Cross-Sectional Analysis of Backward, Forward, and Dual Task Gait Kinematics in People With Parkinson Disease With and Without Freezing of Gait

Abstract

People with Parkinson disease demonstrate increased gait variability, but the primary variability sources are poorly understood. People with Parkinson disease and freezing of gait (freezers) have greater gait impairments than people with Parkinson disease without freezing of gait (nonfreezers), which may relate to cerebellar dysfunction. Thirteen freezers and 31 nonfreezers completed backward, forward, and forward with dual task gait trials. Sagittal joint angle waveforms were extracted for the hip, knee, and ankle using 3D motion capture. Decomposition indices were calculated for the 3 joint combinations. Principal component analysis extracted variance sources from the joint waveforms. Freezers had significantly greater decomposition between hip–ankle (F1,42 = 5.1, P = .03) and hip–knee (F1,42 = 5.3, P = .03) movements. The principal component analysis did not differentiate freezers and nonfreezers; however, primary variance sources differed between conditions. Primary variance during forward and forward with dual task gait came from joint angle magnitude and peak angle timing. Backward gait showed primary variance from joint angle magnitude and range of motion. The results show that freezers decompose movement more than nonfreezers, implicating cerebellar involvement in freezing of gait. Primary variance differs between gait conditions, and tailoring gait interventions to address variability sources may improve intervention efficacy.

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

“…After full-text screening, 2 studies were excluded. The remaining 7 studies fulfilled the eligibility criteria and were included in this systematic review [7,9,[17][18][19][20][21]. The study selection process is illustrated in Figure 1.…”

“…Publication year of the 7 included studies ranged from 2009 [9] to 2022 [7]. One study (14%) was published in each of the following years: 2009 [9], 2010 [17], 2012 [18], 2017 [19], 2018 [20], 2020 [21], and 2022 [7].…”

“…Journal. The 7 included studies have been published in 6 different journals: 2 (29%) in Gait & Posture [7,20], and 1 (14%) in each of the following journals: Movement Disorders [9], Neurorehabilitation and Neural Repair [17], Journal of Applied Biomechanics [21], Parkinsonism and Related Disorders [18] and Journal of Rehabilitation Medicine [19].…”

“…Funding information was reported in all studies (n = 7). Four studies (57%) were supported by the American Parkinson Disease Association in the USA [9,17,18,21]. Four studies (57%) received grants from the National Institutes of Health [17][18][19]21].…”

“…Finally, BW alterations in PD have been reported to be more closely related to motor symptoms and fear of falling than forward walking, thus suggesting that BW analysis could be a potential progression biomarker [16]. Recent studies have also reported that patients with PD, particularly those with FOG, had greater impairments in BW than in forward walking [7,9,[17][18][19][20][21]. This subgroup of patients demonstrated to be more prone to multiple falls and injuries [22] and backward walking has been linked to FOG occurrence [18].…”