Gait impairments in Parkinson's disease

Mirelman, Anat; Bonato, Paolo; Camicioli, Richard; Ellis, Terry; Giladi, Nir; Hamilton, Jamie; Hass, Chris J.; Hausdorff, Jeffrey M.; Pelosin, Elisa; Almeida, Quincy J.

doi:10.1016/s1474-4422(19)30044-4

Cited by 502 publications

(445 citation statements)

References 98 publications

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“…However, over time chronic levodopa treatment can be associated with decreased response and motor complications such as "wearing-off phenomena" and dyskinesia [1,2]. Postural and motor impairments are among the most debilitating symptoms for patients with PD, directly affecting their quality of life [3]. Postural instability can be defined as the impairment of balance that compromises the ability to maintain or change posture, being considered one of the main features of Parkinson's disease, along with resting tremors, rigidity, and bradykinesia [4].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Additionally, PD asymmetry can be explained for a reduced number of neurons in one side of substantia nigra [34]. However, the asymmetrical side might be merely coincidental, and in the early stage, the degeneration is lower [35]. In our study, the asymmetry between the sides was considered when the valued was less than 5% in the statistic test [23].…”

Section: Discussionmentioning

confidence: 99%

Effects of Nordic Walking on Gait Symmetry in Mild Parkinson’s Disease

et al. 2019

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Individuals with Parkinson’s disease (PD) have gait asymmetries, and exercise therapy may reduce the differences between more and less affected limbs. The Nordic walking (NW) training may contribute to reducing the asymmetry in upper and lower limb movements in people with PD. We compared the effects of 11 weeks of NW aerobic training on asymmetrical variables of gait in subjects with mild PD. Fourteen subjects with idiopathic PD, age: 66.8 ± 9.6 years, and Hoehn and Yard stage of 1.5 points were enrolled. The kinematic analysis was performed pre and post-intervention. Data were collected at two randomized walking speeds (0.28 m·s−1 and 0.83 m·s−1) during five minutes on the treadmill without poles. The more affected and less affected body side symmetries (threshold at 5% between sides) of angular kinematics and spatiotemporal gait parameters were calculated. We used Generalized Estimating Equations with Bonferroni post hoc (α = 0.05). Maximal flexion of the knee (p = 0.007) and maximal abduction of the hip (p = 0.041) were asymmetrical pre and became symmetrical post NW intervention. The differences occurred in the knee was less affected and the hip was more affected. We concluded that 11 weeks of NW training promoted similarities in gait parameters and improved knee and hip angular parameters for PD subjects.

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“…First, during the prodromal phase of PD, subtle gait impairments may more easily become overt under challenging conditions, such as dual‐task walking. Therefore, assessing the change in gait parameters under different walking conditions might reveal even earlier gait impairments in prodromal PD.…”

Section: Potential Conflicts Of Interestmentioning

confidence: 99%

“…This might be problematic for the prediction of PD in a population not at high risk for PD. Alternatively, assessing quantitative gait measures specific for PD, such as shuffling, might facilitate the prediction of conversion to clinical PD in the general population.…”

Section: Potential Conflicts Of Interestmentioning

confidence: 99%

“…Walter Maetzler, MD, 1 Silvia Del Din, PhD , 2 Morad Elshehabi, MSc, MD, 1 Brook Galna, PhD, 2,3 Daniela Berg, MD, 1,4 and Lynn Rochester, PhD 2,5,6 We thank Dommershuijsen et al for their valuable comments on our recent article. 1 They raise the question as to whether the use of dual-task gait protocols may provide even more sensitive markers to predict conversion to clinically established Parkinson disease (PD).…”

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confidence: 99%

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