Self-paced treadmills do not allow for valid observation of linear and non-linear gait variability outcomes in patients with Parkinson’s disease

AbstractBackgroundDue to the imposed constant belt speed, motorized treadmills are known to change linear and non-linear gait variability outcomes. This is particularly true of patients with Parkinson’s disease where the treadmill can act as an external pacemaker. Therefore, the use of treadmills is generally not recommended when quantifying gait variability. Self-paced treadmills allow for updating the belt speed relative to the walking speed of the subject and might, therefore, be a useful tool for the collection of long consecutive walking trials, necessary for gait variability observations.Research questionTo validate gait variability measures collected on a self-paced treadmill as compared to overground walking.MethodsThirteen healthy subjects and thirteen patients with Parkinson’s disease performed 5 – 8 minute long walking trials: overground, on a treadmill at a constant speed, as well as in three different self-paced treadmill modes. Stride times and stride lengths were recorded using a validated IMU-system and variability was quantified using the coefficient of variation, sample entropy, and detrended fluctuation analysis. Overground and treadmill trials were compared using Pearson’s correlation coefficient, method error, and Bland and Altman analysis.ResultsFor healthy subjects, the self-paced treadmill resulted in increased correlation coefficients of 0.57 – 0.74 as compared to a constant speed treadmill. Correlation coefficients for stride length variability between overground and treadmill walking were not significant. For patients, generally, large errors of 33-40% of stride time variability were observed between overground and treadmill walking. Stride length variability is most similar at a constant belt speed and shows errors of 14-39%.SignificanceDespite an improvement of temporal gait variability validity in the self-paced mode for healthy subjects, the large systematic and random errors between overground and self-paced treadmill walking prohibit meaningful gait variability observations in patients with Parkinson’s disease using self-paced treadmills.

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Gait dynamics in Parkinson’s disease: Common and distinct behavior among stride length, gait variability, and fractal-like scaling

Chaos An Interdisciplinary Journal of Nonlinear Science ◽

10.1063/1.3147408 ◽

2009 ◽

Vol 19 (2) ◽

pp. 026113 ◽

Cited By ~ 297

Author(s):

Jeffrey M. Hausdorff

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Stride Length ◽

Gait Variability ◽

Gait Dynamics

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Characterization of gait variability in multiple system atrophy and Parkinson’s disease

Journal of Neurology ◽

10.1007/s00415-020-10355-y ◽

2020 ◽

Author(s):

Victoria Sidoroff ◽

Cecilia Raccagni ◽

Christine Kaindlstorfer ◽

Sabine Eschlboeck ◽

Alessandra Fanciulli ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Multiple System Atrophy ◽

Stride Length ◽

Gait Variability ◽

Postural Instability ◽

Gait Velocity ◽

Control Group ◽

Stride Time ◽

Stance Time

Abstract Background Gait impairment is a pivotal feature of parkinsonian syndromes and increased gait variability is associated with postural instability and a higher risk of falls. Objectives We compared gait variability at different walking velocities between and within groups of patients with Parkinson-variant multiple system atrophy, idiopathic Parkinson’s disease, and a control group of older adults. Methods Gait metrics were recorded in 11 multiple system atrophy, 12 Parkinson’s disease patients, and 18 controls using sensor-based gait analysis. Gait variability was analyzed for stride, swing and stance time, stride length and gait velocity. Values were compared between and within the groups at self-paced comfortable, fast and slow walking speed. Results Multiple system atrophy patients displayed higher gait variability except for stride time at all velocities compared with controls, while Parkinson’s patients did not. Compared with Parkinson’s disease, multiple system atrophy patients displayed higher variability of swing time, stride length and gait velocity at comfortable speed and at slow speed for swing and stance time, stride length and gait velocity (all P < 0.05). Stride time variability was significantly higher in slow compared to comfortable walking in patients with multiple system atrophy (P = 0.014). Variability parameters significantly correlated with the postural instability/gait difficulty subscore in both disease groups. Conversely, significant correlations between variability parameters and MDS-UPDRS III score was observed only for multiple system atrophy patients. Conclusion This analysis suggests that gait variability parameters reflect the major axial impairment and postural instability displayed by multiple system atrophy patients compared with Parkinson’s disease patients and controls.

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Gait parameters of Parkinson’s disease compared with healthy controls: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-80768-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ana Paula Janner Zanardi ◽

Edson Soares da Silva ◽

Rochelle Rocha Costa ◽

Elren Passos-Monteiro ◽

Ivan Oliveira dos Santos ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Stride Length ◽

Walking Speed ◽

Meta Analysis ◽

The Self ◽

Double Support ◽

Swing Time ◽

Gait Parameters ◽

Healthy Control

AbstractWe systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s−1) and on overground (.17 m s−1) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).

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Implementation and Validation of a Stride Length Estimation Algorithm, Using a Single Basic Inertial Sensor on Healthy Subjects and Patients Suffering from Parkinson’s Disease

Health ◽

10.4236/health.2015.76084 ◽

2015 ◽

Vol 07 (06) ◽

pp. 704-714 ◽

Cited By ~ 16

Author(s):

Benoît Sijobert ◽

Mourad Benoussaad ◽

Jennifer Denys ◽

Roger Pissard-Gibollet ◽

Christian Geny ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Healthy Subjects ◽

Stride Length ◽

Inertial Sensor ◽

Estimation Algorithm ◽

Length Estimation

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Impaired Economy of Gait and Decreased Six-Minute Walk Distance in Parkinson's Disease

Parkinson s Disease ◽

10.1155/2012/241754 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Leslie I. Katzel ◽

Frederick M. Ivey ◽

John D. Sorkin ◽

Richard F. Macko ◽

Barbara Smith ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Oxygen Consumption ◽

Walking Speed ◽

Treadmill Walking ◽

The Self ◽

Peak Oxygen Consumption ◽

Walk Distance ◽

Minute Walk Distance ◽

Minute Walk

Changes in the biomechanics of gait may alter the energy requirements of walking in Parkinson's Disease (PD). This study investigated economy of gait during submaximal treadmill walking in 79 subjects with mild to moderate PD and the relationship between gait economy and 6-minute walk distance (6 MW). Oxygen consumption (VO2) at the self-selected treadmill walking speed averaged 64% of peak oxygen consumption (VO2peak). Submaximal VO2levels exceeded 70% of VO2peak in 30% of the subjects. Overall the mean submaximal VO2was 51% higher than VO2levels expected for the speed and grade consistent with severe impairment in economy of gait. There was an inverse relationship between economy of gait and 6MW (r=−0.31,P<0.01) and with the self-selected walking speed (r=−0.35,P<0.01). Thus, the impairment in economy of gait and decreased physiologic reserve result in routine walking being performed at a high percentage of VO2peak.

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Do Upper and Lower Camptocormias Affect Gait and Postural Control in Patients with Parkinson’s Disease? An Observational Cross-Sectional Study

Parkinson s Disease ◽

10.1155/2019/9026890 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Christian Geroin ◽

Marialuisa Gandolfi ◽

Isacco Maddalena ◽

Nicola Smania ◽

Michele Tinazzi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Postural Control ◽

Gait Speed ◽

Stride Length ◽

Cross Sectional Study ◽

Gait Variability ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional

Gait impairments and camptocormia (CC) are common and debilitating in patients with Parkinson’s disease (PD). Two types of CC affect patients with PD, but no studies investigated their relative contribution in worsening gait and postural control. Therefore, we investigated spatiotemporal gait parameters, gait variability, and asymmetry and postural control in PD patients (Hoehn & Yahr ≤4) with upper CC and lower CC and patients without CC. This observational cross-sectional study involving patients with PD and upper CC (n=16) and lower CC (n=14) and without CC (n=16). The primary outcome measure was gait speed assessed by the GAITRite System. The secondary outcome measures were other spatiotemporal parameters, gait variability, and asymmetry. Postural control and balance were assessed with posturography and the Mini-BESTest. Patients with lower CC showed a higher H&Y stage (p=0.003), a worse PDQ8 (p=0.042), and a lower Mini-BESTest score (p=0.006) than patients with PD without CC. Patients with lower CC showed a reduced gait speed (p=0.012), stride length, and velocity than patients with PD without CC. Upper CC patients showed a higher stride length than lower CC ones (p=0.007). In the eyes open and closed condition, patients with lower CC showed a higher (worse) velocity of CoP displacement in mediolateral direction and length of CoP than patients with PD without CC. No significant between-group differences were measured in gait variability and asymmetry. In conclusion, lower CC was associated with more severe gait and postural control impairment than patients with upper CC and without CC. Categorizing CC based on the bending fulcrum is compulsory to identify patients with the worst performance and to implement specific rehabilitation programs.

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