Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson's Disease

Abstract

Background: Gait disorders represent one of the most disabling features of Parkinson's disease, which may benefit from rehabilitation. No consistent evidence exists about which gait biomechanical factors can be modified by rehabilitation and which clinical characteristic can predict rehabilitation-induced improvements. Objectives: The aims of the study were as follows: (i) to recognize the gait parameters modifiable by a short-term rehabilitation program; (ii) to evaluate the gait parameters that can normalize after rehabilitation; and (iii) to identify clinical variables predicting improvements in gait function after rehabilitation. Methods: Thirty-six patients affected by idiopathic Parkinson's disease in Hoehn-Yahr stage 1–3 and 22 healthy controls were included in the study. Both clinical and instrumental (gait analysis) evaluations were performed before and after a 10-weeks rehabilitation treatment. Time-distance parameters, lower limb joint, and trunk kinematics were measured. Results: At baseline evaluation with matched speed, almost all gait parameters were significantly different between patients and healthy controls. After the 10-weeks rehabilitation, most gait parameters improved, and spatial asymmetry and trunk rotation normalized. Multiple linear regression of gender combined with Unified Parkinson's Disease Rating Scale-III predicted both ΔSpeed and ΔStep length of both sides; gender combined with Unified Parkinson's Disease Rating Scale-II predicted ΔCadence; age combined with Hoehn-Yahr score and disease duration predicted Δtrunk rotation range of motion. Conclusions: Impaired gait parameters are susceptible to improvement by rehabilitation, and younger men with Parkinson's disease who are less severely affected and at early disease stage are more susceptible to improvements in gait function after a 10-weeks rehabilitation program.

An artificial neural network approach to detect presence and severity of Parkinson’s disease via gait parameters

“…In the confirmatory analysis, the combination of both knee and trunk rotation RoMs, as the numerical sum of knee and trunk rotation angles, showed a good ability to discriminate PwPD from HCs, with a cumulative threshold value of ≤ 66.23° ( Table 3 ). Knee and trunk rotation RoM abnormalities characterize the gait pattern of PwPD, as found in the current study ( Table 1 ) and in previous studies [ 53 – 58 ], which also revealed a series of other kinematic gait abnormalities. Our findings indicate an ANN algorithm resulted in a drastic reduction in the amount of redundant information, allowing a focus on a few meaningful features that could be used to diagnose and monitor gait function in PwPD.…”

“…Reduced trunk motion combined with postural abnormalities can greatly alter the role of the spine in balance maintenance [ 6 , 68 , 75 – 78 ], ultimately predisposing patients to falls [ 71 ]. Notably, a recent study showed that trunk rotation is a predictor of gait recovery after rehabilitation [ 57 ], suggesting that rehabilitation should focus on recovering trunk control [ 79 , 80 ] to improve both gait and balance [ 56 – 58 ]. Altogether, these findings underline the importance of considering trunk kinematic abnormalities as an integral part of the gait deficit in PwPD.…”

Mild Gait Impairment and Its Potential Diagnostic Value in Patients with Early-Stage Parkinson’s Disease

“…This method can avoid confusion due to step changes caused by the asymmetry between the left and right sides in PD [ 24 ]. The symmetry of gait parameters was assessed through the asymmetry index (AI) (Equation ( 3 )) [ 25 – 27 ]. …”

Gait Analysis of Old Individuals with Mild Parkinsonian Signs and Those Individuals’ Gait Performance Benefits Little from Levodopa

“… 29 , 30 The clinical symptoms of PD are often asymmetric, and this asymmetry has also been confirmed in previous studies. 22 , 31 , 32 In the symmetry analysis of the MPS group, no difference was found in any of those parameters which indicates that MPS group still remains a symmetrical gait pattern. This finding is consistent with the clinical manifestations of MPS because the clinical symptom evaluation of these participants does not exhibit a difference between the left and right sides.…”

“…19 The asymmetry index (AI) was used to assess the symmetry of gait parameters (Formula (3)). [20][21][22] Formula (1): CV separate = SD ÷ mean value…”