Whilst deep brain stimulation of the subthalamic nucleus (DBS-STN) improves the motor symptoms of Parkinson’s disease (PD), its effect on daily activity is unknown. We aimed to quantify changes in ambulatory activity following DBS-STN in advanced PD using novel accelerometry based measures that describe changes to the volume and pattern of walking. Seventeen participants with advanced PD were measured over a 7-day period using an activPAL™ activity monitor. Data were collected 6 weeks before and 6 months after surgery and included measures that describe the volume and pattern of ambulatory activity (number of steps per day, accumulation, diversity and variability of walking time), alongside standard measures for disease severity, freezing of gait, gait speed, and extended activities of daily living. Activity outcomes were compared pre- and 6 months post-surgery using linear mixed models and correlated with standard outcomes. The results of this study are despite significant improvements in motor symptoms after surgery, the volume of ambulatory activity (total number of steps per day) did not change (P = 0.468). However, significant increases in length and variability of walking bouts emerged, suggesting improvements in diversity and flexibility of walking patterns. Motor severity and extended activities of daily living scores were significantly correlated with walking bout variability but not with volume of walking. Thus, the conclusions are reduction in motor symptom severity after DBS-STN translated into selective improvements in daily activity. Novel measures derived from accelerometry provide a discrete measure of performance and allow closer interpretation of the impact of DBS-STN on real-world activity.
This is a preview of subscription content, log in to check access.
Funding from the Parkinson’s UK, grant number 8048. Lynn Rochester is supported by the UK NIHR Biomedical Research Centre for Ageing and Age-Related Disease award to the Newcastle upon Tyne Hospitals NHS Foundation Trust.
Conflict of interest
The authors declare that they have no conflict of interest.
Kleiner-Fisman G, Herzog J, Fisman D, Tamma F, Lyons K, Pahwa R et al (2006) Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 21(14):S290–S304PubMedCrossRefGoogle Scholar
Moro E, Lozano A, Pollak P, Agid Y, Rehncrona S, Violkmann J et al (2010) Long-term results of a multicenter study on subthalamic and pallidal stimulation of Parkinson’s disease. Mov Disord 25(5):578–586PubMedCrossRefGoogle Scholar
Williams A, Gill S, Jenkinson C, Quinn N, Mitchell R, Scott R et al (2010) Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s diease (PD surg trial): a randomised, open-label trial. Lancet Neurol 9:581–591PubMedCrossRefGoogle Scholar
Copeland J, Eslinger D (2009) Accelerometer assessment of physical activity in active, healthy older adults. J Aging Phys Act 17(1):17–30Google Scholar
Lord S, Chastin S, McInnes L, Little L, Briggs P, Rochester L (2011) Exploring patterns of daily physical and sedentary behaviour in community-dwelling older adults. Age Ageing 40(2):205–210PubMedCrossRefGoogle Scholar
Chastin S, Granat M (2010) Methods for objective measure, quantification and analysis of sedentary behaviour and inactivity. Gait Posture 31:82–86PubMedCrossRefGoogle Scholar
Varo J, Martínez-González M, De Irala-Estévez J, Kearney J, Gibney M, Martínez J (2003) Distribution and determinants of sedentary lifestyles in the European Union. Int J Epidemiol 32:138–146PubMedCrossRefGoogle Scholar
Hamilton M, Healy G, Dunstan D, Zderic T, Owen N (2008) Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behaviour. Curr Cardiovasc Rep 2:292–298CrossRefGoogle Scholar
Chastin S, Baker K, Jones D, Burn D, Granat M, Rochester L (2010) The pattern of habitual sedentary behaviour is different in advanced Parkinson’s disease. Mov Disord 25(13):2114–2120PubMedCrossRefGoogle Scholar
Fahn S, Elton E (eds) (1987) The unified Parkinson’s disease rating scale. Macmillan, New JerseyGoogle Scholar
Folstein M, Folstein S, McHugh P (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
Montgomery S, Asberg M (1979) A new depression scale designated to be sensitive to change. B J Psychiatry 134:382–389CrossRefGoogle Scholar
Nouri FM, Lincoln N (1987) An extended activities of daily living index for stroke patients. Clin Rehabil 1:301–305CrossRefGoogle Scholar
Goetz C, Stebbins S, Shale H, Lang A, Chernik D, Chmura T et al (1994) Utility of an objective dyskinesia rating scale for Parkinson’s disease: inter- and intra-rate reliability assessment. Mov Disord 9:390–394PubMedCrossRefGoogle Scholar
Nieuwboer A, Rochester L, Herman T, Vandenberghe W, Emil G, Thomaes T et al (2009) Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson’s disease and their careers. Gait Posture 30(4):459–463PubMedCrossRefGoogle Scholar
Grant P, Ryan C, Tigbe W, Granat M (2006) The validation of a novel activity monitor in the measurement of posture and motion during everyday activities. Br J Sports Med 40:992–997PubMedCrossRefGoogle Scholar
Tomlinson C, Stowe R, Patel S, Rick C, Gray R, Clarke C (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25(15):2649–2685PubMedCrossRefGoogle Scholar
Ferraye M, Debu B, Fraix V, Xie-Brustolin J, Chabardes S, Krack P et al (2008) Effects of subthalamic nucleus stimulation and levodopa on freezing of gait in Parkinson disease. Neurology 7016(2):1431–1437CrossRefGoogle Scholar
Ferrarin M, Rizzone M, Bergamasco B, Lanotte M, Recalcati M, Pedotti A et al (2005) Effects of bilateral subthalamic stimulation on gait kinematics and kinetics in Parkinson’s disease. Exp Brain Res 160(4):517–527PubMedCrossRefGoogle Scholar
Faist M, Xie J, Kurz D, Berger W, Maurer C, Pollak P et al (2001) Effect of bilateral subthalamic nucleus stimulation on gait in Parkinson’s disease. Brain 124(8):1590–1600PubMedCrossRefGoogle Scholar
White D, Wagenaar R, Ellis T, Tickle-Degnen L (2009) Changes in walking activity and endurance following rehabilitation for people with Parkinson’s disease. Arch Phys Med Rehabil 90:43–50PubMedCrossRefGoogle Scholar
Grant P, Dall P, Mitchell S, Granat M (2008) Activity monitoring accuracy in measuring step number and cadence in community-dwelling older adults. J Ageing Phys Activ 16:201–214Google Scholar
Lim I, Van Wegen E, Jones D, Rochester L, Nieuwboer A, Willems AM et al (2010) Does cueing training improve physical activity in patients with Parkinson’s disease? Neurorehabil Neural Repair 24(5):469–477PubMedCrossRefGoogle Scholar
Rochester L, Jones D, Hetherington V, Nieuwboer A, Willems AM, Kwakkel G et al (2006) Gait and gait-related activities and fatigue in Parkinson’s disease: what is the relationship? Disabil Rehabil 28(22):1365–1371PubMedCrossRefGoogle Scholar