionales e internacionales indexadas. Se llegó a la conclusión de que las principales alteraciones biomecánicas se encuentran en los parámetros espacio-temporales, como menor longitud de la zancada y estabilidad dinámica, además de una baja activación electromiográfica de los músculos propulsores, como menor velocidad autoseleccionada de la marcha. Estos resultados convierten en necesarios protocolos de entrenamiento de la marcha que tengan en cuenta estos parámetros para la rehabilitación de personas con EP.

          Translated abstract

          Abstract The purpose of this review was to analyze the biomechanical aspects of walking in individuals with Parkinson's disease (PD), as well as to examine the effects of intervention on gait pattern of PD. We carried out a bibliographic search on electronic databases SciELO and PubMed, using the following words: human locomotion, biomechanics, pathologic gait e Parkinson's disease, in national and international scientific journals. The main alterations on walking biomechanics are related to spatiotemporal parameters, lower stride length and dynamical stability, as well as reduced electromyographic activation on propulsion muscles and lower self-selected speed. These outcomes seem to be important targets in walking training protocols for rehabilitation of gait in PD.

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          Impaired regulation of stride variability in Parkinson's disease subjects with freezing of gait.

          Patients with Parkinson's disease (PD) often experience freezing of gait, a debilitating phenomenon during which the subject suddenly becomes unable to start walking or to continue to move forward. Little is known about the gait of those subjects with PD who experience freezing of gait or the pathophysiology of freezing. One possibility is that freezing of gait is a truly paroxysmal phenomenon and that the usual walking pattern of subjects who experience freezing of gait is not different than that of other patients with PD who do not experience these transient episodes of freezing of gait. On the other hand, a recent study noted gait changes just prior to freezing and concluded that dyscontrol of the cadence of walking contributes to freezing. To address this question, we compared the gait of PD subjects with freezing of gait to PD subjects without freezing of gait. Given the potential importance of the dyscontrol of the cadence of walking in freezing, we focused on two aspects of gait dynamics: the average stride time (the inverse of cadence, a measure of the walking pace or rate) and the variability of the stride time (a measure of "dyscontrol," arrhythmicity and unsteadiness). We found that although the average stride time was similar in subjects with and without freezing, stride-to-stride variability was markedly increased among PD subjects with freezing of gait compared to those without freezing of gait, both while "on" (P<0.020) and "off" (P<0.002) anti-parkinsonian medications. Further, we found that increased gait variability was not related to other measures of motor control (while off medications) and levodopa apparently reduced gait variability, both in subjects with and without freezing. These results suggest that a paradigm shift should take place in our view of freezing of gait. PD subjects with freezing of gait have a continuous gait disturbance: the ability to regulate the stride-to-stride variations in gait timing and maintain a stable walking rhythm is markedly impaired in subjects with freezing of gait. In addition, these findings suggest that the inability to control cadence might play an important role in this debilitating phenomenon and highlight the key role of dopamine-mediated pathways in the stride-to-stride regulation of walking.
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            Stride length regulation in Parkinson's disease. Normalization strategies and underlying mechanisms.

            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 markers or a mental picture of the appropriate stride size. Following training, the gait patterns were monitored (i) every 15 min for 2 h; (ii) whilst interspersing secondary tasks of increasing levels of complexity; (iii) covertly, when subjects were unaware that measurement was taking place. The results demonstrated that training with both visual cues and attentional strategies could maintain normal gait for the maximum recording time of 2 h. Secondary tasks reduced stride length towards baseline values as did covert monitoring. The findings confirm that the ability to generate a normal stepping pattern is not lost in Parkinson's disease and that gait hypokinesia reflects a difficulty in activating the motor control system. Normal stride length can be elicited in Parkinson's disease using attentional strategies and visual cues. Both strategies appear to share the same mechanism of focusing attention on the stride length. The effect of attention appears to require constant vigilance to prevent reverting to more automatic control mechanisms.
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              The influence of gait speed on local dynamic stability of walking.

              The focus of this study was to examine the role of walking velocity in stability during normal gait. Local dynamic stability was quantified through the use of maximum finite-time Lyapunov exponents, lambda(Max). These quantify the rate of attenuation of kinematic variability of joint angle data recorded as subjects walked on a motorized treadmill at 20%, 40%, 60%, and 80% of the Froude velocity. A monotonic trend between lambda(Max) and walking velocity was observed with smaller lambda(Max) at slower walking velocities. Smaller lambda(Max) indicates more stable walking dynamics. This trend was evident whether stride duration variability remained or was removed by time normalizing the data. This suggests that slower walking velocities lead to increases in stability. These results may reveal more detailed information on the behavior of the neuro-controller than variability-based analyses alone.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbce
                Revista Brasileira de Ciências do Esporte
                Rev. Bras. Ciênc. Esporte
                Colégio Brasileiro de Ciências do Esporte (Porto Alegre, RS, Brazil )
                0101-3289
                2179-3255
                December 2017
                : 39
                : 4
                : 450-457
                Affiliations
                [3] Porto Alegre RS orgnameHospital de Clínicas de Porto Alegre orgdiv1Setor de Pesquisas em Distúrbios do Movimento Brasil
                [1] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal do Rio Grande do Sul orgdiv1Programa de Pós-Graduação em Ciências do Movimento Humano orgdiv2Laboratório de Pesquisa do Exercício Brazil
                [4] Porto Alegre Rio Grande do Sul orgnamePontifícia Universidade Católica do Rio Grande do Sul orgdiv1Laboratório de Biologia Desenvolvimental e Neurobiologia Brazil
                [2] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal de Ciências da Saúde de Porto Alegre orgdiv1Programa de Pós-Graduação em Ciências da Saúde Brazil
                Article
                S0101-32892017000400450
                10.1016/j.rbce.2016.07.003
                0d6f505b-ea3d-4e18-962a-902649322942

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 07 December 2015
                : 30 July 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 8
                Product

                SciELO Brazil


                Cinemática,Electromiografía,Marcha patológica,Parkinsonismo primario,Eletromiografia,Parkinsonismo primário,Kinematic,Electromyography,Pathologic gait,Parkinsonism

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