Publication

Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson’s Disease

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Last modified
  • 05/15/2025
Type of Material
Authors
    Giovanni Martino, Emory UniversityJ. Lucas McKay, Emory UniversityStewart Factor, Emory UniversityLena Ting, Emory University
Language
  • English
Date
  • 2020-12-09
Publisher
  • Frontiers
Publication Version
Copyright Statement
  • © Copyright © 2020 Martino, McKay, Factor and Ting.
License
Final Published Version (URL)
Title of Journal or Parent Work
Volume
  • 14
Start Page
  • 602595
End Page
  • 602595
Grant/Funding Information
  • SF has received royalties from Demos, Blackwell Futura, Springer for textbooks and Uptodate.
  • LT has received research funding or support from the National Institutes of Health and the National Science Foundation.
  • This study was supported in part by National Institutes of Health grants R01HD046922, R01HD090642, K25HD086276, and the Sartain Lanier Family Foundation.
  • SF has received honoraria from Lundbeck, Sunovion, Biogen, Acadia, Impel, Acorda, CereSpir.
  • SF has received research funding or support from Medtronics, Boston Scientific, Biohaven, Impax, Lilly, US World Meds, Sunovion Therapeutics, Vaccinex, Voyager, Jazz Pharmaceuticals, CHDI Foundation, Michael J. Fox Foundation, NIH (U10 NS077366), Parkinson Foundation.
  • JM has received research funding or support from the National Institutes of Health
Abstract
  • Leg rigidity is associated with frequent falls in people with Parkinson’s disease (PD), suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate (or “activate”) rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls.
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Keywords
Research Categories
  • Biology, Neuroscience
  • Engineering, Biomedical

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