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Please use this identifier to cite or link to this thesis: http://hdl.handle.net/10589/131416

Author: FRITTOLI, SERENA
Supervisor: GALLI, MANUELA
Coordinator: ALIVERTI, ANDREA
Tutor: FARE', SILVIA
Assistant supervisor: CIMOLIN, VERONICA
Department : DIPARTIMENTO DI ELETTRONICA, INFORMAZIONE E BIOINGEGNERIA
PhD course: BIOINGEGNERIA
Cycle: 27
Scientific Disciplinary Sector: ING-INF/06 BIOINGEGNERIA ELETTRONICA E INFORMATICA
Date: 6-Feb-2017
Title: Quantitative movement analysis of dystonia: development of protocols for the characterization and assessment of focal dystonia
Italian abstract: Background and aims: Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. Nowadays, diagnosis of dystonia can be made difficult and the diagnostic tools remain based on clinical diagnostic skills. Therefore there is an increasing need for more accurate and precise methods for both delineating the nature of abnormal movements and rating their severity. In this framework, the research activity carried out during my Doctoral program represents a multi-disciplinary work that includes engineering technologies and current clinical knowledge regarding primary dystonia, seeking to improve the characterization and the assessment of this movement disorder. More specifically, my research focused on defining specific protocols to assess four different focal dystonia: lower limb, upper limb, cervical dystonia and blepharospasm. The developed protocols were based on motion analysis (kinematics analysis, and dynamic electromyography) as a tool to characterize the motor phenotype in a population of patients with a clinical diagnosis of primary dystonia and to highlight the interlinkages in movement patterns and muscle activation. Materials and methods: the present work is composed of four studies and the total of 65 patients with focal dystonia, with a mean age of 52.8 ± 13.2 years were studied: the first study investigated the role of lower limb dystonia analysing spatiotemporal, kinematic, and kinetic gait parameters in 15 patients with parkin disease (PARK2) during walking at comfortable speed; the second study investigated the role of dystonia associated to dystonic tremor in 15 patients affected by focal upper limb dystonia during the execution of a goal-directed task: the finger-nose test was assessed by means of an optoelectronic system to characterize by kinematic parameters this movement; the third study aimed to characterize the head’s movements in 15 patients with cervical dystonia, by assessing quantitatively the postural and motor adjustment and computing significant kinematic parameters (kinematic and electromyographic parameters) that define the motor strategies adopted by the patients during the execution of the movements of the neck and of the head (flexion-extension, rotation, lateral flexion, anterior-posterior shifts); the fourth study aimed to characterize the eyelids’ movements in 20 patients with blepharospasm, by assessing the amplitude, frequency and duration of the blinking during the execution of three tasks: rest, reading and conversation. Each group of patients was compared to healthy age- and gender- matched controls. Results: Here following the main results, study by study: 1) The evaluation of lower limb dystonia in parkin disease patients revealed that these patients are characterized by increased ankle plantar flexion, excessive knee flexion and increased jerk index at three joints; these parameters may thus be the instrumented expression of the dystonic features, indicating a reduced movement smoothness at a given joint. 2) The main findings of the assessment of patients affected by upper limb dystonia associated to dystonic tremor, in comparison to the healthy participants, were: higher movement’s duration, lower movement’s mean velocity, higher frequency in change of direction, higher number of movement unit; all these features were a clear sign of the motor disability that characterizes these group of participants. 3) The assessment of patients with cervical dystonia showed the extreme heterogeneity of the pathology and the difficult to find similar characteristics between patients with the same diagnosis; these results provide evidence that each patient is different from the other. 4) The analysis of blinking in patients with blepharospasm showed that in most patients with blepharospasm blink rate at rest was higher than blink rate during conversation, while the pattern blink rate, observed in the healthy participants, during conversation was higher than blink rate at rest. Conclusions: This study demonstrated protocols and new indexes for assessment of four kinds of focal dystonia using instrumented movement analysis. Indeed, each protocol has objectively characterized motor abnormalities in focal dystonia by identifying specific parameters resulting from the valuation of motor patterns and the corresponding muscle activation. The quantitative analysis of the dystonia becomes important in the clinic environment to investigate changes in movement biomechanical characteristics longitudinally.
English abstract: Background and aims: Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. Nowadays, diagnosis of dystonia can be made difficult and the diagnostic tools remain based on clinical diagnostic skills. Therefore there is an increasing need for more accurate and precise methods for both delineating the nature of abnormal movements and rating their severity. In this framework, the research activity carried out during my Doctoral program represents a multi-disciplinary work that includes engineering technologies and current clinical knowledge regarding primary dystonia, seeking to improve the characterization and the assessment of this movement disorder. More specifically, my research focused on defining specific protocols to assess four different focal dystonia: lower limb, upper limb, cervical dystonia and blepharospasm. The developed protocols were based on motion analysis (kinematics analysis, and dynamic electromyography) as a tool to characterize the motor phenotype in a population of patients with a clinical diagnosis of primary dystonia and to highlight the interlinkages in movement patterns and muscle activation. Materials and methods: the present work is composed of four studies and the total of 65 patients with focal dystonia, with a mean age of 52.8 ± 13.2 years were studied: the first study investigated the role of lower limb dystonia analysing spatiotemporal, kinematic, and kinetic gait parameters in 15 patients with parkin disease (PARK2) during walking at comfortable speed; the second study investigated the role of dystonia associated to dystonic tremor in 15 patients affected by focal upper limb dystonia during the execution of a goal-directed task: the finger-nose test was assessed by means of an optoelectronic system to characterize by kinematic parameters this movement; the third study aimed to characterize the head’s movements in 15 patients with cervical dystonia, by assessing quantitatively the postural and motor adjustment and computing significant kinematic parameters (kinematic and electromyographic parameters) that define the motor strategies adopted by the patients during the execution of the movements of the neck and of the head (flexion-extension, rotation, lateral flexion, anterior-posterior shifts); the fourth study aimed to characterize the eyelids’ movements in 20 patients with blepharospasm, by assessing the amplitude, frequency and duration of the blinking during the execution of three tasks: rest, reading and conversation. Each group of patients was compared to healthy age- and gender- matched controls. Results: Here following the main results, study by study: 1) The evaluation of lower limb dystonia in parkin disease patients revealed that these patients are characterized by increased ankle plantar flexion, excessive knee flexion and increased jerk index at three joints; these parameters may thus be the instrumented expression of the dystonic features, indicating a reduced movement smoothness at a given joint. 2) The main findings of the assessment of patients affected by upper limb dystonia associated to dystonic tremor, in comparison to the healthy participants, were: higher movement’s duration, lower movement’s mean velocity, higher frequency in change of direction, higher number of movement unit; all these features were a clear sign of the motor disability that characterizes these group of participants. 3) The assessment of patients with cervical dystonia showed the extreme heterogeneity of the pathology and the difficult to find similar characteristics between patients with the same diagnosis; these results provide evidence that each patient is different from the other. 4) The analysis of blinking in patients with blepharospasm showed that in most patients with blepharospasm blink rate at rest was higher than blink rate during conversation, while the pattern blink rate, observed in the healthy participants, during conversation was higher than blink rate at rest. Conclusions: This study demonstrated protocols and new indexes for assessment of four kinds of focal dystonia using instrumented movement analysis. Indeed, each protocol has objectively characterized motor abnormalities in focal dystonia by identifying specific parameters resulting from the valuation of motor patterns and the corresponding muscle activation. The quantitative analysis of the dystonia becomes important in the clinic environment to investigate changes in movement biomechanical characteristics longitudinally.
Italian keywords: analisi cinematica; EMG; distonia cervicale; blefarospasmo; PARK2; distonia degli arti superiori
English keywords: kinematics; EMG; cervical dystonia; blepharospasm; Park2; upper limb dystonia
Language: eng
Publisher: Politecnico di Milano
Type of document: Tesi di dottorato
Appears in Collections:POLITesi >Tesi di Dottorato

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