Publications by authors named "Jorik Nonnekes"

87 Publications

Face mask sign.

Pract Neurol 2021 Dec 27;21(6):554. Epub 2021 Sep 27.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.

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http://dx.doi.org/10.1136/practneurol-2021-003174DOI Listing
December 2021

Freezing of Gait Before Levodopa.

J Parkinsons Dis 2021;11(4):2093-2094

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.

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http://dx.doi.org/10.3233/JPD-212933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8673499PMC
December 2021

Perception and Use of Compensation Strategies for Gait Impairment by Persons With Parkinson Disease.

Neurology 2021 Sep 8. Epub 2021 Sep 8.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.

Background: Gait impairments are common and disabling in Parkinson's disease (PD). Applying compensation strategies helps to overcome these gait deficits. Clinical observations suggest that the efficacy of different compensation strategies varies depending on both individual patient characteristics and the context in which the strategies are applied. This has never been investigated systematically, hampering the ability of clinicians to provide a more personalized approach to gait rehabilitation.

Objective: We had three aims: (1) to evaluate patients' awareness and actual use of compensation categories for gait impairments in PD; (2) to investigate the patient-rated efficacy of the various compensation strategies, and whether this efficacy depends on the context in which the strategies are applied; and (3) to explore differences in the efficacy between subgroups based on sex, age, disease duration, freezing status, and ability to perform a dual task.

Methods: A survey was conducted among 4,324 adults with PD and self-reported disabling gait impairments.

Results: The main findings are: (1) compensation strategies for gait impairments are commonly used by persons with PD, but their awareness of the full spectrum of available strategies is limited; (2) the patient-rated efficacy of compensation strategies is high, but varies depending on the context in which they are applied; and (3) compensation strategies are useful for all types of PD patients, but the efficacy of the different strategies varies per person.

Conclusions: The choice of compensation strategies for gait impairment in PD should be tailored to the individual patient, as well as to the context in which the strategy needs to be applied.

Classification Of Evidence: This data provides Class IV evidence that compensation strategies are an effective treatment for gait impairment in Parkinson's disease patients with gait impairment
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http://dx.doi.org/10.1212/WNL.0000000000012633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520387PMC
September 2021

Letter to the Editor: Randomized Trial of Botulinum Toxin Type A in Hereditary Spastic Paraplegia-The SPASTOX Trial.

Mov Disord 2021 07;36(7):1733

Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Centre, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.

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http://dx.doi.org/10.1002/mds.28659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361968PMC
July 2021

Improved Gait Capacity after Bilateral Achilles Tendon Lengthening for Irreducible Pes Equinus Due to Hereditary Spastic Paraplegia: a Case Report.

J Rehabil Med Clin Commun 2021 6;4:1000059. Epub 2021 May 6.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation.

Objective: Toe walking due to progressive shortening of the calf muscles is common in people with hereditary spastic paraplegia. Achilles tendon lengthening is a treatment option, but clinicians are often hesitant to use this procedure, as it may result in weakening of the calf muscles and, subsequently, in reduced ankle power and knee instability during the stance phase of gait. We report here a case report supporting that these negative side-effects can be avoided in well-selected people with hereditary spastic paraplegia.

Method: Bilateral Achilles tendon lengthening, combined with bilateral tenotomy of the tibialis posterior and toe flexors, was performed in a 29-year-old woman with uncomplicated hereditary spastic paraplegia who experienced progressive gait instability due to shortening of the soleus and gastrocnemius muscles (resulting in irreducible pes equinus).

Results: Bilateral Achilles tendon lengthening resulted in improvement in both subjective and objective outcomes. Self-selected gait speed improved from 0.75 m/s before surgery to 1.07 m/s after surgery ( < 0.001). Knee instability during the stance phase did not occur post-surgery. The ankle moment trajectories normalized after surgery, while peak ankle powers increased.

Conclusion: Correction of bilateral irreducible pes equinus by Achilles tendon lengthening may improve gait capacity in well-selected subjects with hereditary spastic paraplegia.
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http://dx.doi.org/10.2340/20030711-1000059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192886PMC
May 2021

TAILORED USE OF COMPENSATION STRATEGIES TO ENABLE EXERCISE DESPITE FESTINATION IN PARKINSON'S DISEASE.

J Rehabil Med Clin Commun 2021 15;4:1000055. Epub 2021 Apr 15.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands.

Despite increasing evidence for, and heightened awareness of, the importance of exercise in Parkinson's disease, many patients remain sedentary. This tendency to lead an inactive lifestyle has various underlying reasons, including the presence of gait and balance impairments that complicate the patients' ability to perform sports activities. This case report illustrates that a personally tailored approach may be required in these patients, supported, if needed, by the use of compensation strategies or novel technological advances.
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http://dx.doi.org/10.2340/20030711-1000055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072410PMC
April 2021

Music to move persons with Parkinson's disease: a personalized approach.

J Neurol 2022 Jan 22;269(1):251-252. Epub 2021 May 22.

Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

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http://dx.doi.org/10.1007/s00415-021-10615-5DOI Listing
January 2022

Management of gait impairments in people with Charcot-Marie-Tooth disease: A treatment algorithm.

J Rehabil Med 2021 May 21;53(5):jrm00194. Epub 2021 May 21.

Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, 6541GX Nijmegen, The Netherlands. E-mail:

Gait impairments in people with Charcot Marie Tooths disease are the combined result of ankle-foot deformities, muscle weakness, and somatosensory impairments. People with Charcot-Marie-Tooth disease often experience pain and difficulties when walking, especially barefoot. They also trip and fall frequently and have a lower than normal gait speed and distance. Because these gait impairments and related complaints are disabling, clinical management aimed at improving gait is important. Management involves both conservative and surgical treatment options, each with limited scientific evidence. However, a treatment algorithm that describes both conservative and surgical treatment options is currently lacking. This study sets out a step-wise treatment algorithm, based on evidence, if available, and otherwise reflecting practice-based experience. The treatment algorithm will be of value in daily clinical practice, and will serve as a template for future research.
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http://dx.doi.org/10.2340/16501977-2831DOI Listing
May 2021

Author Correction: Pallidal stimulation as treatment for camptocormia in Parkinson's disease.

NPJ Parkinsons Dis 2021 Mar 29;7(1):32. Epub 2021 Mar 29.

Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

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http://dx.doi.org/10.1038/s41531-021-00178-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007607PMC
March 2021

Parkinson's Kinesia Paradoxa Is Not a Paradox.

Mov Disord 2021 05 3;36(5):1115-1118. Epub 2021 Mar 3.

Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.

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http://dx.doi.org/10.1002/mds.28550DOI Listing
May 2021

The European Reference Network for Rare Neurological Diseases.

Front Neurol 2020 14;11:616569. Epub 2021 Jan 14.

Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.

While rare diseases (RDs) are by definition of low prevalence, the total number of patients suffering from an RD is high, and the majority of them have neurologic manifestations, involving central, peripheral nerve, and muscle. In 2017, 24 European Reference Networks (ERNs), each focusing on a specific group of rare or low-prevalence complex diseases, were formed to improve the care for patients with an RD. One major aim is to have "the knowledge travel instead of the patient," which has been put into practice by the implementation of the Clinical Patient Management System (CPMS) that enables clinicians to perform pan-European virtual consultations. The European Reference Network for Rare Neurological Diseases (ERN-RND) provides an infrastructure for knowledge sharing and care coordination for patients affected by a rare neurological disease (RND) involving the most common central nervous system pathological conditions. It covers the following disease groups: (i) Cerebellar Ataxias and Hereditary Spastic Paraplegias; (ii) Huntington's disease and Other Choreas; (iii) Frontotemporal dementia; (iv) Dystonia, (non-epileptic) paroxysmal disorders, and Neurodegeneration with Brain Iron Accumulation; (v) Leukoencephalopathies; and (vi) Atypical Parkinsonian Syndromes. At the moment, it unites 32 expert centers and 10 affiliated partners in 21 European countries, as well as patient representatives, but will soon cover nearly all countries of the European Union as a result of the ongoing expansion process. Disease expert groups developed and consented on diagnostic flowcharts and disease scales to assess the different aspects of RNDs. ERN-RND has started to discuss diagnostically unclear patients in the CPMS, is one of four ERNs that serve as foundation of Solve-RD, and has established an RND training and education program. The network will facilitate trial readiness through the establishment of an ERN-RND registry with a minimal data of all patients seen at the ERN-RND centers, thus providing a unique overview of existing genotype-based cohorts. The overall aim of the ERNs is to improve access for patients with RDs to quality diagnosis, care, and treatment. Based on this objective, ERNs are monitored by the European Commission on a regular basis to provide transparency and reassurance to the RD community and the general public.
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http://dx.doi.org/10.3389/fneur.2020.616569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840612PMC
January 2021

Letter to the Editor on "A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait".

Mov Disord 2020 11;35(11):2122-2123

Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1002/mds.28294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756703PMC
November 2020

Pallidal stimulation as treatment for camptocormia in Parkinson's disease.

NPJ Parkinsons Dis 2021 Jan 18;7(1). Epub 2021 Jan 18.

Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Camptocormia is a common and often debilitating postural deformity in Parkinson's disease (PD). Few treatments are currently effective. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) shows potential in treating camptocormia, but evidence remains limited to case reports. We herein investigate the effect of GPi-DBS for treating camptocormia in a retrospective PD cohort. Thirty-six consecutive PD patients who underwent GPi-DBS were reviewed. The total and upper camptocormia angles (TCC and UCC angles) derived from video recordings of patients who received GPi-DBS were used to compare camptocormia alterations. Correlation analysis was performed to identify factors associated with the postoperative improvements. DBS lead placement and the impact of stimulation were analyzed using Lead-DBS software. Eleven patients manifested pre-surgical camptocormia: seven had lower camptocormia (TCC angles ≥ 30°; TCC-camptocormia), three had upper camptocormia (UCC angles ≥ 45°; UCC-camptocormia), and one had both. Mean follow-up time was 7.3 ± 3.3 months. GPi-DBS improved TCC-camptocormia by 40.4% (angles from 39.1° ± 10.1° to 23.3° ± 8.1°, p = 0.017) and UCC-camptocormia by 22.8% (angles from 50.5° ± 2.6° to 39.0° ± 6.7°, p = 0.012). Improvement in TCC angle was positively associated with pre-surgical TCC angles, levodopa responsiveness of the TCC angle, and structural connectivity from volume of tissue activated to somatosensory cortex. Greater improvement in UCC angles was seen in patients with larger pre-surgical UCC angles. Our study demonstrates potential effectiveness of GPi-DBS for treating camptocormia in PD patients. Future controlled studies with larger numbers of patients with PD-related camptocormia should extend our findings.
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http://dx.doi.org/10.1038/s41531-020-00151-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813849PMC
January 2021

Improving gait adaptability in patients with hereditary spastic paraplegia (Move-HSP): study protocol for a randomized controlled trial.

Trials 2021 Jan 7;22(1):32. Epub 2021 Jan 7.

Department of Rehabilitation; Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior; Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

Background: People with hereditary spastic paraplegia (HSP) experience difficulties adapting their gait to meet environmental demands, a skill required for safe and independent ambulation. Gait adaptability training is possible on the C-Mill, a treadmill equipped with augmented reality, enabling visual projections to serve as stepping targets or obstacles. It is unknown whether gait adaptability can be trained in people with HSP.

Aim: The aim of Move-HSP is to study the effects of ten 1-h sessions of C-Mill training, compared with usual care, on gait adaptability in people with pure HSP. In addition, this study aims to identify key determinants of C-Mill training efficacy in people with pure HSP.

Method: Move-HSP is a 5-week, two-armed, open-label randomized controlled trial with a cross-over design for the control group. Thirty-six participants with pure HSP will be included. After signing informed consent, participants are randomized (1:1) to intervention or control group. All participants register (near) falls for 15 weeks, followed by the first assessment (week 16), and, thereafter, wear an Activ8 activity monitor for 7 days (week 16). The intervention group receives 10 sessions of C-Mill training (twice per week, 1-h sessions; weeks 17-21), whereas control group continues with usual care (weeks 17-21). Afterwards, both groups are re-assessed (week 22). Subsequently, the intervention group enter follow-up, whereas control group receives 10 sessions of C-Mill training (weeks 23-27), is re-assessed (week 28), and enters follow-up. During follow-up, both groups wear Activ8 activity monitors for 7 days (intervention group: week 23, control group: week 29) and register (near) falls for 15 weeks (intervention group: weeks 23-37, control group: weeks 29-43), before the final assessment (intervention group: week 38, control group: week 44). The primary outcome is the obstacle subtask of the Emory Functional Ambulation Profile. Secondary outcomes consist of clinical tests assessing balance and walking capacity, physical activity, and fall monitoring.

Discussion: Move-HSP will be the first RCT to assess the effects of C-Mill gait adaptability training in people with pure HSP. It will provide proof of concept for the efficacy of gait adaptability training in people with pure HSP.

Trial Registration: Clinicaltrials.gov NCT04180098 . Registered on November 27, 2019.
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http://dx.doi.org/10.1186/s13063-020-04932-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788541PMC
January 2021

[Movement technology in the rehabilitation after stroke: hype or hope?]

Ned Tijdschr Geneeskd 2020 12 10;164. Epub 2020 Dec 10.

Radboudumc, afd. Revalidatie, Nijmegen.

Application of movement technology in the rehabilitation of neurological disorders has gained a firm position within a short time span, but the effectiveness of many technological innovations is still poorly supported by evidence. Should this burst of movement technology be considered a hype or is it offering realistic hope? This perspective focuses on motor rehabilitation after unilateral stroke and addresses the value of rehabilitation robots, virtual-reality training, peripheral neurostimulation, and brain stimulation. Current rehabilitation robots offer added value compared to conventional training, but only early after stroke for patients who are not yet able to walk independently. The effects of peripheral neurostimulation or brain stimulation are still hard to prove or relatively small. Virtual-reality training seems to be most promising for regaining motor skills, particularly when adjusted to individual capacities. Overall, functional benefits of movement technology in the rehabilitation of neurological disorders keep the middle between hype and hope.
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December 2020

[Heterotopic ossifications after COVID-19 pneumonia].

Ned Tijdschr Geneeskd 2020 09 24;164. Epub 2020 Sep 24.

Radboudumc, Nijmegen: Afd. Revalidatie.

COVID-19 patients admitted to the Intensive Care Unit may develop painful range of motion restrictions of the large joints due to heterotopic ossifications. Here we describe two patients who developed restricted and painful passive and active mobility of the hips, shoulders and elbows after mechanical ventilation because of respiratory failure due to COVID-19 pneumonia. Conventional radiography showed extensive heterotopic ossifications. Retrospectively, alkaline phosphatase levels were elevated. It is likely that local and systemic factors contribute to the development of heterotopic ossifications. Early diagnosis is important to provide complementary non-pharmacological interventions (gentle passive mobilization) and medication (non-steroidal anti-inflammatory drugs, such as indomethacin). If pain and limited joint mobility remain present, surgical removal of ectopic bone could be considered. Future trials are needed to systematically map the prevalence of heterotopic ossifications in COVID-19 patients who were admitted to the Intensive Care Unit, andto evaluate whether prophylactic treatment with non-steroidal anti-inflammatory drug is of relevance.
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September 2020

Reply to: Nonfatal Drowning in People with Parkinson's Disease.

Mov Disord Clin Pract 2020 Nov 16;7(8):1001. Epub 2020 Sep 16.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation Center of Expertise for Parkinson & Movement Disorders Nijmegen The Netherlands.

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http://dx.doi.org/10.1002/mdc3.13080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604674PMC
November 2020

Freezing of gait detection in Parkinson's disease via multimodal analysis of EEG and accelerometer signals.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:847-850

Parkinson's disease (PD) patients with freezing of gait (FOG) can suddenly lose their forward moving ability leading to unexpected falls. To overcome FOG and avoid the falls, a real-time accurate FOG detection or prediction system is desirable to trigger on-demand cues. In this study, we designed and implemented an in-place movement experiment for PD patients to provoke FOG and meanwhile acquired multimodal physiological signals, such as electroencephalography (EEG) and accelerometer signals. A multimodal model using brain activity from EEG and motion data from accelerometers was developed to improve FOG detection performance. In the detection of over 700 FOG episodes observed in the experiments, the multimodal model achieved 0.211 measured by Matthews Correlation Coefficient (MCC) compared with the single-modal models (0.127 or 0.139).Clinical Relevance- This is the first study to use multimodal: EEG and accelerometer signal analysis in FOG detection, and an improvement was achieved.
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http://dx.doi.org/10.1109/EMBC44109.2020.9175288DOI Listing
July 2020

Perceptions of Compensation Strategies for Gait Impairments in Parkinson's Disease: A Survey Among 320 Healthcare Professionals.

J Parkinsons Dis 2020 ;10(4):1775-1778

Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation; Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.

Compensation strategies are an essential part of managing gait impairments in people with Parkinson's disease (PD). We conducted an online survey among 320 healthcare professionals with specific expertise in PD management, to evaluate their knowledge of compensation strategies for gait impairments in people with PD, and whether they applied these in daily practice. Only 35% of professionals was aware of all categories of compensation strategies. Importantly, just 23% actually applied all seven available categories of strategies when treating people with PD in clinical practice. We discuss the clinical implications, and provide recommendations to overcome this knowledge gap.
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http://dx.doi.org/10.3233/JPD-202176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683052PMC
September 2021

Effects of multimodal balance training supported by rhythmical auditory stimuli in people with advanced stages of Parkinson's disease: a pilot randomized clinical trial.

J Neurol Sci 2020 Nov 11;418:117086. Epub 2020 Aug 11.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.

Non-pharmacological interventions such as physiotherapy are recognized as important elements in the overall clinical management of motor impairments in PD, but evidence of physiotherapy in advanced disease stages is sparse. A recent trial found positive effects of multimodal balance training in people with mild to moderate PD, with greater and more sustained effects when rhythmical auditory stimuli were added. It is unclear whether such multimodal balance training is also effective in people with advanced PD (Hoehn & Yahr stage 4).

Methods: We performed a pilot prospective single-blind, randomized clinical trial to study the effectiveness of multimodal training with and without rhythmical auditory stimuli. We screened 76 people with Parkinson's disease and Hoehn & Yahr stage 4 by telephone; 35 patients were assigned randomly into two groups: (1) multimodal balance training with rhythmical auditory stimuli (RAS-supported intervention, n = 17) and (2) multimodal balance training without rhythmical auditory cues (n = 18). Training was performed for 5 weeks, two times/week. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by the same two blinded assessors at baseline, immediately post intervention, and after one and 6-months follow-up.

Results: Immediately post-intervention, both intervention groups improved significantly on Mini-Best scores, without differences between both intervention modalities. In both groups, results were retained at one-month follow-up. At 6-months follow-up, the effects were retained only in the RAS-supported intervention group. For both intervention groups, no improvements were found on secondary outcome measures for gait.

Conclusion: Both RAS-supported multimodal balance training and regular multimodal balance training improve balance in PD patients in advanced disease stages. Effects appear to sustain longer in the RAS-supported training group.
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http://dx.doi.org/10.1016/j.jns.2020.117086DOI Listing
November 2020

Multimodal Balance Training Supported by Rhythmic Auditory Stimuli in Parkinson Disease: Effects in Freezers and Nonfreezers.

Phys Ther 2020 10;100(11):2023-2034

Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, and Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center.

Objective: To fulfill the potential of nonpharmacological interventions for people with Parkinson disease (PD), individually tailored treatment is needed. Multimodal balance training supported by rhythmic auditory stimuli (RAS) can improve balance and gait in people with PD. The purpose of this study was to determine whether both freezers and nonfreezers benefit.

Methods: A secondary analysis was conducted on a large randomized controlled trial that included 154 patients with PD (Hoehn & Yahr Stages 1-3 while ON-medication) who were assigned randomly to 3 groups: (1) multimodal balance training with RAS delivered by a metronome (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmic auditory cues; and (3) a control intervention (involving an educational program). Training was performed for 5 weeks, twice per week. The primary outcome was the Mini-BESTest score directly after the training period. Assessments were performed by a single, masked assessor at baseline, directly postintervention, and after 1-month and 6-month follow-up. Outcomes were analyzed in 1 analysis, and the results were presented separately for freezers and nonfreezers with a linear mixed model, adjusted for baseline Mini-BESTest scores, Unified Parkinson's Disease Rating Scale scores, and levodopa equivalent dose.

Results: In both freezers and nonfreezers, both RAS-supported multimodal training and regular training significantly improved the Mini-BESTest scores compared with baseline scores and with the control group scores. The improvement was larger for RAS-supported training compared with regular training, for both freezers and nonfreezers. Only the RAS-supported training group retained the improvements compared with baseline measurements at 6-month follow-up, and this was true for both freezers and nonfreezers.

Conclusions: RAS-supported multimodal training is effective in improving balance performance in both freezers and nonfreezers.

Impact: Until this study, it was unknown whether both freezers and nonfreezers could benefit from multimodal balance training. With this information, clinicians who work with people with PD will be better able to apply personalized gait rehabilitation.

Lay Summary: Adding rhythmic auditory stimuli (RAS) to balance training is beneficial for both freezers and nonfreezers, at least in persons with mild to moderate disease stages. This RAS-supported multimodal training has good potential for a wider clinical implementation with good long-term effects.
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http://dx.doi.org/10.1093/ptj/pzaa146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596891PMC
October 2020

Sex and freezing of gait in Parkinson's disease: a systematic review and meta-analysis.

J Neurol 2021 Jan 30;268(1):125-132. Epub 2020 Jul 30.

Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, Nijmegen, HB, The Netherlands.

Objective: It is unknown how sex affects the prevalence of freezing of gait (FOG). We conducted a systematic review and meta-analysis to establish the sex-specific prevalence of FOG in persons with Parkinson's disease (PD). In addition, we investigated whether men and women were represented accurately in intervention trials targeting FOG.

Methods: We queried the EMBASE and PubMed databases and identified 2637 articles. Of these, 16 epidemiological studies were included in the meta-analysis, and 51 intervention studies were included in the comparative analysis.

Results: In total, 5702 persons were included in the final meta-analysis of epidemiological studies. The pooled estimate of overall FOG prevalence was 43% [95% CI 33-53%]. We found no difference in FOG prevalence between men [44% (34-54%)] and women [42% (31-52%)] with PD. However, women were markedly underrepresented in intervention trials targeting FOG, with an average proportion of only 29.6% of women in trial populations. The percentage of women included in trials was similar across intervention types but differed greatly across geographical regions.

Conclusion: Sex is not a predictor of FOG. This could aid clinicians in counseling persons with PD about FOG. Importantly, a global effort is needed to include more women into clinical trials. Given the skewed distribution of men and women included in intervention trials targeting FOG, caution might be warranted when extrapolating results from FOG trials to women.
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http://dx.doi.org/10.1007/s00415-020-10117-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815550PMC
January 2021

Young Onset Parkinson's Disease: A Modern and Tailored Approach.

J Parkinsons Dis 2020 ;10(s1):S29-S36

Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders Nijmegen, The Netherlands.

In people with young onset Parkinson's disease (YOPD), onset of symptoms is between 21 and 40 years of age. The distinction between YOPD and late-onset Parkinson's disease is supported by genetic differences (a genetic etiology is more common in people with YOPD) and clinical differences (e.g., dystonia and levodopa-induced dyskinesias are more common inYOPD). Moreover, people with YOPD tend to have different family and societal engagements compared to those with late-onset PD. These unique features have implications for clinical management, and call for a tailored multidisplinary approach involving shared-decision making.
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http://dx.doi.org/10.3233/JPD-202135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592661PMC
October 2021

COVID-19 reveals influence of physical activity on symptom severity in hereditary spastic paraplegia.

J Neurol 2020 Dec 7;267(12):3462-3464. Epub 2020 Jul 7.

Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands.

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http://dx.doi.org/10.1007/s00415-020-10016-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339095PMC
December 2020

Why People With Parkinson's Disease Experience Near-Drowning-and How to Prevent It.

Mov Disord Clin Pract 2020 Jul 2;7(5):573-574. Epub 2020 Jun 2.

Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands.

View Supplementary Video S1 View Supplementary Video S2 View Supplementary Video S3.
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http://dx.doi.org/10.1002/mdc3.12989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328419PMC
July 2020

Functional gait disorders: A sign-based approach.

Neurology 2020 06 1;94(24):1093-1099. Epub 2020 Jun 1.

From the Department of Rehabilitation (J.N.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders; Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Neurology and Centre of Clinical Neuroscience (E.R., T.S.), First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic; Department of Neurology (S.G.R.), The University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (B.R.B.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands; andNational Institute of Neurological Disorders and Stroke (M.H.), Bethesda, MD.

Functional gait disorders are common in clinical practice. They are also usually disabling for affected individuals. The diagnosis is challenging because no single walking pattern is pathognomonic for a functional gait disorder. Establishing a diagnosis is based not primarily on excluding organic gait disorders but instead predominantly on recognizing positive clinical features of functional gait disorders, such as an antalgic, a buckling, or a waddling gait. However, these features can resemble and overlap with organic gait disorders. It is therefore necessary to also look for inconsistency (variations in clinical presentation that cannot be reconciled with an organic lesion) and incongruity (combination of symptoms and signs that is not seen with organic lesions). Yet, these features also have potential pitfalls as inconsistency can occur in patients with dystonic gait or those with freezing of gait. Similarly, patients with dystonia or chorea can present with bizarre gait patterns that may falsely be interpreted as incongruity. A further complicating factor is that functional and organic gait disorders may coexist within the same patient. To improve the diagnostic process, we present a sign-based approach-supported by videos-that incorporates the diverse clinical spectrum of functional gait disorders. We identify 7 groups of supportive gait signs that can signal the presence of functional gait disorders. For each group of signs, we highlight how specific clinical tests can bring out the inconsistencies and incongruencies that further point to a functional gait disorder.
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http://dx.doi.org/10.1212/WNL.0000000000009649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455329PMC
June 2020

Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease.

J Parkinsons Dis 2020 ;10(3):1087-1098

Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands.

Background: Optimal management in expert centers for Parkinson's disease (PD) usually involves pharmacological and non-pharmacological interventions, delivered by a multidisciplinary approach. However, there is no guideline specifying how this model should be organized. Consequently, the nature of multidisciplinary care varies widely.

Objective: To optimize care delivery, we aimed to provide recommendations for the organization of multidisciplinary care in PD.

Methods: Twenty expert centers in the field of multidisciplinary PD care participated. Their leading neurologists completed a survey covering eight themes: elements for optimal multidisciplinary care; team members; role of patients and care partners; team coordination; team meetings; inpatient versus outpatient care; telehealth; and challenges towards multidisciplinary care. During a consensus meeting, outcomes were incorporated into concept recommendations that were reviewed by each center's multidisciplinary team. Three patient organizations rated the recommendations according to patient priorities. Based on this feedback, a final set of recommendations (essential elements for delivery of multidisciplinary care) and considerations (desirable elements) was developed.

Results: We developed 30 recommendations and 10 considerations. The patient organizations rated the following recommendations as most important: care is organized in a patient-centered way; every newly diagnosed patient has access to a core multidisciplinary team; and each team has a coordinator. A checklist was created to further facilitate its implementation.

Conclusion: We provide a practical tool to improve multidisciplinary care for persons with PD at the organizational level. Future studies should focus on implementing these recommendations in clinical practice, evaluating their potential applicability and effectiveness, and comparing alternative models of PD care.
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http://dx.doi.org/10.3233/JPD-202078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415700PMC
September 2021

Biphasic Levodopa-Induced Freezing of Gait in Parkinson's Disease.

J Parkinsons Dis 2020 ;10(3):1245-1248

Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise For Parkinson & Movement Disorders, Nijmegen, The Netherlands.

The relation between freezing of gait in Parkinson's disease and levodopa is complex. Here, we describe a new phenotype of freezing of gait, namely levodopa-induced freezing of gait with a biphasic pattern. Our observation supports the idea that freezing of gait might emerge because of a mismatch between cognitive/limbic loops and motor loops involved in gait control. Moreover, it underscores the importance of assessing the influence of dopaminergic medication in daily clinical practice, including objective assessment in all three dopaminergic states. The possibility of biphasic freezing will only emerge after such a comprehensive evaluation, and will have immediate therapeutic consequences.
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http://dx.doi.org/10.3233/JPD-201997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458497PMC
September 2021

Understanding the dual-task costs of walking: a StartReact study.

Exp Brain Res 2020 May 30;238(5):1359-1364. Epub 2020 Apr 30.

Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.

The need to perform multiple tasks more or less simultaneously is a common occurrence during walking in daily life. Performing tasks simultaneously typically impacts task performance negatively. Hypothetically, such dual-task costs may be explained by a lowered state of preparation due to competition for attentional resources, or alternatively, by a 'bottleneck' in response initiation. Here, we investigated both hypotheses by comparing 'StartReact' effects during a manual squeezing task under single-task (when seated) and dual-task (when walking) conditions. StartReact is the acceleration of reaction times by a startling stimulation (a startling acoustic stimulus was applied in 25% of trials), attributed to the startling stimulus directly releasing a pre-prepared movement. If dual-task costs are due to a lowered state of preparation, we expected trials both with and without an accompanying startling stimulus to be delayed compared to the single-task condition, whereas we expected only trials without a startling stimulus to be delayed if a bottleneck in response initiation would underlie dual-task costs. Reaction times of the manual squeezing task in the flexor digitorum superficialis and extensor carpi radialis muscle were significantly delayed (approx. 20 ms) when walking compared to the seated position. A startling acoustic stimulus significantly decreased reaction times of the squeezing task (approx. 60 ms) both when walking and sitting. Dual-task costs during walking are, therefore, likely the result of lowered task preparation because of competition for attentional resources.
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http://dx.doi.org/10.1007/s00221-020-05817-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237398PMC
May 2020

Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson's Disease: A Randomized Clinical Trial.

J Parkinsons Dis 2020 ;10(1):333-346

Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.

Background: Balance impairment in Parkinson's disease (PD) improves only partially with dopaminergic medication. Therefore, non-pharmacological interventions such as physiotherapy are important elements in clinical management. External cues are often applied to improve gait, but their effects on balance control are unclear.

Objective/methods: We performed a prospective, single-blind, randomized clinical trial to study the effectiveness of balance training with and without rhythmical auditory cues. We screened 201 volunteers by telephone; 154 were assigned randomly into three groups: (1) multimodal balance training supported by rhythmical auditory stimuli (n = 56) (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmical auditory stimuli (n = 50); and (3) control intervention involving a general education program (n = 48). Training was performed for 5 weeks, two times/week. Linear mixed models were used for all outcomes. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by a single, blinded assessor at baseline, immediately post intervention, and after one and 6-months follow-up.

Results: Immediately post intervention, RAS-supported multimodal balance training was more effective than regular multimodal balance training on MBEST (difference 3.5 (95% Confidence Interval (CI) 2.2; 4.8)), p < 0.001). Patients allocated to both active interventions improved compared to controls (MBEST estimated mean difference versus controls 6.6 (CI 5.2; 8.0), p < 0.001 for RAS-supported multimodal balance training; and 3.0 (CI 2.7; 5.3), p < 0.001 for regular multimodal balance training). Improvements were retained at one-month follow-up for both active interventions, but only the RAS-supported multimodal balance training group maintained its improvement at 6 months.

Conclusion: Both RAS-supported multimodal balance training and regular multimodal balance training improve balance, but RAS-supported multimodal balance training-adding rhythmical auditory cues to regular multimodal balance training-has greater and more sustained effects.
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http://dx.doi.org/10.3233/JPD-191752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029328PMC
April 2021
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