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Gait and upper limb variability in Parkinson’s disease patients with and without freezing of gait

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Abstract

Patients with Parkinson’s disease (PD) and freezing of gait (FOG) (freezers) demonstrate high gait variability. The objective of this study was to determine whether freezers display a higher variability of upper limb movements and elucidate if these changes correlate with gait. We were the first group to compare directly objectively measured gait and upper limb movement variability of freezers between freezing episodes. Patients with objectively verified FOG (n = 11) and PD patients without FOG (non-freezers) (n = 11) in a non-randomized medication condition (OFF/ON) were analyzed. Uncued antiphasic finger tapping and forearm diadochokinetic movements were analyzed via three-dimensional ultrasound kinematic measurements. Gait variability of straight gait was assessed using ground reaction forces. Freezers had shorter stride length (p = 0.004) and higher stride length variability (p = 0.005) in the medication OFF condition. Movement variability was not different during finger tapping or diadochokinesia between the groups. There was a trend towards more freezing of the upper limb during finger tapping for the freezers (p = 0.07). Variability in stride length generation and stride timing was not associated with variability of upper limb movement in freezers. Our findings demonstrate that: (1) freezers have a higher spatial gait variability between freezing episodes; (2) freezing-like episodes of the upper limb occur in PD patients, and tend to be more pronounced among freezers than non-freezers for finger tapping; (3) spatial and temporal upper extremity variability is equally affected in freezers and non-freezers in an uncued task. Upper limb freezing is not correlated to lower limb freezing, implicating a different pathophysiology.

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Abbreviations

CoF:

Center of force

CV:

Coefficient of variation

FOG:

Freezing of gait

FOGQ:

Freezing of gait questionnaire

FOUL:

Freezing of the upper limb

ITI:

Inter tap interval

MMSE:

Mini-mental state examination

PD:

Parkinson’s disease

TTD:

Total travel distance

UPDRS:

Unified Parkinson’s Disease Rating Scale

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Acknowledgments

We thank the patients for their cooperation, as well as B. Tutlewski for her support with gait measurements. The study was funded by the German Research Foundation (KFO 219).

Conflicts of interest

M.T.B: received honoraria for speaking engagements from GE Medical and Medtronic Inc. and travel grants from Medtronic Inc.

M.A: none.

A.H.S: Grants: Prinses Beatrix Fonds (PBF), Netherlands Organisation for Health Research and Development (NWO) grant 92.003.490), employment Radboud University Medical Centre (RUNMC) none.

E.F.: none.

E.L.Q.: none.

B.R.B.: RUNMC employment, grants from NWO/ZonMw, PBF, MJ Fox Foundation, Consultancy for GlaxoSmithKline, Boehringer Ingelheim, TEVA, UCB, Novartis.

E.S.: study support by Novotec medical, Pforzheim, Germany.

G.R.F.: GRF serves as an editorial board member of Cortex, Zeitschrift für Neuropsychologie and Fortschritte der Neurologie Psychiatrie; receives royalties from the publication of the book Funktionelle MRT in Psychiatrie und Neurologie and Neurologische Differentialdiagnose; received honoraria for speaking engagements from TEVA, GlaxoSmith-Kline and Boehringer Ingelheim; and receives research support from the Bundesministerium für Bildung und Forschung and the Deutsche Forschungsgemeinschaft.

L.T.: Consulting: Medtronic Inc, Boston Scientific, Bayer Healthcare, UCB Schwarz Pharma Honoraria on sponsored symposia: TEVA Pharma, Lundbeck Pharma, Bracco, Gianni PR, Medas Pharma, UCB Schwarz Pharma, Desitin Pharma, Bayer Vital, Boehringer Ingelheim, GlaxoSmithKline, Eumecom, Orion Pharma, Medtronic, Boston Scientific, Cephalon, Abott, GE Medical, Grants: DFG, BMBF, Manfred und Ursula.

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Authors and Affiliations

  1. Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Michael T. Barbe, Martin Amarell, Esther Florin, Eva-Lotte Quatuor, Gereon R. Fink & Lars Timmermann

  2. Institute for Neuroscience and Medicine, INM-3, Forschungszentrum Jülich, Jülich, Germany

    Michael T. Barbe & Gereon R. Fink

  3. Department of Neurology, Parkinson Center Nijmegen, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands

    Anke H. Snijders & Bastiaan R. Bloem

  4. Department of Pediatrics, University Hospital Cologne, Cologne, Germany

    Eckhard Schönau

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  1. Michael T. Barbe
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Correspondence to Michael T. Barbe.

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M. T. Barbe and M. Amarell contributed equally.

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Barbe, M.T., Amarell, M., Snijders, A.H. et al. Gait and upper limb variability in Parkinson’s disease patients with and without freezing of gait. J Neurol 261, 330–342 (2014). https://doi.org/10.1007/s00415-013-7199-1

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  • DOI: https://doi.org/10.1007/s00415-013-7199-1

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