Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation
Identifieur interne : 001469 ( Istex/Corpus ); précédent : 001468; suivant : 001470Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation
Auteurs : Gammon M. Earhart ; B. Ruth Clark ; Samer D. Tabbal ; Joel S. PerlmutterSource :
- Movement Disorders [ 0885-3185 ] ; 2009-02-15.
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- KwdEn :
Abstract
Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society
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DOI: 10.1002/mds.22356
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Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Gammon M. 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Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. 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Ruth</forename><surname>Clark</surname><roleName type="degree">PT, PhD</roleName></persName><affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation></author><author><persName><forename type="first">Samer D.</forename><surname>Tabbal</surname><roleName type="degree">MD</roleName></persName><affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation></author><author><persName><forename type="first">Joel S.</forename><surname>Perlmutter</surname><roleName type="degree">MD</roleName></persName><affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Anatomy and Neurobiology, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Radiology, Washington University, St. Louis, Missouri, USA</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. 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Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>locomotion</term></item><item><term>balance</term></item><item><term>essential tremor</term></item><item><term>deep brain stimulation</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2008-07-15">Received</change><change when="2008-09-24">Registration</change><change when="2009-02-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/304074EB2F2A55773D5689243DB488E76E46531C/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. 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Stein Family Fund and the Jack Buck Fund for PD Research)</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn5"><p>Potential conflict of interest: None reported.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 3-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Gait and Balance in ET</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Gait and balance in essential tremor: Variable effects of bilateral thalamic stimulation</title></titleInfo><name type="personal"><namePart type="given">Gammon M.</namePart><namePart type="family">Earhart</namePart><namePart type="termsOfAddress">PhD, PT</namePart><affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Anatomy and Neurobiology, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation><description>Correspondence: Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd., St. Louis, MO 63108, USA</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B. Ruth</namePart><namePart type="family">Clark</namePart><namePart type="termsOfAddress">PT, PhD</namePart><affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Samer D.</namePart><namePart type="family">Tabbal</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Joel S.</namePart><namePart type="family">Perlmutter</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Program in Physical Therapy, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Anatomy and Neurobiology, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Neurology, Washington University, St. Louis, Missouri, USA</affiliation><affiliation>Department of Radiology, Washington University, St. Louis, Missouri, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2009-02-15</dateIssued><dateCaptured encoding="w3cdtf">2008-07-15</dateCaptured><dateValid encoding="w3cdtf">2008-09-24</dateValid><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">3</extent><extent unit="tables">2</extent><extent unit="references">19</extent><extent unit="words">4899</extent></physicalDescription><abstract lang="en">Essential tremor (ET) is a multi‐faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared with a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared with controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up‐and‐Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical to reduce falls and fractures in this group. © 2008 Movement Disorder Society</abstract><note type="content">*Potential conflict of interest: None reported.</note><note type="funding">NIH grants - No. K01 HD048437; No. R01 NS041509; </note><note type="funding">American Parkinson Disease Association (APDA) Center for Advanced PD Research at Washington University</note><note type="funding">Greater St. Louis Chapter of the APDA</note><note type="funding">Barnes‐Jewish Hospital Foundation (the Elliot H. Stein Family Fund and the Jack Buck Fund for PD Research)</note><subject lang="en"><genre>Keywords</genre><topic>locomotion</topic><topic>balance</topic><topic>essential tremor</topic><topic>deep brain stimulation</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>24</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>386</start><end>391</end><total>6</total></extent></part></relatedItem><identifier type="istex">304074EB2F2A55773D5689243DB488E76E46531C</identifier><identifier type="DOI">10.1002/mds.22356</identifier><identifier type="ArticleID">MDS22356</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2008 Movement Disorder Society</accessCondition><recordInfo><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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