Beneficial Effect of Foot Plantar Stimulation in Gait Parameters in Individuals with Parkinson’s Disease

Abstract

New treatments based on peripheral stimulation of the sensory-motor system have shown to be promising in rehabilitation strategies for patients with neurological disorders, including Parkinson’s disease (PD), especially in regards to reducing gait impairment, and hence, the incidence of falls. The aim of this study was to evaluate the change in several gait parameters measured by sensor inertial measurement in PD patients after acute plantar stimulation, under the distal phalanx of the big toe, and underneath the head of the first metatarsal joint of both feet, using a 3D printing insole. In order to assess whether the effects are selective for PD patients, we compared the effect of the treatment in a control group (age-matched) consisting of patients with other neurological disorders which also displayed gait and balance impairment, and a similar cognitive function, depressive symptoms, body mass index, and comorbidity burden observed in the PD group. Plantar foot stimulation in PD patients eliminated the significant (p < 0.05) alterations existing in stride asymmetry and in stride variability. When comparing the effects of post-plantar stimulation with the respective basal level, considered as 100% in both groups, we observed a significant (p = 0.019, Mann–Whitney test) increase in stride length compared to basal in the PD group and control group. No significant effects of foot plantar stimulation were observed in any of the gait parameters in the control group. Plantar foot stimulation has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. No significant effect was observed on bradykinesia because it did not improve walking velocity. These findings indicate that foot plantar stimulation using a 3D printing insole seems to generate a more stable walking pattern in PD patients, with an interesting applicability, and a low-cost, for reducing gait impairment in PD patients.

Immediate Effects of Medially Posted Insoles on Lower Limb Joint Contact Forces in Adult Acquired Flatfoot: A Pilot Study

“…In this study, we utilized the MSK model approach to investigate the influence of the foot orthosis (medial arch support with forefoot medial posting) on the biomechanics of the lower extremity for adults with flatfoot. Compared to the traditional joint angle or moment parameters, the estimated joint force could provide a relatively direct interpretation of clinical manifestation, which is difficult to measure in vivo [38,39]. Thus, the medial and lateral contact force of the tibiofemoral and the patellofemoral joints were estimated.…”

<p>Reference Values of Gait Speed and Gait Spatiotemporal Parameters for a South East Asian Population: The Yishun Study</p>

“…Slow gait is a determinant for sarcopenia 1 and cognitive frailty. 2 Disease-associated abnormal gait, such as foot pain 3 and Parkinson disease, 4 predispose older adults to a greater fall risk. Hence, gait impairment predicts institutionalization and early mortality.…”

Mechanical Plantar Foot Stimulation in Parkinson′s Disease: A Scoping Review

“…The studies using insoles to stimulate plantar foot used a static protocol of stimulation prior to analysis of the gait [54,56]; or used textured insole [57][58][59]. A variety of stimulation periods were found with the other procedures, ranging from a few seconds [54], minutes [56], and even days [59]. As regards the anatomical location of mechanical stimulation on plantar foot, most studies stimulated the head of the big toe and the base of the first metatarsal bone.…”

“…The clinical features of PD patients enrolled in these studies are classified in the Hoehn and Yahr staging scale as level 2-3 in most of the studies. The studies by Pagnussat et al [60] and Brognara et al [56] also included patients in stage 4 (e.g., severe disability; still able to walk or stand unassisted). In the study of Qiu et al, the mean Hoehn and Yahr staging scale was 1.4, and as such so the clinical features of these patients were milder compared to the rest of the analysed studies.…”

“…The most common beneficial effects of mechanical plantar stimulation reported were gait velocity (reported in seven studies: [55,57,60,[62][63][64][65]), stride length (reported in 6 studies: [55,56,59,60,63,64]) and step length (reported in five studies [57,61,62,64,65]) ( Table 3). However other parameters less extensively investigated in the gait analysis also improved after plantar foot stimulation, including step variability (reported in two studies [57,62]), asymmetry and pitch contact (reported in 1 study [56]) ( Table 3). An important issue for understanding how this intervention acts is the reporting of gait parameters that did not improve walking speed [56,59].…”