Effects of augmented proprioceptive cues on the parameters of gait of individuals with Parkinson′s disease

Abstract

Context:Impairment of initiating sequential movements and processing of proprioception contribute to characteristic Parkinson's disease (PD) gait abnormalities. Many studies have used a single external cue or 2 different cues to correct PD gait.Aim:An aim of this study was to determine the influence of paired proprioceptive cues on gait parameters of individuals with PD.Setting and Design:Double-blind randomized controlled trial.Materials and Methods:Subjects were 30 PD patients who had mild to moderate impairment according to the United Parkinson's Disease Rating Scale (UPDRS). They were randomly assigned to either a routine physiotherapy program or treadmill training with vibratory stimuli applied to the feet plantar surfaces and proprioceptive neuromuscular facilitation (PNF) as well as the same physiotherapy program. All Participants received a 45-minutes session of low intensity physiotherapy program, 3 times a week, for 8 weeks. The duration of treadmill training was 5 minutes at baseline and 25 minutes at the end of treatment. Walking speed and distance were recorded from the treadmill control panel for both groups before and immediately after the end of treatment. The Qualysis ProReflex motion analysis system was used to measure cadence, stride length, hip, knee, and ankle joints’ angular excursion.Results:The cadence, stride length, and lower limb joints’ angular excursion showed a significant improvement in both groups (P ≤ 0.05). These improvements in spatio-temporal parameters and angular excursion were higher in the study group than in the control group (P ≤ 0.05).Conclusion:Potentiated proprioceptive feedback improves parkinsonian gait kinematics, the hip, knee, and ankle joints’ angular excursion.

International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease

“…80 In contrast, 2 high-quality studies were negative; 1 using an avatar versus conventional balance training for balance 81 and 1 evaluating robotic gait training versus balance training. 82,83 Other technologies that were evaluated included the use of a Nintendo Wii versus balance exercises, 84 smartphone biofeedback 85 and a gamepad-"dancing software," 86 vibratory devices added to shoes 87 with overall positive outcomes in both groups, but all were lower quality studies. Studies in which there was no active intervention and where participants received the usual medical therapy as a comparator or where there was unclear final statistical analysis were all lowquality, and therefore the interpretations of outcome conclusions were limited.…”

Age-Related Imbalance Is Associated With Slower Walking Speed: An Analysis From the National Health and Nutrition Examination Survey

“…20–21 Moreover, one study found that proprioceptive feedback exercises improved walking speed in individuals with Parkinson’s disease, suggesting the importance of proprioceptive inputs to gait function. 22 We adjusted for both visual acuity and monofilament testing in our regression models and did not observe that these factors explained the association between static balance and walking speed. However, vision loss and proprioceptive impairment are multifaceted, and also involve contrast sensitivity, visual fields, and depth perception in the case of vision and joint and muscle proprioception in the case of proprioception.…”

Comparison of three physical therapy interventions with an emphasis on the gait of individuals with Parkinson’s disease

“…The first treatment proposed was Rhythmic Cues, as auditory and visual rhythmic cues are effective in improving the gait of individuals with PD; these improve step preparation (12) due to the greater attention demanded during the task (13). Studies reveal that rhythmic cues help PD patients to replace typical automatic gait control with a more conscious and perhaps, more discreet movement, making walking easier.…”