Effects of Galvanic Vestibular Stimulation on Upper and Lower Extremities Motor Symptoms in Parkinson’s Disease

As a neurodegenerative movement disorder, Parkinson’s disease (PD) is commonly characterized by motor symptoms such as resting tremor, rigidity, bradykinesia, and balance and postural impairments. While the main cause of PD is still not clear, it is shown that the basal ganglia loop, which has a role in adjusting a planned movement execution through fine motor control, is altered during this disease and contributes toward the manifested motor symptoms. Galvanic vestibular stimulation (GVS) is a non-invasive technique to influence the vestibular system and stimulate the motor system. This study explores how the motor symptoms of upper and lower extremities in PD are instantly affected by vestibular stimulation. In this regard, direct current GVS was applied to 11 individuals with PD on medication while they were performing two sets of experiments: (1) Instrumented Timed Up and Go (iTUG) test and (2) finger tapping task. The performance of participants was recorded with accelerometers and cameras for offline processing of data. Several outcome measures including coefficient of variation of the step duration, gait phase, phase coordination index, tapping score, and the number and duration of manual motor blocks (MMBs) were considered for objective quantifying of performance. Results showed that almost all of considered outcome measures were improved with the application of GVS and that the improvement in the coefficient of variation of the step duration, the tapping score, and the number of MMBs was statistically significant (p-value < 0.05). The results of this study suggest that GVS can be used to alleviate some of the common motor symptoms of PD. Further research is required to fully characterize the effects of GVS and determine its efficacy in the long term.

[1]  D. Thurman,et al.  How common are the “common” neurologic disorders? , 2007, Neurology.

[2]  S. Krafczyk,et al.  Noise-Enhanced Vestibular Input Improves Dynamic Walking Stability in Healthy Subjects , 2016, Brain Stimulation.

[3]  A. Mulavara,et al.  Effects of Stochastic Vestibular Galvanic Stimulation and LDOPA on Balance and Motor Symptoms in Patients With Parkinson's Disease , 2015, Brain Stimulation.

[4]  Marten Munneke,et al.  Clinimetrics of freezing of gait , 2008, Movement disorders : official journal of the Movement Disorder Society.

[5]  W. Schady,et al.  The influence of external timing cues upon the rhythm of voluntary movements in Parkinson's disease. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[6]  Nir Giladi,et al.  Hand rhythmic tapping and timing in Parkinson's disease. , 2004, Parkinsonism & related disorders.

[7]  C. Menon,et al.  Investigation on the effect of noisy galvanic vestibular stimulation on fine motor skills during a visuomotor task in healthy participants , 2019, PloS one.

[8]  Jeffrey M. Hausdorff,et al.  A new measure for quantifying the bilateral coordination of human gait: effects of aging and Parkinson’s disease , 2007, Experimental Brain Research.

[9]  Valentina Dilda,et al.  Autonomous identification of freezing of gait in Parkinson's disease from lower-body segmental accelerometry , 2013, Journal of NeuroEngineering and Rehabilitation.

[10]  Jeffrey M. Hausdorff,et al.  Dual tasking, gait rhythmicity, and Parkinson's disease: Which aspects of gait are attention demanding? , 2005, The European journal of neuroscience.

[11]  R. Barker,et al.  Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines , 2012, Movement disorders : official journal of the Movement Disorder Society.

[12]  Peter Feys,et al.  Upper limb movement interruptions are correlated to freezing of gait in Parkinson’s disease , 2009, The European journal of neuroscience.

[13]  Nir Giladi,et al.  Characterizing freezing of gait in Parkinson's disease: Models of an episodic phenomenon , 2013, Movement disorders : official journal of the Movement Disorder Society.

[14]  L. Cohen,et al.  Transcranial direct current stimulation: State of the art 2008 , 2008, Brain Stimulation.

[15]  Paul F. Smith Vestibular Functions and Parkinson's Disease , 2018, Front. Neurol..

[16]  Agid Yves Levodopa‐induced dyskinesia , 1992 .

[17]  S. Morioka,et al.  Can Postural Instability Respond to Galvanic Vestibular Stimulation in Patients with Parkinson’s Disease? , 2015, Journal of movement disorders.

[18]  L. Chiari,et al.  Quantification of Motor Impairment in Parkinson's Disease Using an Instrumented Timed Up and Go Test , 2013, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[19]  Bradford J McFadyen,et al.  Magnitude effects of galvanic vestibular stimulation on the trajectory of human gait , 2000, Neuroscience Letters.

[20]  P. Haggard,et al.  Vestibular modulation of spatial perception , 2013, Front. Hum. Neurosci..

[21]  Gábor Fazekas,et al.  Analysis of finger-tapping movement , 2005, Journal of Neuroscience Methods.

[22]  M. McKeown,et al.  Multifaceted effects of noisy galvanic vestibular stimulation on manual tracking behavior in Parkinson’s disease , 2015, Front. Syst. Neurosci..

[23]  F. Mcdowell,et al.  Vestibular dysfunction in Parkinson disease , 1982, Neurology.

[24]  J. Colebatch,et al.  Stochastic galvanic vestibular stimulation produces a small reduction in sway in Parkinson's disease. , 2009, Journal of vestibular research : equilibrium & orientation.

[25]  J. Obeso,et al.  The basal ganglia in Parkinson's disease: Current concepts and unexplained observations , 2008, Annals of neurology.

[26]  Z. Struzik,et al.  Noisy vestibular stimulation improves autonomic and motor responsiveness in central neurodegenerative disorders , 2005, Annals of neurology.

[27]  Mark Hallett,et al.  Transcranial direct current stimulation for the treatment of Parkinson's disease , 2010, Journal of Neurology, Neurosurgery & Psychiatry.

[28]  W. Ondo,et al.  Ambulatory monitoring of freezing of gait in Parkinson's disease , 2008, Journal of Neuroscience Methods.

[29]  D. Thurman,et al.  How common are the “common” neurologic disorders? , 2007, Neurology.

[30]  Tom Robinson,et al.  Levodopa-induced dyskinesia in Parkinson’s disease: clinical features, pathogenesis, prevention and treatment , 2007, Postgraduate Medical Journal.

[31]  M. Rogers,et al.  Disorders of posture, balance, and gait in Parkinson's disease. , 1996, Clinics in geriatric medicine.

[32]  F. Seco,et al.  A comparison of Pedestrian Dead-Reckoning algorithms using a low-cost MEMS IMU , 2009, 2009 IEEE International Symposium on Intelligent Signal Processing.

[33]  R. Djaldetti,et al.  Early‐occurrence of manual motor blocks in Parkinson's disease: a quantitative assessment , 1999, Acta neurologica Scandinavica.

[34]  Y. Yamamoto,et al.  Improvement of motor functions by noisy vestibular stimulation in central neurodegenerative disorders , 2008, Journal of Neurology.