Using Lower Limb Range of Motion to Examine the Effects of High and Low Frequency Deep Brain Stimulation on Gait Function of Parkinson’s Disease Patients with Freezing of Gait

• Main Authors: Nien, Ching, 粘擎
• Other Authors: Yang, Bing-Shiang
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/9ae668

碩士 === 國立交通大學 === 機械工程系所 === 106 === Parkinson’s disease (PD) patients’ gait function deteriorated after deep brain stimulation (DBS) was implanted and patients usually developed Freezing of gait (FOG). Compared to the conventional high frequency (130 Hz) stimulation, low frequency (60 Hz) stimulation could ameliorate gait function. Unfortunately, current clinical assessment and temporal gait parameters could not obviously observe the various gait performance in different stimulation conditions and FOG severity evaluation depended on subjective freezing of gait questionnaire. And that results in high risk of falling. Hence, the purpose of this study was using spatial parameters including the range of motion (ROM) of shank, thigh and knee to evaluate gait performance in different stimulation conditions, also examining whether the parameters could correlate to FOG severity. 3 PD patients (P1: 63 years, DBS surgery 4 moths, P 2: 70 years, DBS surgery 5 months, P 3: 59 years, DBS surgery 9 years) with FOG under high frequency DBS condition were recruited, and 5 inertial sensors were attached to subjects’ sacrum, thighs and shanks separately. Subjects were instructed to walk on a 100 m path under three conditions: 60 Hz, 130 Hz and off DBS. The power spectrum results of shank angular velocity in sagittal plane was used to distinguish whether FOG occur in path walking. Evaluation parameters including 1. spatial parameters: shank, thigh and knee ROM in sagittal plane 2. temporal parameters: stride time, stance time and percentage, swing time and percentage, double support time percentage 3. clinical assessment: Stand-walk-sit test (SWSt) completion time and part III of Unified Parkinson’s Disease Rating Scale (UPDRS). The results show that unaffected side (right leg) shank ROM of P1, P2 and P3 significantly increased 13.2%、99.6%、6.1% in 60 Hz condition when compared to 130 Hz condition. In temporal parameters results, only double support time percentage was significantly different between 60 Hz and 130 Hz conditions in all 3 subjects. When compared to 130 Hz condition, the double support time % of S1 and S2 significantly decreased 6.3% and 18.4% in 60 Hz condition, and that of S3 significantly increased 4.4%. Shank ROM of unaffected side (right leg) and the percentage of FOG in path walking were highly correlated (R2 = 0.71). UPDRS score variation of 60 Hz to off DBS condition and 130 Hz to off DBS condition were not significantly different. Only S1 and S2 SWS completion time significantly decreased 42.9% and 42.4% in 60 Hz condition compared to 130 Hz condition. In conclusion, all subjects’ shank ROM of unaffected side (right leg) significantly increased in 60 Hz condition when compared to 130 Hz condition. Shank ROM was highly correlated to severity of FOG. Therefore, clinicians could evaluate gait performance and severity of FOG when DBS frequency is adjusted immediately.