Abstract
BackgroundThe supplementary motor area (SMA) is implicated in stereotypic multi-limb movements such as walking with arm swing. Gait difficulties in Parkinson's Disease (PD) include reduced arm swing, which is associated with reduced SMA activity. ObjectiveTo test whether enhanced arm swing improves Parkinsonian gait and explore the role of the SMA in such an improvement. MethodsCortical activity and gait characteristics were assessed by ambulant EEG, accelerometers and video recordings in 27 PD patients with self-reported gait difficulties and 35 healthy participants when walking normally. Within these two groups, 19 PD patients additionally walked with enhanced arm swing and 30 healthy participants walked without arm swing. Power changes across the EEG frequency spectrum were assessed by Event Related Spectral Perturbation analysis of recordings from Fz over the putative SMA and gait analysis was performed. ResultsBaseline PD gait, characterized by reduced arm swing among other features, exhibited reduced within-step Event Related Desynchronization (ERD)/Synchronization (ERS) alternation (Fz; 20–50Hz), accompanied by a reduced step length and walking speed. All became similar to normal gait when patients walked with enhanced arm swing. When healthy controls walked without arm swing, their alternating ERD-ERS pattern decreased, mimicking baseline PD gait. ConclusionEnhanced arm swing may serve as a driving force to overcome impaired gait control in PD patients by restoring reduced ERD-ERS alternation over the putative SMA. Accompanied by increased step length and walking speed, this provides a neural underpinning of arm swing as an effective rehabilitation concept for improving Parkinsonian gait.
Highlights
Parkinson’s Disease (PD) is characterized by a wide spectrum of motor and non-motor symptoms
This changed Event Related Desynchronization (ERD)-ERS pattern in healthy subjects mimicked the pattern of less demarcated ERD-ERS alternation over the mediofrontal cortex of PD baseline gait, accompanied by reduced or absent arm swing. In both groups, reduced power modulations were accompanied by shorter steps, while only in PD patients this resulted in reduced walking speed. This points at a consistent association between well-demarcated ERD-ERS alternations over the mediofrontal cortex, arm swing and efficient gait, which can be attentively modulated in both healthy participants and PD patients
Ambulatory EEG and accelerometer recordings during overground walking demonstrated that baseline PD gait, characterized by reduced arm swing, exhibited reduced within-step 20–50 Hz ERD-ERS alterna tion over the mediofrontal cortex accompanied by reduced step length and walking speed compared to healthy participants
Summary
Parkinson’s Disease (PD) is characterized by a wide spectrum of motor and non-motor symptoms. Behavioral studies have claimed that enhancing arm swing increases walking speed and step length in PD patients [10,11]. These findings laid ground for the present study, testing whether enhanced arm swing during continuous gait might serve as an SMA-mediated driving force to overcome impaired gait control in PD. Results: Baseline PD gait, characterized by reduced arm swing among other features, exhibited reduced withinstep Event Related Desynchronization (ERD)/Synchronization (ERS) alternation (Fz; 20–50Hz), accompanied by a reduced step length and walking speed. Conclusion: Enhanced arm swing may serve as a driving force to overcome impaired gait control in PD patients by restoring reduced ERD-ERS alternation over the putative SMA. Accompanied by increased step length and walking speed, this provides a neural underpinning of arm swing as an effective rehabilitation concept for improving Parkinsonian gait
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