Sensorimotor control of reactive balance in individuals with Parkinson's disease before and after adapted tango
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1 Sensorimotor control of rectie blnce in iniiuls with Prkinson's isese before n fter pte tngo J. Lucs McKy, Ph.D. Emory Uniersity n Georgi Tech Len H. Ting, Ph.D. Emory Uniersity n Georgi Tech Meleine E. Hckney, Ph.D. Atlnt VAMC / Emory Uniersity Supporte in prt by PHS Grnt UL1 RR from the Clinicl n Trnsltionl Science Awr Progrm, NIH, NCRR n NIH HD46922
2 Sensorimotor control of rectie blnce in iniiuls with Prkinson's isese before n fter pte tngo J. Lucs McKy, Ph.D. Emory Uniersity n Georgi Tech Len H. Ting, Ph.D. Emory Uniersity n Georgi Tech Meleine E. Hckney, Ph.D. Atlnt VAMC / Emory Uniersity Supporte in prt by PHS Grnt UL1 RR from the Clinicl n Trnsltionl Science Awr Progrm, NIH, NCRR n NIH HD46922
3 Posturl instbility in Prkinson s isese les to flls n injury PD is neuroegenertie isorer ffecting the bsl gngli in the brin Posturl instbility is hllmrk sign of PD 3-month fll rte in PD 46%; 1 6-month fll rte in PD 5 s. gemtche ults 2 Posturl instbility my be poorly responsie to phrmcotherpy 2,4 or DBS 5 1 Pickering RM et l. Mo Disor 22: , 2007; 2 Bloem BR et l. J Neurol 248: , Melton LJ, 3 r et l. Mo Disor 21: , 2006; 4 Klwns HL. Mo Disor 1: , 1986; 5 St George RJ et l. Neurology 75: , 2010
4 Apte tngo (AT) improes blnce n mobility in iniiuls with PD Promotes herence counters excessie ttrition in PD Apte for PD sfety, ynmic blnce, internl + externl moement cues Effectie gins on Berg Blnce Scle, git spee, n other clinicl mesures 1-4 retine for 1 month 1 1 Hckney ME, n Erhrt GM. Neurorehbil Neurl Repir 24: , 2010; 2 Am J Dnce Ther 31: 41-45, 2010; 3 J Rehbil Me 41: , Duncn RP, n Erhrt GM. Neurorehbil Neurl Repir 26: , 2012
5 Deficit Wht re the neurl mechnisms of posturl instbility in PD? Neurorehbilittion How oes pte tngo improe posturl instbility in iniiuls with PD?
6 We use rectie blnce prigm n to ientify neurl mechnisms of blnce Motion cpture system Trnsltion Perturbtion Pltform Electromyogrphy (EMG) electroes Chtl SA, Torres-Oieo G, Sfyni SA, n Ting LH. J Neurophysiol 106: , 2011 Sfyni SA, n Ting LH. J Neurophysiol 107: , 2012
7 The sensorimotor response moel (SRM) escribes mpping from to EMG Sensory estimtes of center of mss () Sensorimotor Response Moel (SRM) Motor responses mesure with electromyogrm (EMG) Lockhrt DB, n Ting LH. Nt Neurosci 10: , 2007 Welch TDJ, n Ting LH. J Neurophysiol 101: , 2009; Sfyni SA, n Ting LH. J Neurophysiol 109: 31-45, 2013
8 Agonists re recruite in proportion to (t) bckwr bckwr brinstem & spinl cor feebck gins ely elye scle sum threshol tibilis nterior (TA) δ(t-λ) support surfce trnsltion Sensory estimtes of center of mss () Sensorimotor Response Moel (SRM) Motor responses mesure with electromyogrm (EMG)
9 Agonists re recruite in proportion to (t) bckwr bckwr brinstem & spinl cor feebck gins ely elye scle sum threshol tibilis nterior (TA) δ(t-λ) support surfce trnsltion Sensory estimtes of center of mss () Sensorimotor Response Moel (SRM) Motor responses mesure with electromyogrm (EMG)
10 Agonists re recruite in proportion to (t) bckwr bckwr brinstem & spinl cor feebck gins ely elye scle sum threshol reconstructe TA timing n mgnitue tibilis nterior (TA) δ(t-λ) recore TA EMG support surfce trnsltion Sensory estimtes of center of mss () Sensorimotor Response Moel (SRM) Motor responses mesure with electromyogrm (EMG)
11 Antgonists re lso recruite in proportion to t the en of the perturbtion (t) forwr forwr brinstem & spinl cor feebck gins ely elye scle sum threshol meil gstrocnemius (MG) support surfce trnsltion bckwr bckwr feebck gins δ(t-λ) brinstem & spinl cor ely bsl gngli elye scle sum inhibit inpproprite progrm threshol δ(t-λ)
12 Antgonists cn lso coctite with gonists t the strt of the perturbtion (t) forwr forwr brinstem & spinl cor feebck gins ely elye scle sum threshol meil gstrocnemius (MG) support surfce trnsltion bckwr bckwr feebck gins δ(t-λ) brinstem & spinl cor ely bsl gngli elye scle sum inhibit inpproprite progrm threshol δ(t-λ) Coctition with thret: Crpenter MG, Frnk JS, Akin AL, Pton A, Allum JH. J Neurophysiol 92: , 2004
13 The bsl gngli my selectiely inhibit lternte motor progrms (t) forwr forwr brinstem & spinl cor feebck gins ely elye scle sum threshol meil gstrocnemius (MG) support surfce trnsltion bckwr bckwr feebck gins δ(t-λ) brinstem & spinl cor ely bsl gngli elye scle sum inhibit inpproprite progrm threshol δ(t-λ) Bsl gngli motor progrm selection : Mink, JW. Prog Neurobiol 50: , 1996
14 Impire motor progrm selection my result in inpproprite coctition in PD meil gstrocnemius (MG) (t) support surfce trnsltion forwr forwr bckwr bckwr brinstem & spinl cor feebck gins feebck gins ely δ(t-λ) brinstem & spinl cor ely elye scle PD bsl gngli elye scle sum sum threshol insufficient inhibition threshol increse ntgonist coctition ue to inpproprite progrm recore MG EMG H&Y 2 H δ(t-λ) Compromise motor progrm selection in PD: Mink, JW. Prog Neurobiol 50: , 1996 Hork FB, Frnk J, n Nutt J. J Neurophysiol 75: , 1996; Helmich, RC, Arts, E, e Lnge, FP, Bloem, B, Toni, I. J Neurosci 29: , 2009
15 If AT improes bsl gngli progrm selection, we preict: Clinicl mobility mesures pre-at post-at
16 If AT improes bsl gngli progrm selection, we preict: Clinicl mobility mesures Approprite SRM feebck gins Inpproprite SRM feebck gins pre-at post-at
17 We trcke 9 iniiuls with PD before n fter 3-week AT 3-week PD pte tngo PRE N=22 3-week PD pte tngo POST N=20 PD 3-wee Apte Tngo Pre (Ull) N=9 Rectie blnce PRE & POST N=9 Apte rgentine tngo lessons lessons / 3 weeks 1.5 h / lesson ON mes ssessment 1 Hckney ME, n Erhrt GM. Neurorehbil Neurl Repir 24: , 2010; 2 Am J Dnce Ther 31: 41-45, 2010; 3 Complement Ther Me 17: , 2009
18 3-week AT improe clinicl scles of blnce n mobility in iniiuls with PD Mximum Possible Score Pre (N=9) Post (N=9) P-lue Unifie Prkinson s Disese Rting Scle Motor Subscle III 56 30±5 28± * Berg Blnce Scle 56 50±7 54± * Fullerton Ance Blnce Scle 40 27±8 31± * Dynmic Git Inex 24 19±4 21±3 0.09
19 3-week AT reuce ntgonist SRM gins n increse gonist SRM gins Pre-AT Subject 3 H&Y 2.5 (t) TA Kp=0.024, K=0.054, K=0.661,T=0.100 Kp=0.000, K=0.000, K=0.000,T=0.100 bis=0.093,r2=0.553, VAF=0.759 EMG (men) EMG (trils) SRM fit Appoprite SRM Component Inpproprite SRM Component Kp=0.000, K=0.000, K=0.000,T=0.100 Kp=0.035, K=0.036, K=0.507,T=0.100 MG bis=0.369,r2=0.559, VAF=0.925 support surfce trnsltion 5 cm 0.0 (sec) 1.0
20 3-week AT reuce ntgonist SRM gins n increse gonist SRM gins Subject 3 H&Y 2.5 Pre-AT Kp=0.024, K=0.054, K=0.661,T=0.100 Post-AT Kp=0.020, K=0.036, K=1.331,T=0.100 (t) TA Kp=0.000, K=0.000, K=0.000,T=0.100 bis=0.093,r2=0.553, VAF=0.759 Kp=0.036, K=0.012, K=0.001,T=0.100 bis=0.045,r2=0.625, VAF=0.825 Kp=0.000, K=0.000, K=0.000,T=0.100 Kp=0.014, K=0.032, K=4.415,T=0.099 Kp=0.035, K=0.036, K=0.507,T=0.100 Kp=0.012, K=0.002, K=0.001,T=0.095 MG bis=0.369,r2=0.559, VAF=0.925 bis=0.185,r2=0.719, VAF=0.905 support surfce trnsltion 5 cm 0.0 (sec) cm 0.0 (sec) 1.0
21 3-week AT reuce ntgonist SRM gins n increse gonist SRM gins Subject 3 H&Y 2.5 Pre-AT Kp=0.024, K=0.054, K=0.661,T=0.100 Post-AT Kp=0.020, K=0.036, K=1.331,T=0.100 Young Helthy (t) TA Kp=0.000, K=0.000, K=0.000,T=0.100 bis=0.093,r2=0.553, VAF=0.759 Kp=0.036, K=0.012, K=0.001,T=0.100 bis=0.045,r2=0.625, VAF=0.825 u Kp=0.000, K=0.000, K=0.000,T=0.100 Kp=0.014, K=0.032, K=4.415,T=0.099 Kp=0.035, K=0.036, K=0.507,T=0.100 Kp=0.012, K=0.002, K=0.001,T=0.095 MG bis=0.369,r2=0.559, VAF=0.925 bis=0.185,r2=0.719, VAF=0.905 u support surfce trnsltion 5 cm 0.0 (sec) cm 0.0 (sec) 1.0
22 3-week AT reuce ntgonist SRM gins n increse gonist SRM gins Subject 3 H&Y 2.5 Pre-AT Kp=0.024, K=0.054, K=0.661,T=0.100 Post-AT Kp=0.020, K=0.036, K=1.331,T=0.100 (t) TA Kp=0.000, K=0.000, K=0.000,T=0.100 bis=0.093,r2=0.553, VAF=0.759 Kp=0.036, K=0.012, K=0.001,T=0.100 bis=0.045,r2=0.625, VAF=0.825 Kp=0.000, K=0.000, K=0.000,T=0.100 Kp=0.014, K=0.032, K=4.415,T=0.099 Kp=0.035, K=0.036, K=0.507,T=0.100 Kp=0.012, K=0.002, K=0.001,T=0.095 MG bis=0.369,r2=0.559, VAF=0.925 bis=0.185,r2=0.719, VAF=0.905 support surfce trnsltion UPDRS H&Y BBS FAB DGI UPDRS H&Y BBS FAB DGI
23 3-week AT reuce ntgonist SRM gins n increse gonist SRM gins Subject 1 H&Y 2 Pre-AT Kp=0.001, K=0.057, K=2.433,T=0.100 Post-AT Kp=0.001, K=0.062, K=1.669,T=0.100 (t) TA Kp=0.000, K=0.000, K=0.000,T=0.100 bis=0.194,r2=0.610, VAF=0.834 Kp=0.000, K=0.000, K=0.000,T=0.100 bis=0.021,r2=0.729, VAF=0.826 Kp=0.000, K=0.000, K=0.000,T=0.100 Kp=0.001, K=0.054, K=1.092,T=0.100 Kp=0.000, K=0.000, K=0.000,T=0.100 Kp=0.001, K=0.008, K=0.428,T=0.100 MG bis=0.258,r2=0.530, VAF=0.849 bis=0.228,r2=0.138, VAF=0.840 support surfce trnsltion UPDRS H&Y BBS FAB DGI UPDRS H&Y BBS FAB DGI
24 Deficit Impire progrm selection by bsl gngli my le to posturl instbility in PD Neurorehbilittion Apte tngo my improe posturl instbility by improing progrm selection
25 Acknowlegments Prticipnts Kte Pirog Reill, PhD Emory Uniersity Morris K. Ull Center of Excellence for Prkinson s Disese Reserch Atlnt Clinicl & Trnsltionl Science Institute The Dn & Merrie Boone Fountion Georgi Tech n Emory Stuent Volunteers The Ting Lbortory Emory Uniersity Doctorte of Physicl Therpy stuents: Keton Krmer, Mitchell McCll, Courtney Pope, n Austin Richrs GA Tech/GA Stte Center for Ance Brin Imging Tngo uner the Tent fountion
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