Gait quantitation in Parkinson's disease ? locomotor disability and correlation to clinical rating scales

Vieregge, P.; Stolze, Henning; Klein, Christine; Heberlein, Ilse

doi:10.1007/bf01273184

Cited by 73 publications

(32 citation statements)

References 34 publications

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“…This is consistent with the increased double support phases found and the increased flexion in all joints before freezing, indicating strategies to lower the centre of gravity possibly as an adjustment to potential loss of stability. However, increasing stride width was apparently not used as a compensatory strategy, which is in line with previous reports that in PD stride width is not different from controls [30] and narrows as the disease progresses [31].…”

Section: Discussionsupporting

confidence: 88%

Does freezing in Parkinson’s disease change limb coordination?

et al. 2007

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The aim of this study was to analyse the kinematic characteristics of the strides before freezing and compare this with a voluntary stop and ongoing gait. Also, we investigated whether gait profiles were different as a function of the side of the body. Ten patients were included with a mean age of 64.8 years (SD 5.1). Within a Vicon 3D gait laboratory, patients performed several trials of normal walking and voluntary stops or were exposed to circumstances, which provoked freezing in the off-phase of the medication cycle. Spatiotemporal and key kinematic data of the four strides prior to freezing were compared between body sides and walking conditions using multiple regression models for repeated measures. Prior to freezing patients had severely decreased movement ranges in the sagittal plane (ranging between 31% and 61.5%), most notably in the ankle and hip joints. The general shape of movement remained in the pre-freezing profiles with largely intact dissociation of knee and hip movement in stance but reduced dissociation in swing. Also present were reduced push-off movements in the ankle with fixed dorsiflexion, increased flexion in hip and knee and anterior tilt of the pelvis. During both voluntary (stopping) and involuntary deceleration (freezing), the body side with the last complete stride before the freeze, showed significantly smaller joint ranges (p < .01). Body side differences were larger than sequential deterioration of consecutive steps within each side. Freezing is distinct from normal deceleration of gait in that the reduction of propulsive movement is much greater. Despite hastening of steps, timing deficits did not affect overall movement shapes, except for the tendency to have a flexed walking pattern. The side of the body where gait terminated before freezing was in most cases the side of symptom-dominance, but not consistently so.

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Section: Discussionsupporting

confidence: 88%

Does freezing in Parkinson’s disease change limb coordination?

et al. 2007

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“…Finally, the off-state UPDRS scores were not matched at the two off-state assessments. The motor improvement at visit 2 was partly driven by a reduction in the axial scores, with which gait velocity has been found to correlate [28], and was not explained by changes in medications or differences at the time of testing. This overall motor improvement may have acted as a confounder in the relationship between sensory cues and gait improvement.…”

Section: Limitations Of This Studymentioning

confidence: 96%

At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease

Espay¹,

Baram²,

Dwivedi³

et al. 2010

JRRD

135

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Abstract-Shuffling and freezing while walking can impair function in patients with Parkinson disease (PD). Open-loop devices that provide fixed-velocity visual or auditory cues can improve gait but may be unreliable or exacerbate freezing of gait in some patients. We examined the efficacy of a closedloop, accelerometer-driven, wearable, visual-auditory cueing device in 13 patients with PD with off-state gait impairment at baseline and after 2 weeks of twice daily (30 minute duration) at-home use. We measured gait velocity, stride length, and cadence using a validated electronic gait-analysis system. Subjects underwent standard motor assessment and completed a self-administered Freezing of Gait Questionnaire (FOGQ) (range 0-24; lower is better). After training, device use enhanced walking velocity (61.6 ± 20.1 cm/s to 72.6 ± 26.5 cm/s, p = 0.006) and stride length (74.3 ± 16.4 cm to 84.0 ± 18.5 cm, p = 0.004). Upon device removal, walking velocity (64.5 ± 21.4 cm/s to 75.4 ± 21.5 cm/s, p < 0.001) and stride length (79.0 ± 20.3 cm to 88.8 ± 17.7 cm, p = 0.003) exhibited a greater magnitude of change, suggesting immediate residual benefits. Also upon device removal, nearly 70 percent of subjects improved by at least 20 percent in either walking velocity, stride length, or both. An overall improvement in gait was measured by the FOGQ (14.2 ±1.9 to 12.4 ± 2.5, p = 0.02). Although issues related to compliance and response variability render a definitive interpretation of study outcome difficult, devices using closed-loop sensory feedback appear to be effective and desirable nonpharmacologic interventions to improve walking in selected individuals with PD.

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“…Temporal (e.g., stride time) and spatial (e.g., stride length) parameters are used to examine variation in human gait. Gait stability has been assessed efficiently using the variability measure not only in elderly subjects (Gabell and Nayak 1984;Stolze et al 2000), but also in physically disabled post-stroke patients (Zverev et al 2002) and patients with Parkinson's disease (Vieregge et al 1997). In fact, Gabell and Nayak (1984) reported that in both older and younger groups, the gait-patterning mechanism (step length and stride time) is more consistent than the balance-control mechanism (step width and double-support time) and that increased variability in gait is not necessarily a normal concomitant of old age.…”

Section: Discussionmentioning

confidence: 99%

“…Disturbances in gait pattern and its constancy can be assessed by the coefficient of variation (CV) of gait characteristics such as stride length, step length, and step width (Isaacs 1982;Gabell and Nayak 1984). Moreover, previous studies (Isaacs 1982;Gabell and Nayak 1984;Maruyama and Nagasaki 1992;Vieregge et al 1997;Stolze et al 2000;Brach et al 2001) have proposed that variation in gait represents a measure of gait performance stability. This study used a footprint method to quantitatively assess the effect of PAFO on gait stability in hemiplegic stroke patients.…”

mentioning

confidence: 99%