Interlimb coordination is impaired during walking in persons with Parkinson's disease

Abstract

Background Coordination between the upper and lower extremities is important to providing dynamic stability during human gait. Though limited, previous research has suggested that interlimb coordination may be impaired in persons with Parkinson’s disease. We extend this previous work using continuous analytical techniques to enhance our understanding of interlimb coordination during gait in persons with Parkinson’s disease. Methods Eighteen adults with Parkinson’s disease and fifteen healthy older adults walked overground while undergoing three-dimensional motion capture. Ipsilateral and contralateral interlimb coordination between the sagittal shoulder and hip angles was assessed using cross-covariance techniques. Independent samples and paired samples t-tests compared measures of interlimb coordination between groups and between sides within the participants with Parkinson’s disease, respectively. Pearson’s correlations were applied to investigate associations between interlimb coordination measures and subscores of gait, posture, and bradykinesia on the Unified Parkinson’s Disease Rating Scale. Findings Ipsilateral and contralateral interlimb coordination was reduced in persons with Parkinson’s disease compared to the healthy older adults. Ipsilateral coordination between the upper and lower extremities more affected by disease was found to be negatively associated with clinical scores of gait and posture. Interlimb coordination was not significantly associated with clinical measures of bradykinesia. Interpretation Persons with Parkinson’s disease exhibit reduced interlimb coordination during gait when compared to healthy older adults. These reductions in coordination are related to clinically-meaningful worsening of gait and posture in persons with PD and coordination of arm and leg movements should be considered in future research on gait therapy in this population.

Dopaminergic Modulation of Arm Swing During Gait Among Parkinson's Disease Patients

“…Our data agree with prior findings that PD subjects exhibit reduced symmetry and impaired coordination of arm swing during ambulation [9–12]. Most interestingly, the current study showed that whereas arm swing velocity and symmetry may improve following acute dopaminergic treatment, bilateral coordination deficits persist.…”

“…Lewek et al [9] demonstrated recently that early-stage PD subjects exhibit marked arm swing asymmetry (ASA) while walking. Related research has highlighted upper-limb gait asymmetry and coordination deficits as a common and relatively early feature of PD [10–12]. Biomechanically, several lines of evidence suggest that impaired arm swing may arise from wrongly timed activation of the shoulder flexors or extensors [13], axial rigidity [14, 15], and/or loss of trunk rotation during ambulation [16–18].…”

Is the Assessment of 5 Meters of Gait with a Single Body-Fixed-Sensor Enough to Recognize Idiopathic Parkinson’s Disease-Associated Gait?

“…Shortened step duration is often seen in patients with PD,20 possibly as a consequence of trunk rigidity23 or reduced lower-extremity extension-flexion movements 19. Accordingly, intermediate, pre-last steps and mean values across steps were of shorter duration in the PDg under both conditions (SS and FS).…”

Neural Control of Walking in People with Parkinsonism

“…This represents a relative "inflexibility" to alter postural responses to match changes in task conditions or contexts (24). However, despite potentially slowed rates of adaptation and learning, people with PD can eventually adapt gait and stepping patterns with repetition (11,56,90,118).…”