The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease
Identifieur interne : 000D27 ( Main/Corpus ); précédent : 000D26; suivant : 000D28The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease
Auteurs : Cris Zampieri ; Arash Salarian ; Patricia Carlson-Kuhta ; Kamiar Aminian ; John G. Nutt ; Fay B. HorakSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2010-02.
Abstract
The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 m (traditional TUG) to 7 m. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.
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DOI: 10.1136/jnnp.2009.173740
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Nutt</name><affiliation><mods:affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</mods:affiliation></affiliation></author><author><name sortKey="Horak, Fay B" sort="Horak, Fay B" uniqKey="Horak F" first="Fay B" last="Horak">Fay B. 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Nutt</name><affiliation><mods:affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</mods:affiliation></affiliation></author><author><name sortKey="Horak, Fay B" sort="Horak, Fay B" uniqKey="Horak F" first="Fay B" last="Horak">Fay B. Horak</name><affiliation><mods:affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2010-02">2010-02</date><biblScope unit="volume">81</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="171">171</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">8F743F97DD5EA1888083EF12EF0208D4F7B3EFC2</idno><idno type="DOI">10.1136/jnnp.2009.173740</idno><idno type="href">jnnp-81-171.pdf</idno><idno type="ArticleID">jnnp173740</idno><idno type="PMID">19726406</idno><idno type="local">jnnp;81/2/171</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 m (traditional TUG) to 7 m. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Cris Zampieri</name><affiliations><json:string>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</json:string></affiliations></json:item><json:item><name>Arash Salarian</name><affiliations><json:string>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</json:string><json:string>Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, Lausanne, Switzerland</json:string></affiliations></json:item><json:item><name>Patricia Carlson-Kuhta</name><affiliations><json:string>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</json:string><json:string>E-mail: carlsonp@ohsu.edu</json:string></affiliations></json:item><json:item><name>Kamiar Aminian</name><affiliations><json:string>Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, Lausanne, Switzerland</json:string></affiliations></json:item><json:item><name>John G Nutt</name><affiliations><json:string>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</json:string><json:string>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</json:string></affiliations></json:item><json:item><name>Fay B Horak</name><affiliations><json:string>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</json:string><json:string>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Research paper</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>timed up and go</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>inertial sensors</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gait</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>postural transitions</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Gait</value></json:item></subject><language><json:string>eng</json:string></language><abstract>The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 m (traditional TUG) to 7 m. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.</abstract><qualityIndicators><score>7.486</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>7</keywordCount><abstractCharCount>1262</abstractCharCount><pdfWordCount>4670</pdfWordCount><pdfCharCount>30683</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>193</abstractWordCount></qualityIndicators><title>The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's 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type="first">Patricia</forename><surname>Carlson-Kuhta</surname></persName><email>carlsonp@ohsu.edu</email><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation></author><author><persName><forename type="first">Kamiar</forename><surname>Aminian</surname></persName><affiliation>Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, Lausanne, Switzerland</affiliation></author><author><persName><forename type="first">John G</forename><surname>Nutt</surname></persName><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><affiliation>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation></author><author><persName><forename type="first">Fay B</forename><surname>Horak</surname></persName><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><affiliation>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2010-02"></date><biblScope unit="volume">81</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="171">171</biblScope></imprint></monogr><idno type="istex">8F743F97DD5EA1888083EF12EF0208D4F7B3EFC2</idno><idno type="DOI">10.1136/jnnp.2009.173740</idno><idno type="href">jnnp-81-171.pdf</idno><idno type="ArticleID">jnnp173740</idno><idno type="PMID">19726406</idno><idno type="local">jnnp;81/2/171</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009-09-02</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 m (traditional TUG) to 7 m. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>timed up and go</term></item><item><term>inertial sensors</term></item><item><term>gait</term></item><item><term>postural transitions</term></item><item><term>Gait</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-09-02">Created</change><change when="2010-02">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/8F743F97DD5EA1888083EF12EF0208D4F7B3EFC2/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">JNNP</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp173740</article-id><article-id pub-id-type="doi">10.1136/jnnp.2009.173740</article-id><article-id pub-id-type="other">jnnp;81/2/171</article-id><article-id pub-id-type="other">jnnp;jnnp.2009.173740</article-id><article-id pub-id-type="pmid">19726406</article-id><article-id pub-id-type="other">171</article-id><article-id pub-id-type="other">jnnp.2009.173740</article-id><article-categories><subj-group subj-group-type="heading"><subject content-type="original">Research paper</subject></subj-group></article-categories><title-group><article-title>The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Zampieri</surname><given-names>Cris</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Salarian</surname><given-names>Arash</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Carlson-Kuhta</surname><given-names>Patricia</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Aminian</surname><given-names>Kamiar</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Nutt</surname><given-names>John G</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Horak</surname><given-names>Fay B</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</aff><aff id="aff2"><label>2</label>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</aff><aff id="aff3"><label>3</label>Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, Lausanne, Switzerland</aff><author-notes><corresp><label>Correspondence to</label> Dr Patricia Carlson-Kuhta, Oregon Health & Science University, Department of Neurology, 505 NW 185th Avenue, Portland, OR 97006 USA; <email>carlsonp@ohsu.edu</email></corresp></author-notes><pub-date pub-type="epub-original"><day>2</day><month>9</month><year>2009</year></pub-date><pub-date pub-type="ppub"><month>2</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>2</day><month>9</month><year>2009</year></pub-date><volume>81</volume><volume-id pub-id-type="other">81</volume-id><volume-id pub-id-type="other">81</volume-id><issue>2</issue><issue-id pub-id-type="other">jnnp;81/2</issue-id><issue-id pub-id-type="other">2</issue-id><issue-id pub-id-type="other">81/2</issue-id><fpage>171</fpage><history><date date-type="received"><day>28</day><month>1</month><year>2009</year></date><date date-type="rev-recd"><day>22</day><month>6</month><year>2009</year></date><date date-type="accepted"><day>19</day><month>7</month><year>2009</year></date></history><permissions><copyright-statement>© 2009, Published by the BMJ Publishing Group Limited For permission to use, (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</copyright-statement><copyright-year>2009</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-81-171.pdf"></self-uri><abstract><p>The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 m (traditional TUG) to 7 m. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.</p></abstract><kwd-group><kwd>Parkinson's disease</kwd><kwd>timed up and go</kwd><kwd>inertial sensors</kwd><kwd>gait</kwd><kwd>postural transitions</kwd><kwd>Gait</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Cris</namePart><namePart type="family">Zampieri</namePart><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Arash</namePart><namePart type="family">Salarian</namePart><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><affiliation>Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, Lausanne, Switzerland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Patricia</namePart><namePart type="family">Carlson-Kuhta</namePart><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><affiliation>E-mail: carlsonp@ohsu.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kamiar</namePart><namePart type="family">Aminian</namePart><affiliation>Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, Lausanne, Switzerland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">John G</namePart><namePart type="family">Nutt</namePart><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><affiliation>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Fay B</namePart><namePart type="family">Horak</namePart><affiliation>Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><affiliation>Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2010-02</dateIssued><dateCreated encoding="w3cdtf">2009-09-02</dateCreated><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 m (traditional TUG) to 7 m. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.</abstract><subject><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>timed up and go</topic><topic>inertial sensors</topic><topic>gait</topic><topic>postural transitions</topic><topic>Gait</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">JNNP</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2010</date><detail type="volume"><caption>vol.</caption><number>81</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>171</start></extent></part></relatedItem><identifier type="istex">8F743F97DD5EA1888083EF12EF0208D4F7B3EFC2</identifier><identifier type="DOI">10.1136/jnnp.2009.173740</identifier><identifier type="href">jnnp-81-171.pdf</identifier><identifier type="ArticleID">jnnp173740</identifier><identifier type="PMID">19726406</identifier><identifier type="local">jnnp;81/2/171</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2009, Published by the BMJ Publishing Group Limited For permission to use, (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><annexes><json:item><original>true</original><mimetype>image/jpeg</mimetype><extension>jpeg</extension><uri>https://api.istex.fr/document/8F743F97DD5EA1888083EF12EF0208D4F7B3EFC2/annexes/jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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