Step length and stance time variability are independently associated with dynamic balance control in people with Parkinson’s disease

Gait impairment and increased gait variability are common among individuals with Parkinson’s disease (PD) and have been associated with increased risk for falls. The development of composite scores has gained interest to aggregate multiple aspects of gait into a single metric. The Enhanced Gait Variability Index (EGVI) was developed to compare an individual’s gait variability to the amount of variability in a healthy population, yet the EGVI’s individual parts may also provide important information that may be lost in this conversion. We sought to contrast individual gait measures as predictors of fall frequency and the EGVI as a single predictor of fall frequency in individuals with PD. 273 patients (189M, 84F; 68 ± 10 yrs) with idiopathic PD walked over an instrumented walkway and reported fall frequency over three months (never, rarely, monthly, weekly, or daily). The predictive ability of gait velocity, step length, step time, stance time, and single support time and the EGVI was assessed using regression techniques to predict fall frequency. The EGVI explained 15.1% of the variance in fall frequency (p<0.001, r = 0.389). Although the regression using the combined spatiotemporal measures to predict fall frequency was significant (p=0.002, r = 0.264), none of the components reached significance (gait velocity: p=0.640, step length: p=0.900, step time: p=0.525, stance time: p=0.532, single support time: p=0.480). The EGVI is a better predictor of fall frequency in persons with PD than its individual spatiotemporal components. Patients who fall more frequently have more variable gait, based on the interpretation of the EGVI. While the EGVI provides an objective measure of gait variability with some ability to predict fall frequency, full clinical interpretations and applications are currently unknown.

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Spatiotemporal Gait Patterns During Overt and Covert Evaluation in Patients With Parkinson’s Disease and Healthy Subjects: Is There a Hawthorne Effect?

Journal of Applied Biomechanics ◽

10.1123/jab.2013-0319 ◽

2015 ◽

Vol 31 (3) ◽

pp. 189-194 ◽

Cited By ~ 38

Author(s):

Verónica Robles-García ◽

Yoanna Corral-Bergantiños ◽

Nelson Espinosa ◽

María Amalia Jácome ◽

Carlos García-Sancho ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Healthy Subjects ◽

Small Sample Size ◽

Step Length ◽

Gait Pattern ◽

Small Sample ◽

Time Variability ◽

Expectancy Effects ◽

Experimental Conditions

Parkinson’s disease (PD) and aging lead to gait impairments. Some of the disturbances of gait are focused on step length, cadence, and temporal variability of gait cycle. Under experimental conditions gait can be overtly evaluated, but patients with PD are prone to expectancy effects; thus it seems relevant to determine if such evaluation truly reflects the spontaneous gait pattern in such patients, and also in healthy subjects. Thirty subjects (15 subjects with PD and 15 healthy control subjects) were asked to walk using their natural, preferred gait pattern. In half of the trials subjects were made aware that they were being evaluated (overt evaluation), while in the rest of the trials the evaluation was performed covertly (covert evaluation). During covert evaluation the gait pattern was modified in all groups. Gait speed was significantly increased (P = .022); step cadence and average step length were also significantly modified, the average step length increased (P = .002) and the cadence was reduced (P ≤ .001). Stride cycle time variability was unchanged significantly (P = .084). These changes were not significantly different compared between elderly and young healthy controls either. Due to the small sample size, a note of caution is in order; however, the significant results suggest that covert evaluation of gait might be considered to complement experimental evaluations of gait.

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Gait Training in Virtual Reality: Short-Term Effects of Different Virtual Manipulation Techniques in Parkinson’s Disease

Cells ◽

10.3390/cells8050419 ◽

2019 ◽

Vol 8 (5) ◽

pp. 419 ◽

Cited By ~ 7

Author(s):

Omar Janeh ◽

Odette Fründt ◽

Beate Schönwald ◽

Alessandro Gulberti ◽

Carsten Buhmann ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Virtual Reality ◽

Pilot Study ◽

Freezing Of Gait ◽

Strong Relationship ◽

Step Length ◽

Gait Training ◽

Time Variability ◽

Gait Symmetry

It is well documented that there is a strong relationship between gait asymmetry and the freezing of gait (FOG) in Parkinson’s Disease. The purpose of this pilot study was to find a “virtual reality (VR)- based” gait manipulation strategy to improve gait symmetry by equalizing step length. Fifteen male PD patients (mean age of 67.6 years) with FOG were assessed on a GAITRite® walkway. Natural gait was compared with walking conditions during “VR-based” gait modulation tasks that aimed at equalizing gait symmetry using visual or proprioceptive signals. Compared to natural gait, VR manipulation tasks significantly increased step width and swing time variability for both body sides. Within the VR conditions, only the task with “proprioceptive-visual dissociation” by artificial backward shifting of the foot improved spatial asymmetry significantly with comparable step lengths of both sides. Specific, hypothesis-driven VR tasks represent an efficient tool to manipulate gait features as gait symmetry in PD potentially preventing FOG. This pilot study offers promising “VR-based” approaches for rehabilitative training strategies to achieve gait symmetry and prevent FOG.

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Redistribution of Joint Moments and Dynamic Balance Control During Sit to Stand Task in Persons with Parkinson’s Disease

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2021.07.027 ◽

2021 ◽

Author(s):

Jared W. Skinner ◽

Hyo Keun Lee ◽

Chris J. Hass

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Balance Control ◽

Dynamic Balance ◽

Joint Moments ◽

Sit To Stand

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Effects of a Multidisciplinary Intervention on Daily-Living Gait Among Older Adults With Parkinson’s Disease

Innovation in Aging ◽

10.1093/geroni/igaa057.746 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 231-231

Author(s):

Jeffrey Hausdorff ◽

Moriya Cohen ◽

Natalie Ganz ◽

Yitchak Green ◽

Inbal Badichi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Gait Speed ◽

Daily Living ◽

Step Length ◽

Rehabilitation Program ◽

Adverse Outcomes ◽

Time Variability ◽

Walking Gait ◽

Gait Quality

Abstract Multidisciplinary interventions can improve gait and balance in patients with Parkinson’s disease (PD). However, it is not yet known if these interventions also positively impact the quality of daily-living walking. We, therefore, examined the effects of a multidisciplinary, intensive out-patient rehabilitation program (MIOR) as delivered by the rehabilitation center of EZRA–LEMARPE organization on gait and balance as measured in the clinic and on every-day walking, as measured during 1-week of continuous measurement. 46 PD patients (age: 70.05±7.71; gender: 31.3% women; disease duration: 8.85±6.27 yrs) were evaluated before and after participating in 8-weeks of physical, occupational, and hydro-therapy, boxing, and dance (3 days/week; 5 hrs/day). After the intervention, clinical measures of balance (MiniBest Test of Balance delta: 1.82±3.30 points, p=0.001), mobility (TUG delta: -1.78±6.15sec; p=0.001), and usual-walking speed (delta 19±16cm/s; p<0.001) improved. Daily-living step counts and daily-living gait quality did not change (p>0.5). In exploratory analyses, subjects were categorized as responders (Rs) and non-responders (NRs) based on changes in their daily-living walking gait speed. Rs increased their daily-living gait speed (delta: 10±14cm/s; p<0.001); NRs did not. Rs (n=21) also improved their daily-living gait quality measures (e.g. stride regularity, step length, stride time variability). At baseline, disease severity (MDS-UPDRSIII) was lower (p=0.02) in Rs (25.33±11.47), compared to the NRs (34.38±14.27). These results demonstrate that improvements in the clinic do not necessarily transfer to improvements in daily-living gait. Further, in select patients, MIOR can ameliorate daily-living walking quality, potentially reducing the risk of falls and other adverse outcomes associated with impaired mobility.

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Impaired Weight-Shift Amplitude in People with Parkinson’s Disease with Freezing of Gait

Journal of Parkinson s Disease ◽

10.3233/jpd-202370 ◽

2021 ◽

pp. 1-14

Author(s):

Bauke Wybren Dijkstra ◽

Moran Gilat ◽

L. Eduardo Cofré Lizama ◽

Martina Mancini ◽

Bruno Bergmans ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Balance Control ◽

Dynamic Balance ◽

Center Of Mass ◽

Freezing Of Gait ◽

Dopaminergic Medication ◽

Weight Shift ◽

Future Work ◽

Weight Shifting

Background: People with Parkinson’s disease and freezing of gait (FOG; freezers) suffer from pronounced postural instability. However, the relationship between these phenomena remains unclear and has mostly been tested in paradigms requiring step generation. Objective: To determine if freezing-related dynamic balance deficits are present during a task without stepping and determine the influence of dopaminergic medication on dynamic balance control. Methods: Twenty-two freezers, 16 non-freezers, and 20 healthy age-matched controls performed mediolateral weight-shifts at increasing frequencies when following a visual target projected on a screen (MELBA task). The amplitude and phase shift differences between center of mass and target motion were measured. Balance scores (Mini-BESTest), 360° turning speed and the freezing ratio were also measured. Subjects with Parkinson’s disease were tested ON and partial OFF (overnight withdrawal) dopaminergic medication. Results: Freezers had comparable turning speed and balance scores to non-freezers and took more levodopa. Freezers produced hypokinetic weight-shift amplitudes throughout the MELBA task compared to non-freezers (p = 0.002), which were already present at task onset (p < 0.001). Freezers also displayed an earlier weight-shift breakdown than controls when OFF-medication (p = 0.008). Medication improved mediolateral weight-shifting in freezers and non-freezers. Freezers decreased their freezing ratio in response to medication. Conclusion: Hypokinetic weight-shifting proved a marked postural control deficit in freezers, while balance scores and turning speed were similar to non-freezers. Both weight-shift amplitudes and the freezing ratio were responsive to medication in freezers, suggesting axial motor vigor is levodopa-responsive. Future work needs to test whether weight-shifting and freezing severity can be further ameliorated through training.

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Gait Initiation and Dynamic Balance Control in Parkinson’s Disease

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2005.05.013 ◽

2005 ◽

Vol 86 (11) ◽

pp. 2172-2176 ◽

Cited By ~ 87

Author(s):

Chris J. Hass ◽

Dwight E. Waddell ◽

Richard P. Fleming ◽

Jorge L. Juncos ◽

Robert J. Gregor

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Balance Control ◽

Dynamic Balance ◽

Gait Initiation

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Dopamine-mediated improvements in dynamic balance control in Parkinson’s disease

Gait & Posture ◽

10.1016/j.gaitpost.2020.08.132 ◽

2020 ◽

Vol 82 ◽

pp. 68-74

Author(s):

Daniel J Kuhman ◽

Harrison C Walker ◽

Christopher P Hurt

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Balance Control ◽

Dynamic Balance

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Gait and Balance Changes with Investigational Peripheral Nerve Cell Therapy during Deep Brain Stimulation in People with Parkinson’s Disease

Brain Sciences ◽

10.3390/brainsci11040500 ◽

2021 ◽

Vol 11 (4) ◽

pp. 500

Author(s):

Geetanjali Gera ◽

Zain Guduru ◽

Tritia Yamasaki ◽

Julie A. Gurwell ◽

Monica J. Chau ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Peripheral Nerve ◽

Brain Stimulation ◽

Step Length ◽

Gait Velocity ◽

Balance Performance ◽

Improved Performance ◽

Deep Brain

Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: In a study where APNG was unilaterally implanted into the substantia nigra, we explored the effects on clinical gait and balance assessments over two years in 14 individuals with Parkinson’s disease. Methods: Computerized gait and balance evaluations were performed without medication, and stimulation was in the off state for at least 12 h to best assess the role of APNG implantation alone. We hypothesized that APNG might improve gait and balance deficits associated with PD. Results: While people with a degenerative movement disorder typically worsen with time, none of the gait parameters significantly changed across visits in this 24 month study. The postural stability item in the UPDRS did not worsen from baseline to the 24-month follow-up. However, we measured gait and balance improvements in the two most affected individuals, who had moderate PD. In these two individuals, we observed an increase in gait velocity and step length that persisted over 6 and 24 months. Conclusions: Participants did not show worsening of gait and balance performance in the off therapy state two years after surgery, while the two most severely affected participants showed improved performance. Further studies may better address the long-term maintanenace of these results.

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