Parkinson’s disease (PD) leads to impaired mobility and limited independence. We investigated the effects of acupuncture on gait disturbance and analyzed hemodynamic changes caused by acupuncture in the cerebral cortex of patients with PD. Participants (n = 26) with gait disturbance due to PD were randomly assigned to the intervention (acupuncture twice a week for 4 weeks + conventional therapy) or control (conventional therapy) groups. We analyzed gait parameters using the GAITRite system and hemodynamic responses in the cerebral cortices using functional near-infrared spectroscopy, Unified Parkinson’s Disease Rating Scale (UPDRS) scores, neurotransmitter levels, as well as the immediate effects of acupuncture in patients with PD. The participants tended to walk with hypometric gait (high cadence, short steps) overground. After acupuncture treatment, those in the intervention group showed a significant reduction in cadence and the UPDRS scores involving “walking and balance” compared with those in the control group (P = .004 and P = .020, respectively); the stride, swing, and single support times were significantly increased (P = .006, P = .001, and P = .001, respectively). Oxyhemoglobin levels in the intervention group while walking on a treadmill were significantly increased in the prefrontal and supplementary motor areas. The oxyhemoglobin levels in the prefrontal cortex and swing time revealed significant positive correlations. Our findings indicated that acupuncture tended to improve hypometric gait and rearranged activation of the cerebral cortex. Thus, acupuncture may be a useful complementary treatment for gait disturbance, including hypometric gait, in patients with PD. Trial Registration Number. Clinical Research Information Service (KCT0002603), https://cris.nih.go.kr/cris/index.jsp

The second most common progressive neurodegenerative disorder, Parkinson’s disease (PD), is characterized by a broad spectrum of symptoms that are associated with its progression. Several studies have attempted to classify PD according to its clinical manifestations and establish objective biomarkers for early diagnosis and for predicting the prognosis of the disease. Recent comprehensive research on the classification of PD using clinical phenotypes has included factors such as dominance, severity, and prognosis of motor and non-motor symptoms and biomarkers. Additionally, neuroimaging studies have attempted to reveal the pathological substrate for motor symptoms. Genetic and transcriptomic studies have contributed to our understanding of the underlying molecular pathogenic mechanisms and provided a basis for classifying PD. Moreover, an understanding of the heterogeneity of clinical manifestations in PD is required for a personalized medicine approach. Herein, we discuss the possible subtypes of PD based on clinical features, neuroimaging, and biomarkers for developing personalized medicine for PD. In addition, we conduct a preliminary clustering using gait features for subtyping PD. We believe that subtyping may facilitate the development of therapeutic strategies for PD.

Phillips V Z, et al. J Clin Neurol. 2023 Mar;19(2):115-124. https://doi.org/10.3988/jcn.2022.0406

The purpose of this study is to investigate cerebral cortex activation during active movement and passive movement by using a functional near-infrared spectroscopy (fNIRS). Tasks were the flexion/extension of the right hand finger by active movement and passive movement. Oxy-hemoglobin concentration changes calculated from fNIRS and analyzed the activation and connectivity so as to understand dynamical brain relationship. The results demonstrated that the brain activation in passive movements is similar to motor execution. During active movement, the estimated causality patterns showed significant causality value from the supplementary motor area (SMA) to the primary motor cortex (M1). During the passive movement, the causality from the primary somatosensory cortex (S1) to the primary motor cortex (M1) was stronger than active movement. These results demonstrated that active and passive movements had a direct effect on the cerebral cortex but the stimulus pathway of active and passive movement is different. This study may contribute to better understanding how active and passive movements can be expressed into cortical activation by means of fNIRS.

Computed tomography (CT) is a widely used medical imaging modality for diagnosing various diseases. Among CT techniques, 4-dimensional CT perfusion (4D-CTP) of the brain is established in most centers for diagnosing strokes and is considered the gold standard for hyperacute stroke diagnosis. However, because the detrimental effects of high radiation doses from 4D-CTP may cause serious health risks in stroke survivors, our research team aimed to introduce a novel image-processing technique. Our singular value decomposition (SVD)-based image-processing technique can improve image quality, first, by separating several image components using SVD and, second, by reconstructing signal component images to remove noise, thereby improving image quality. For the demonstration in this study, 20 4D-CTP dynamic images of suspected acute stroke patients were collected. Both the images that were and were not processed via the proposed method were compared. Each acquired image was objectively evaluated using contrast-to-noise and signal-to-noise ratios. The scores of the parameters assessed for the qualitative evaluation of image quality improved to an excellent rating (p < 0.05). Therefore, our SVD-based image-denoising technique improved the diagnostic value of images by improving their quality. The denoising technique and statistical evaluation can be utilized in various clinical applications to provide advanced medical services.

We designed and implemented an electromagnetic transducer for implantable bone conduction hearing aids. The proposed transducer is smaller than previous bone conduction transducers for easy implantation and was designed using high permeability metals to produce large electromagnetic forces. In addition, the number of cantilever beams was changed from two to three to minimize distortion of the transducer, potentially due to twisting of the cantilever beam. The proposed transducer consists of a titanium cover with three screw holes, a metal ring, a circular plate, a vibrational membrane with a three-cantilever structure, a metal plate and cylinder, a permanent magnet, top and bottom coils, and a cylindrical titanium case. The transducer was optimally designed based on analysis of electromagnetic and mechanical vibrations, and the target resonance frequency was derived by controlling the variable elements of the vibrational membrane. The transducer was manufactured based on the results of finite element analysis, and the validity of the design was verified by comparing the results of vibration measurement experiments and a simulation. Finally, to evaluate the performance of the proposed transducer, the transducer was attached to the mastoid of participants and functional near-infrared spectroscopy was used to measure brain activation changes of the auditory cortex due to vibration stimulation.