Reduction of freezing of gait in Parkinson's disease by repetitive robot-assisted treadmill training: a pilot study

Abstract

BackgroundParkinson's disease is a chronic, neurodegenerative disease characterized by gait abnormalities. Freezing of gait (FOG), an episodic inability to generate effective stepping, is reported as one of the most disabling and distressing parkinsonian symptoms. While there are no specific therapies to treat FOG, some external physical cues may alleviate these types of motor disruptions. The purpose of this study was to examine the potential effect of continuous physical cueing using robot-assisted sensorimotor gait training on reducing FOG episodes and improving gait.MethodsFour individuals with Parkinson's disease and FOG symptoms received ten 30-minute sessions of robot-assisted gait training (Lokomat) to facilitate repetitive, rhythmic, and alternating bilateral lower extremity movements. Outcomes included the FOG-Questionnaire, a clinician-rated video FOG score, spatiotemporal measures of gait, and the Parkinson's Disease Questionnaire-39 quality of life measure.ResultsAll participants showed a reduction in FOG both by self-report and clinician-rated scoring upon completion of training. Improvements were also observed in gait velocity, stride length, rhythmicity, and coordination.ConclusionsThis pilot study suggests that robot-assisted gait training may be a feasible and effective method of reducing FOG and improving gait. Videotaped scoring of FOG has the potential advantage of providing additional data to complement FOG self-report.

Validity of the Brazilian version of the freezing of gait questionnaire

“…This suggests that the whole scale do not improve the screening of FOG. However, the FOG-Q is a very useful tool to quantify the severity of FOG episodes in patients with PD and to assess the efficacy of interventional studies, which justifies the use of the scale 4,24 . Recently, new versions of the FOG-Q were made available.…”

Robot-assisted gait training versus treadmill training in patients with Parkinson�s disease: a kinematic evaluation with gait profile score

“…On this basis, a wide range of conventional physical therapy approaches has been employed to treat PD, without agreement on the optimal practice in the different phases of the disease (Protas et al, 2005). Forced use therapy, task-specific therapy, and intensive gait rehabilitation programs based on treadmill training have been reported to effectively improve gait speed, walking distance and stride length in PD (Lo et al, 2010). In addition, robotic gait training has been observed to improve gait speed, walking capacity and stride length and reduce fatigue in patients with PD (Picelli et al, 2012;Sale et al, 2013).…”

“…Recently, robotic assistive devices have been used for gait training in neurological disorders such as stroke, spinal cord injury and multiple sclerosis, giving good results in terms of gait recovery (Sale et al, 2012;Semprini et al, 2009;Mehrholz and Pohl, 2012;Spenko et al, 2006;Lee et al, 2011a,b;Roy et al, 2011;Forrester et al, 2011). The literature now also reports interesting results of the application of robotic assistive devices in PD (Lo et al, 2010;Picelli et al, 2012Picelli et al, , 2013Ustinova et al, 2011;Sale et al, 2013): gait was found to be improved and freezing episodes were reduced after using robot-assisted gait training. However, most of these analyses were based mainly on clinical evaluations and questionnaires: Unified Parkinson's Disease Rating Scale (UPDRS), 10-meter walking speed, distance walked in 6 minutes, the Freezing of Gait Questionnaire, the Parkinson's Disease Questionnaire-39.…”

“…However, most of these analyses were based mainly on clinical evaluations and questionnaires: Unified Parkinson's Disease Rating Scale (UPDRS), 10-meter walking speed, distance walked in 6 minutes, the Freezing of Gait Questionnaire, the Parkinson's Disease Questionnaire-39. Only two studies used some quantitative gait indices, but these were limited to spatiotemporal parameters (Lo et al, 2010;Sale et al, 2013), and there was no investigation of gait kinematics. The aim of the present study was to investigate the effects, on walking performance, of an end-effector robotic rehabilitation locomotor training program in patients with PD, comparing these patients with PD subjects who underwent intensive treadmill training therapy.…”

Trastorno de la marcha en la enfermedad de Parkinson: freezing y perspectivas actuales

“…Entre estos se destacan el estudio piloto de Lo et al 25 , donde parkisonianos en entrenamiento de la marcha asistida en una Rev Med Chile 2013; 141: 758-764…”