Both coordination and symmetry of arm swing are reduced in Parkinson's disease

Huang, Xuemei; Mahoney, Joseph M.; Lewis, Mechelle M.; Guangwei Du,; Piazza, Stephen J.; Cusumano, Joseph P.

doi:10.1016/j.gaitpost.2011.10.180

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Volume 35, Issue 3 , Pages 373-377, March 2012

Both coordination and symmetry of arm swing are reduced in Parkinson's disease

Xuemei Huang
- Department of Neurology, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
- Department of Pharmacology, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
- Department of Radiology, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
- Department of Neurosurgery, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, United States
- Corresponding author at: Penn State University – Milton S. Hershey Medical Center, H037, Department of Neurology, 500 University Drive, Hershey, PA 17033-0850, United States. Tel.: +1 717 531 1803; fax: +1 717 531 0226.
Joseph M. Mahoney
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA 16802, United States
Mechelle M. Lewis
- Department of Neurology, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
- Department of Pharmacology, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
Guangwei Du
- Department of Neurology, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
Stephen J. Piazza
- Department of Orthopaedics & Rehabilitation, The Pennsylvania State University – Milton S. Hershey Medical Center, Hershey, PA 17033, United States
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, United States
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA 16802, United States
Joseph P. Cusumano
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA 16802, United States

Received 8 February 2011; received in revised form 3 October 2011; accepted 15 October 2011. published online 18 November 2011.

Abstract

Objective

A recent study reporting significantly reduced symmetry in arm swing amplitude in early Parkinson's disease (PD), as measured during single strides in a gait laboratory, led to this investigation of arm swing symmetry and coordination over many strides using wearable accelerometers in PD.

Methods

Forearm accelerations were recorded while eight early PD subjects and eight Controls performed 8-min walking trials. Arm swing asymmetry (ASA), maximal cross-correlation (MXC), and instantaneous relative phase (IRP) of bilateral arm swing were compared between PD and Controls. Correlations between arm swing measurements (ASA and MXC) and Unified PD Rating Scale (UPDRS) scores were estimated.

Results

PD subjects demonstrated significantly higher ASA (p=0.002) and lower MXC (p<0.001) than Controls. The IRP probability distribution for PD was significantly different than Controls (p<0.001), with an angular standard deviation of 67.2° for PD and 50.6° for Controls. Among PD subjects, ASA was significantly correlated with the UPDRS score for the limbs (R²=0.58, p=0.049), whereas MXC was significantly correlated with the tremor subscore of the limbs (R²=0.64, p=0.031).

Discussion

The study confirms previously reported higher arm swing asymmetry in PD but also shows there is significantly lower MXC and greater IRP variability, suggesting that reduction in bilateral arm coordination may contribute to clinically observed asymmetry in PD. The differential correlation of clinical measures of motor disability with measurements of arm swing during gait is intriguing and deserves further investigation.

Keywords: Parkinson's disease, Arm swing asymmetry, Maximum cross correlation, Relative phase, Synchronization, Gait, Accelerometers