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. 2009 Feb;23(2):166-76.
doi: 10.1177/1545968308320639. Epub 2008 Nov 3.

A kinematic and electromyographic analysis of turning in people with Parkinson disease

Minna Hong  1 , Joel S Perlmutter, Gammon M Earhart
Affiliations

A kinematic and electromyographic analysis of turning in people with Parkinson disease

Minna Hong et al. Neurorehabil Neural Repair. 2009 Feb.

Abstract

Background: Parkinson disease frequently causes difficulty turning that can lead to falls, loss of independence, and diminished quality of life. Turning in tight spaces, which may be particularly impaired in Parkinson disease, is an essential part of our daily lives, yet a comprehensive analysis of in-place turning has not been published.

Objective: This study was conducted to determine whether there are objective differences in turning between people with Parkinson disease and unimpaired people.

Methods: In-place turning with kinematics and electromyographic measures was characterized in 11 participants with Parkinson disease and 12 healthy people. Kinematic data were recorded using a 3-dimensional motion capture system in synchrony with electromyographic data from lower extremity muscles as participants turned 180 degrees . Those with Parkinson disease were tested after overnight withdrawal of medication.

Results: Both groups used 2 distinct turning strategies. In one, the foot ipsilateral to the turning direction initiated the turn; in the other, the foot contralateral to the turning direction initiated the turn. Kinematic analysis demonstrated a craniocaudal sequence of turning in the unimpaired group, whereas those with Parkinson disease had a simultaneous onset of yaw rotation of the head, trunk, and pelvis. They also took a longer time and more steps to complete turns. Overall, lower extremity muscle activation patterns appeared similar between groups.

Conclusion: Differences between the groups were noted for axial control, but lower extremity muscle patterns were similar. This work may provide the foundation for development of new treatments for turning difficulty in Parkinson disease.

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Figures

Figure 1
Figure 1
Distribution of different turning strategies used for PD and unimpaired groups.
Figure 2
Figure 2
Plots of yaw plane angles in the lab coordinate system, of different segments for an unimpaired person (A) and a person with PD (B) as they performed a 180 degree turn.
Figure 3
Figure 3
Normalized onsets of rotation in the yaw plane of the head, trunk and pelvis for unimpaired and PD groups. Asterisk indicates a statistically significant difference between head onset and pelvis onset in the unimpaired group (p<0.05).
Figure 4
Figure 4
Comparison of amplitude of absolute yaw rotation angles for the head, trunk, pelvis, and starting foot for unimpaired and PD groups. Asterisks indicate statistically significant differences between the two group (all p<0.001).
Figure 5
Figure 5
Illustration of rectified EMG data for rightward turns in an unimpaired person. (A) exemplifies muscle activity patterns during a R start R turn and (B) exemplifies a R start L turn. The two vertical lines denote the beginning and end of the stride.
Figure 6
Figure 6
Illustration of all four turning strategies, normalized to the first stride, in the unimpaired group.
Figure 7
Figure 7
Illustration of rectified EMG data for leftward turns in a person with PD. (A) exemplifies muscle activity patterns during a L start L turn and (B) exemplifies a L start R turn. The two vertical lines denote the beginning and end of the stride.
Figure 8
Figure 8
Illustration of Matched and Unmatched Strategies for unimpaired and PD group. Muscles are labeled I (ipsilateral) or C (contralateral) relative to the direction of the turns. Asterisks indicate statistically significant differences in onset and offset of muscles between the two groups (p<0.05).
See this image and copyright information in PMC

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