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

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.

scholarly journals Gait characteristics in individuals with Parkinson’s disease during 1-minute treadmill walking

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9463
Author(s):  
Byungjoo Noh ◽  
Changhong Youm ◽  
Myeounggon Lee ◽  
Sang-Myung Cheon
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Step Length ◽  
Treadmill Walking ◽  
Measurement Unit ◽  
Gait Characteristics ◽  
Age Related ◽  
Axial Acceleration ◽  
Spatiotemporal Parameters

Background No previous study has examined the age-dependent characteristics of gait in individuals between 50 and 79 years simultaneously in healthy individuals and individuals with Parkinson’s disease (PD) over continuous gait cycles. This study aimed to investigate age-related differences in gait characteristics on individuals age ranged 50–79 years, including individuals with PD, during a 1-minute treadmill walking session. Additionally, we aimed to investigate the differences associated with spatiotemporal gait parameters and PD compared in age-matched individuals. Methods This study included 26 individuals with PD and 90 participants age ranged 50–79 years. The treadmill walking test at a self-preferred speed was performed for 1 min. The embedded inertial measurement unit sensor in the left and right outsoles-based system was used to collect gait characteristics based on tri-axial acceleration and tri-axial angular velocities. Results Participants aged >60 years had a decreased gait speed and shortened stride and step, which may demonstrate a distinct shift in aging (all p < 0.005). Individuals with PD showed more of a decrease in variables with a loss of consistency, including gait asymmetry (GA), phase coordination index (PCI) and coefficient of variation (CV) of all variables, than age-matched individuals (all p < 0.001). Gait speed, stride and step length, stance phase, variability, GA and PCI were the variables that highly depended on age and PD. Discussion Older adults could be considered those older than 60 years of age when gait alterations begin, such as a decreased gait speed as well as shortened stride and step length. On the other hand, a loss of consistency in spatiotemporal parameters and a higher GA and PCI could be used to identify individuals with PD. Thus, the CV of all spatiotemporal parameters, GA and PCI during walking could play an important role and be useful in identifying individuals with PD. Conclusion This study provided the notable aging pattern characteristics of gait in individuals >50 years, including individuals with PD. Increasing age after 60 years is associated with deterioration in spatiotemporal parameters of gait during continuous 1-minute treadmill walking. Additionally, GA, PCI and the CV of all variables could be used to identify PD which would be placed after 70 years of age. It may be useful to determine the decline of gait performance in general and among individuals with PD.

Plantarflexor strength, gait speed, and step length change in individuals with Parkinson’s disease

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Staci M. Shearin ◽  
Ann Medley ◽  
Elaine Trudelle-Jackson ◽  
Chad Swank ◽  
Ross Querry
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Length Change ◽  
Step Length

scholarly journals Influence of Autocorrelated Rhythmic Auditory Stimulations on Parkinson’s Disease Gait Variability: Comparison With Other Auditory Rhythm Variabilities and Perspectives

2020 ◽  
Vol 11 ◽  
Author(s):  
Alexis Lheureux ◽  
Thibault Warlop ◽  
Charline Cambier ◽  
Baptiste Chemin ◽  
Gaëtan Stoquart ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Long Range ◽  
Coefficient Of Variation ◽  
Gait Speed ◽  
Step Length ◽  
Temporal Organization ◽  
Fluctuation Analysis ◽  
Gait Parameters ◽  
Stride Duration

Parkinson’s Disease patients suffer from gait impairments such as reduced gait speed, shortened step length, and deterioration of the temporal organization of stride duration variability (i.e., breakdown in Long-Range Autocorrelations). The aim of this study was to compare the effects on Parkinson’s Disease patients’ gait of three Rhythmic Auditory Stimulations (RAS), each structured with a different rhythm variability (isochronous, random, and autocorrelated). Nine Parkinson’s Disease patients performed four walking conditions of 10–15 min each: Control Condition (CC), Isochronous RAS (IRAS), Random RAS (RRAS), and Autocorrelated RAS (ARAS). Accelerometers were used to assess gait speed, cadence, step length, temporal organization (i.e., Long-Range Autocorrelations computation), and magnitude (i.e., coefficient of variation) of stride duration variability on 512 gait cycles. Long-Range Autocorrelations were assessed using the evenly spaced averaged Detrended Fluctuation Analysis (α-DFA exponent). Spatiotemporal gait parameters and coefficient of variation were not modified by the RAS. Long-Range Autocorrelations were present in all patients during CC and ARAS although all RAS conditions altered them. The α-DFA exponents were significantly lower during IRAS and RRAS than during CC, exhibiting anti-correlations during IRAS in seven patients. α-DFA during ARAS was the closest to the α-DFA during CC and within normative data of healthy subjects. In conclusion, Isochronous RAS modify patients’ Long-Range Autocorrelations and the use of Autocorrelated RAS allows to maintain an acceptable level of Long-Range Autocorrelations for Parkinson’s Disease patients’ gait.

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

2015 ◽  
Vol 31 (3) ◽  
pp. 189-194 ◽  
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.

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

Cells ◽  
2019 ◽  
Vol 8 (5) ◽  
pp. 419 ◽  
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.

scholarly journals The Effects of Metronome Frequency Differentially Affects Gait on a Treadmill and Overground in People with Parkinson’s Disease

2019 ◽  
Author(s):  
Madelon Wygand ◽  
Guneet Chawla ◽  
Nina Browner ◽  
Michael D Lewek
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Repeated Measures ◽  
Step Length ◽  
Yahr Stage ◽  
Gait Parameters ◽  
Walking Environment ◽  
Stage 1 ◽  
Walking Speeds

AbstractObjectiveTo determine the effect of different metronome cue frequencies on spatiotemporal gait parameters when walking overground compared to walking on a treadmill in people with Parkinson’s diseaseDesignRepeated-measures, within-subject designSettingResearch laboratoryParticipantsTwenty-one people with Parkinson’s disease (Hoehn & Yahr stage 1-3)InterventionsParticipants walked overground and on a treadmill with and without metronome cues of 85%, 100%, and 115% of their baseline cadence for one minute each.Main Outcome MeasuresGait speed, step length, and cadenceResultsAn interaction effect between cue frequency and walking environment revealed that participants took longer steps during the 85% condition on the treadmill only. When walking overground, metronome cues of 85% and 115% of baseline cadence yielded decreases and increases, respectively, in both cadence and gait speed with no concomitant change in step length.ConclusionsThese data suggest that people with PD are able to alter spatiotemporal gait parameters immediately when provided the appropriate metronome cue and walking environment. We propose to target shortened step lengths by stepping to the beat of slow frequency auditory cues while walking on a treadmill, whereas the use of fast frequency cues during overground walking can facilitate faster walking speeds.

scholarly journals Individuals with Parkinson’s Disease Retain Spatiotemporal Gait Control With Music and Metronome Cues

2019 ◽  
Author(s):  
Guneet Chawla ◽  
Madelon Wygand ◽  
Nina Browner ◽  
Michael D Lewek
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Research Question ◽  
Step Length ◽  
Important Change ◽  
Treadmill Walking ◽  
Gait Control ◽  
Auditory Cues ◽  
Experience Difficulty

AbstractBackgroundParkinson’s disease (PD) is marked by a loss of motor automaticity, resulting in decreased control of step length during gait. Rhythmic auditory cues (metronomes or music) may enhance automaticity by adjusting cadence. Both metronomes and music may offer distinct advantages, but prior attempts at quantifying their influence on spatiotemporal aspects of gait have been confounded by altered gait speeds from overground walking. We hypothesized that when gait speed is fixed, individuals with PD would experience difficulty in modifying cadence due to the concomitant requirement to alter step length, with greater changes noted with metronomes compared to music cues.Research QuestionCan a metronome or music promote spatiotemporal adjustments when decoupled from changes in gait speed in individuals with PD?Methods21 participants with PD were instructed to time their steps to a metronome and music cues (at 85%, 100%, and 115% of overground cadence) during treadmill walking. We calculated cadence, cadence accuracy, and step length during each cue condition and an uncued control condition. We compared the various cue frequencies and auditory modalities.ResultsAt fixed gait speeds, participants were able to increase and decrease cadence in response to auditory cues. Music and metronome cues produced comparable results in cadence manipulation with greater cadence errors noted at slower intended frequencies. Nevertheless, the induced cadence changes created a concomitant alteration in step length, with music and metronomes producing comparable changes. Notably, longer step lengths were induced with both music and metronome during slow frequency cueing.SignificanceThis important change conflicts with conventional prescriptive approaches, which advocate for faster cue frequencies, if applied on a treadmill. The music and metronome cues produced comparable changes to gait, suggesting that either cue may be effective at overcoming the shortened step lengths during treadmill walking if slower frequencies are used.

scholarly journals A feasibility study of dual-task strategy training to improve gait performance in patients with Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bettina Wollesen ◽  
Silvan Rudnik ◽  
Alessandro Gulberti ◽  
Thomas Cordes ◽  
Christian Gerloff ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Step Length ◽  
Strategy Training ◽  
Walking Distance ◽  
Gait Velocity ◽  
Special Focus ◽  
Gait Performance ◽  
Gait Quality

AbstractGait disorders in patients with Parkinson’s disease (PD) impact their mobility and self-dependence. Gait training and dual-task (DT)-training improve gait quality. This study aims to assess the feasibility of a specific, gradually intensified DT-training for PD patients with a special focus on gait performance under single task (ST) and DT conditions. Correlations to Freezing of Gait (FoG) were examined. 17 PD patients (70.1 ± 7.4 years, H&Y Stadium 2–3, FoG-Q 9.0 ± 5.5) participated in a four-week DT-training (1x/week, 60 min) with progressively increasing task difficulty and number of tasks. Gait performance (spatiotemporal parameters) was assessed during ST and DT conditions. The training improved DT gait performance, especially gait velocity + 0.11 m/s; (F(2,16) = 7.163; p = .0171; η2part = .309) and step length (+ 5.73 cm). Also, physical well-being and absolved walking distance improved significantly. Correlation analyses of the FoG score at baseline with relative change of gait metrics post-training revealed significant correlations with training-induced changes of step length and improvement of gait velocity. Overall, the developed DT-training was feasible and effective. Further studies should examine the long-term benefits and the optimal setting to achieve the highest impact. The study was registered in the DRKS (ID DRKS00018084, 23.1.20).

scholarly journals Using a Portable Gait Rhythmogram to Examine the Effect of Music Therapy on Parkinson’s Disease-Related Gait Disturbance

Sensors ◽  
2021 ◽  
Vol 21 (24) ◽  
pp. 8321
Author(s):  
Emiri Gondo ◽  
Saiko Mikawa ◽  
Akito Hayashi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Music Therapy ◽  
Gait Speed ◽  
Step Length ◽  
The Body ◽  
Gait Disturbance ◽  
Music Intervention ◽  
External Cues ◽  
The Brain

External cues improve walking by evoking internal rhythm formation related to gait in the brain in patients with Parkinson’s disease (PD). This study examined the usefulness of using a portable gait rhythmogram (PGR) in music therapy on PD-related gait disturbance. A total of 19 subjects with PD who exhibited gait disturbance were evaluated for gait speed and step length during a 10 m straight walking task. Moreover, acceleration, cadence, and trajectory of the center of the body were estimated using a PGR. Walking tasks were created while incorporating music intervention that gradually increased in tempo from 90 to 120 beats per minute (BPM). We then evaluated whether immediate improvement in gait could be recognized even without music after walking tasks by comparing pre- (pre-MT) and post-music therapy (post-MT) values. Post-MT gait showed significant improvement in acceleration, gait speed, cadence, and step length. During transitions throughout the walking tasks, acceleration, gait speed, cadence, and step length gradually increased in tasks with music. With regard to the trajectory of the center of the body, we recognized a reduction in post-MT medio-lateral amplitude. Music therapy immediately improved gait disturbance in patients with PD, and the effectiveness was objectively shown using PGR.

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