Comparing Backward Walking Performance in Parkinson’s Disease with and without Freezing of Gait—A Systematic Review

Abstract

Introduction: Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor symptoms and gait impairments. Among them, freezing of gait (FOG) is one of the most disabling manifestations. Backward walking (BW) is an activity of daily life that individuals with PD might find difficult and could cause falls. Recent studies have reported that gait impairments in PD were more pronounced in BW, particularly in people presenting FOG. However, to the best of our knowledge, no systematic review has synthetized the literature which compared BW performance in PD patients with and without FOG. Objective: The aim of this study was to evaluate the differences in BW performance between PD patients with FOG and PD patients without FOG. Methods: Two databases, PubMed and Web of Science, were systematically searched to identify studies comparing BW performance in PD patients with and without FOG. The National Institutes of Health (NIH) tool was used to assess the quality of the studies included. Results: Seven studies with 431 PD patients (179 PD with FOG and 252 PD without FOG) met the inclusion criteria and were included in this review. Among them, 5 studies reported walking speed, 3 studies step length, stride length and lower limb range of motion, 2 studies functional ambulation profile, toe clearance height, swing, and stance percent and 1 study reported the decomposition index and stepping coordination. Compared to PD patients without FOG, PD patients with FOG showed slower walking speed and reduced step length in 3 studies, shorter stride length, lower functional ambulation profile and decreased ankle range of motion in 2 studies, and smaller swing percent, higher stance percent, worse stepping coordination, greater decomposition between movements, and lower toe clearance height in one study. Conclusion: Despite the small number of included studies, the findings of this review suggested that PD patients with FOG have worse gait performance during the BW task than PD without FOG.

Forward and Backward Walking: Multifactorial Characterization of Gait Parameters

“…Given the fundamental importance of walking in everyday activities and its tight connection with well-being, gait training is frequently part of the rehabilitation protocols. Forward Walking (FW) can easily be performed by individuals of all ages and fitness levels, and it is commonly indicated for patients recovering from injuries and surgeries at the lower limbs, suffering from chronic conditions, disabilities and neurodegenerative disorders [ 13 ]. More specifically, walking helps preserving muscular strength and balance control, coordination and proprioception, which can reduce the risk of falls and injuries.…”

“…Zhang et al [ 19 ] dedicated attention to the knee external abduction moment during BW, pointing out that this motor task reduced the joint loading and confirmed its potentiality in the management of knee osteoarthritis. Milane et al [ 13 ] showed that BW challenges the body differently than FW, stimulating balance and coordination in a more demanding way, and improving cognitive function, proprioception and spatial awareness. Dissimilarities between FW and BW kinematics have been also identified in people with intellectual disabilities by Gimunova et al [ 26 ].…”

Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study

“…Moreover, the occurrence of FOG is highly variable, making it difficult to measure the frequency and duration of FOG attacks. However, FOG patients often exhibit lower gait speed, shorter stride length, worse gait cycle index, and greater gait variability 20‐22 . Therefore, we used objective quantification of gait kinematics in this study to distinguish the gait characteristics of FOG and quantify the treatment efficacy on FOG.…”