title: Effects of mechanical stimulation of the feet on gait and cardiovascular autonomic control in Parkinson's disease.
abstract: Motor impairment in Parkinson's disease (PD) is partly due to defective central processing of lower limb afferents. Concomitant alterations in cardiovascular autonomic control leading to orthostatic hypotension may worsen motor ability. We evaluated whether mechanical activation of feet sensory afferents could improve gait and modify the response of cardiovascular autonomic control to stressors in 16 patients (age 66 ± 2 yr) with idiopathic PD (Hoehn & Yhar scale 2-3) on their usual therapy. Eight subjects (group A) were randomized to undergo skin pressure (0.58 ± 0.04 kg/mm(2)) stimulation at the hallux tip and first metatarsal joint (effective stimulation; ES) of both feet. Eight remaining patients (group B) underwent sham stimulation (SS) followed by ES. Three-dimensional movement analysis provided quantitative indexes of movement disability before (baseline) and 24 h after ES and SS. Spectral analysis of heart rate and blood pressure variability provided markers of cardiac sympatho-vagal (LF/HF) and vascular sympathetic (LFSAP) modulations. Markers were measured at rest and during 75° head-up tilt, before and 24 h after ES and SS. After ES, step length and gait velocity increased, upright rotation velocity was enhanced, and step number was decreased. After ES, LFSAP declined. The increase in LF/HF and LFSAP induced by tilt was greater than before feet stimulation. No changes in gait and autonomic parameters were observed after SS. Twenty-four hours after ES, patients with PD showed improved gait and increased cardiac and vascular sympathetic modulation during upright position compared with baseline. Conversely, SS was ineffective on both movement and autonomic parameters, indicating a site specificity effect of the stimulation.
authors.affiliation: Internal Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Neuroscience Research Association, Milan, Italy;
authors.forename: Franca
authors.initials: F
authors.lastname: Barbic
authors.forename: Manuela
authors.initials: M
authors.lastname: Galli
authors.forename: Laura
authors.initials: L
authors.lastname: Dalla Vecchia
authors.forename: Margherita
authors.initials: M
authors.lastname: Canesi
authors.forename: Veronica
authors.initials: V
authors.lastname: Cimolin
authors.forename: Alberto
authors.initials: A
authors.lastname: Porta
authors.forename: Vlasta
authors.initials: V
authors.lastname: Bari
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cerri
authors.forename: Franca
authors.initials: F
authors.lastname: Dipaola
authors.forename: Tito
authors.initials: T
authors.lastname: Bassani
authors.forename: Domenico
authors.initials: D
authors.lastname: Cozzolino
authors.forename: Gianni
authors.initials: G
authors.lastname: Pezzoli
authors.forename: Raffaello
authors.initials: R
authors.lastname: Furlan
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D001696:Biomechanical Phenomena / Q000502:physiology; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D005528:Foot / Q000294:innervation / Q000502:physiology*; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000534:rehabilitation*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009475:Neurons, Afferent / Q000502:physiology; D010300:Parkinson Disease / Q000503:physiopathology* / Q000534:rehabilitation*; D010812:Physical Stimulation; D012399:Rotation
keywords: Parkinson's disease; cardiovascular autonomic control; gait analysis; somatosensory feet mechanical stimulation; spectral analysis