scholarly journals Comprehensive Analysis of Walking Characteristics of Patients with Parkinson’s disease: Impact of Freezing of Gait

2020 ◽  
Author(s):  
Minji Son ◽  
Sang-Myung Cheon ◽  
Changhong Youm ◽  
Jae Kim
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Walking Speed ◽  
Freezing Of Gait ◽  
Step Length ◽  
Asymmetry Index ◽  
Comprehensive Analysis ◽  
Backward Walking ◽  
Ankle Joints ◽  
Disease Impact

Abstract Patients with Parkinson’s disease (PD) suffer from walking disturbances. This study was done to comprehensively analyze walking characteristics of PD, including forward and backward walking and turning. Impacts of freezing of gait (FoG) were also determined. Forward and backward walking and 360° turning was recorded at preferred speed in defined ‘off’ state. PD showed narrower step length, slower walking speed, and higher asymmetry index (AI) of step length during forward and backward walking. During turning, PD had more turning steps, longer turning time, and shorter step length than control. There was no difference at forward walking according to FoG, but freezer showed narrower step length and decreased range of motion in ankle joints at backward walking. Freezer showed longer step time and higher AI of step length at turning. The severity of FoG was correlated with step length and walking speed during forward and backward walking, total step count, total step time, and walking speed during turning. Comprehensive analysis showed that PD had narrower step length, slower walking speed, and increased asymmetry of step length. These features were the most prominent during turning, followed by backward and forward walking. Impacts of FoG were also the most prominent during turning.

scholarly journals Exercise Guidelines for Gait Function in Parkinson’s Disease: A Systematic Review and Meta-analysis

2018 ◽  
Vol 32 (10) ◽  
pp. 872-886 ◽  
Author(s):  
Meng Ni ◽  
Joseph B. Hazzard ◽  
Joseph F. Signorile ◽  
Corneliu Luca
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Treatment Effect ◽  
Walking Speed ◽  
Meta Analysis ◽  
Random Effect ◽  
Freezing Of Gait ◽  
Exercise Duration ◽  
Superior Performance

This systematic review and meta-analysis is to provide comprehensive evidence-based exercise recommendations targeting walking function for adults with Parkinson’s disease. Methods. Fixed- or random-effect meta-analyses estimated standardized effect sizes (Hedge’s g), comparing treatment effects from exercise with nonexercise and another form of exercise (non-EXE control and EXE control). Cuing and exercise duration were used as moderators for subanalyses. Results. The 40 included randomized controlled trials comprised 1656 patients. The exercise group showed significantly superior performance in timed up-and-go ( g = −0.458; g = −0.390) compared with non-EXE control and EXE control; significantly greater improvement in comfortable walking speed ( g = 0.449), fast walking speed ( g = 0.430), and stride or step length ( g = 0.379) compared with non-EXE control; and significantly greater cadence ( g = 0.282) compared with EXE controls. No significant differences between intervention and control groups were observed for double-leg support time (DLST), dynamic gait index (DGI), 6-minute walk test, or freezing of gait questionnaire (FOG-Q). Notably, treatment effect from the exercise of interest compared with a standard exercise was greater than for nonexercise for cadence and FOG-Q. Moreover, EXE control was favored for DLST and DGI. Cuing had a significantly positive effect on stride length alone. Exercise duration significantly, but negatively, influenced the treatment effect on comfortable walking speed. Conclusion. Gait-specific training, rather than a general exercise program, should be emphasized if gait is the outcome of interest. Further investigation is needed on exercise dosage and its selective effect on more challenging walking tasks, endurance, and freezing of gait.

scholarly journals Transcranial direct current stimulation (tDCS) in addition to walking training on walking, mobility, and reduction of falls in Parkinson’s disease: study protocol for a randomized clinical trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lucas Rodrigues Nascimento ◽  
Ester Miyuki Nakamura-Palacios ◽  
Augusto Boening ◽  
Daniel Lyrio Cabral ◽  
Alessandra Swarowsky ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Fear Of Falling ◽  
Cortical Excitability ◽  
Freezing Of Gait ◽  
Step Length ◽  
Control Group ◽  
Direct Current Stimulation

Abstract Background Transcranial direct current stimulation (tDCS) has the potential to modulate cortical excitability and enhance the effects of walking training in people with Parkinson’s disease. This study will examine the efficacy of the addition of tDCS to a task-specific walking training to improve walking and mobility and to reduce falls in people with Parkinson’s disease. Methods This is a two-arm, prospectively registered, randomized trial with concealed allocation, blinded assessors, participants and therapists, and intention-to-treat analysis. Twenty-four individuals with Parkinson’s disease, categorized as slow or intermediate walkers (walking speeds ≤ 1.0 m/s), will be recruited. The experimental group will undertake a 30-min walking training associated with tDCS, for 4 weeks. The control group will undertake the same walking training, but with sham-tDCS. The primary outcome will be comfortable walking speed. Secondary outcomes will include walking step length, walking cadence, walking confidence, mobility, freezing of gait, fear of falling, and falls. Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 4), and 1 month beyond intervention (week 8). Discussion tDCS associated with walking training may help improve walking of slow and intermediate walkers with Parkinson’s disease. If walking is enhanced, the benefits may be accompanied by better mobility and reduced fear of falling, and individuals may experience greater free-living physical activity at home and in the community. Trial registration Brazilian Registry of Clinical Trials (ReBEC) RBR-6bvnx6. Registered on September 23, 2019

scholarly journals 3D visual cueing shortens the double support phase of the gait cycle in patients with advanced Parkinson's disease treated with DBS of the STN

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244676
Author(s):  
Kamila Poláková ◽  
Evžen Růžička ◽  
Robert Jech ◽  
David Kemlink ◽  
Jan Rusz ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Freezing Of Gait ◽  
Step Length ◽  
Double Support ◽  
Visual Cueing ◽  
Stn Dbs ◽  
Support Phase ◽  
Double Support Phase

Background Gait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson’s disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters. Aim To evaluate the effect of 3D visual cues and STN-DBS on gait in PD group. Methods We enrolled 35 PD patients treated with DBS of nucleus subthalamicus (STN-DBS). Twenty-five patients (5 females; mean age 58.9 ±6.3) and 25 sex- and age-matched controls completed the gait examination. The gait in 10 patients deteriorated in OFF state. The severity of PD was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY). The PD group filled the Falls Efficacy Scale-International (FES) and Freezing of Gait Questionnaire (FOGQ). Gait was examined using the GaitRite Analysis System, placed in the middle of the 10m marked path. The PD group was tested without dopaminergic medication with and without visual cueing together with the DBS switched ON and OFF. The setting of DBS was double-blind and performed in random order. Results The UPDRS was 21.9 ±9.5 in DBS ON state and 41.3 ±13.7 in DBS OFF state. HY was 2.5 ±0.6, FES 12.4 ±4.1 and FOGQ 9.4 ±5.7. In the DBS OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls. The walking speed and step length increased in the DBS ON state. The double support phase was reduced with 3D visual cueing and DBS; the combination of both cueing and DBS was even more effective. Conclusion Cueing with 3D visual stimuli shortens the double support phase in PD patients treated with DBS-STN. The DBS is more effective in prolonging step length and increasing gait speed. We conclude that 3D visual cueing can improve walking in patients with DBS.

scholarly journals The Effect of One Session Split-Belt Treadmill Training on Gait Adaptation in People With Parkinson’s Disease and Freezing of Gait

2020 ◽  
Vol 34 (10) ◽  
pp. 954-963
Author(s):  
Jana Seuthe ◽  
Nicholas D’Cruz ◽  
Pieter Ginis ◽  
Jos Steffen Becktepe ◽  
Burkhard Weisser ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Training Session ◽  
Step Length ◽  
Treadmill Training ◽  
Initial Exposure ◽  
Gait Adaptation ◽  
Gait Asymmetry ◽  
Adaptation Test

Background Freezing of gait (FOG) in Parkinson’s disease (PD) is associated with gait asymmetry and switching difficulty. A split-belt treadmill may potentially address those deficits. Objective To investigate the immediate and retention effects of one-session split-belt treadmill training (SBT) in contrast to regular tied-belt treadmill training (TBT) on gait asymmetry and adaptation in people with PD and FOG (PD + FOG) and healthy controls (HC). Additionally, to investigate differential effects of 3 SBT protocols and compare different gait adaptation outcomes. Methods PD + FOG (n = 45) and HC (n = 36) were randomized to 1 of 3 SBT groups (belt speeds’ ratio 0.75:1; 0.5:1 or changing ratios) or TBT group. Participants were tested at Pre, Post, and Retention after one treadmill training session. Gait asymmetry was measured during a standardized adaptation test on the split-belt treadmill Results SBT proved beneficial for gait adaptation in PD + FOG and HC ( P < .0001); however, HC improved more. SBT with changing ratios demonstrated significant effects on gait adaptation from Pre to Post in PD + FOG, supported by strong effect sizes ( d = 1.14) and improvements being retained for 24 hours. Mean step length asymmetry during initial exposure was lower in HC compared with PD + FOG ( P = .035) and differentiated best between the groups. Conclusions PD + FOG improved gait adaptation after a single SBT session although effects were smaller than in HC. SBT with changing ratios was the most effective to ameliorate gait adaptation in PD + FOG. These promising results warrant future study on whether long-term SBT strengthens adaptation in PD + FOG and has potential to induce a better resilience to FOG. Clinical trial ID: NCT03725215.

scholarly journals Turning Characteristics of the More-Affected Side in Parkinson’s Disease Patients with Freezing of Gait

Sensors ◽  
2020 ◽  
Vol 20 (11) ◽  
pp. 3098
Author(s):  
Hwayoung Park ◽  
Changhong Youm ◽  
Myeounggon Lee ◽  
Byungjoo Noh ◽  
Sang-Myung Cheon
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Center Of Mass ◽  
Freezing Of Gait ◽  
Step Length ◽  
Control Group ◽  
Maximum Speed ◽  
Step Width ◽  
Affected Side ◽  
Anterior Posterior

This study investigated the turning characteristics of the more-affected limbs in Parkinson’s disease (PD) patients in comparison with that of a control group, and in PD patients with freezing of gait (FOG; freezers) in comparison with those without FOG (non-freezers) for 360° and 540° turning tasks at the maximum speed. A total of 12 freezers, 12 non-freezers, and 12 controls participated in this study. The PD patients showed significantly longer total durations, shorter inner and outer step lengths, and greater anterior–posterior (AP) root mean square (RMS) center of mass (COM) distances compared to those for the controls. The freezers showed significantly greater AP and medial-lateral (ML) RMS COM distances compared to those of non-freezers. The turning task toward the inner step of the more-affected side (IMA) in PD patients showed significantly greater step width, total steps, and AP and ML RMS COM distances than that toward the outer step of the more-affected side (OMA). The corresponding results for freezers revealed significantly higher total steps and shorter inner step length during the 540° turn toward the IMA than that toward the OMA. Therefore, PD patients and freezers exhibited greater turning difficulty in performing challenging turning tasks such as turning with an increased angle and speed and toward the more-affected side.

scholarly journals Effects of Gait Inducing Assist for Patients with Parkinson’s Disease on Double Support Phase During Gait

2020 ◽  
Vol 32 (4) ◽  
pp. 798-811
Author(s):  
Ai Higuchi ◽  
Junichiro Shiraishi ◽  
Yuichi Kurita ◽  
Tomohiro Shibata ◽  
◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Step Length ◽  
Motor Symptom ◽  
Elderly Subjects ◽  
Healthy Elderly ◽  
Wide Range ◽  
Healthy Elderly Subjects ◽  
Support Phase

Parkinson’s disease (PD) is a common progressive neurodegenerative disease that affects a wide range of motor and non-motor symptoms. Freezing of gait (FOG) is such a motor symptom of PD that frequently results in falling, and almost half of PD patients suffer from FOG. In this study, we investigated the effectiveness of a robotic assistance system called UPS-PD, which was developed to suppress FOG. The double limb support phase (DLS) in a 10-m straight-line walking task, the gait time and step counts were measured in five PD subjects. In addition, the safety of the UPS-PD in a healthy person was investigated using OpenSim, and the DLS parameters in four healthy elderly subjects were evaluated. In the experiment with the PD patients, the DLS parameters of two subjects showed an improvement. Furthermore, the step length of one subject and the step length and walking speed of the other subject were improved. Moreover, there were no problems in terms of instability of gait in both the PD patients. The UPS-PD did not adversely affect the gait of healthy elderly subjects and the walking of a healthy subject model in the simulation. Therefore, the UPS-PD is considered to be a useful device for improving walking in PD patients.

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 Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Sensors ◽  
2019 ◽  
Vol 19 (24) ◽  
pp. 5468 ◽  
Author(s):  
Niveditha Muthukrishnan ◽  
James J. Abbas ◽  
Holly A. Shill ◽  
Narayanan Krishnamurthi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Closed Loop ◽  
Freezing Of Gait ◽  
Movement Patterns ◽  
Step Length ◽  
Open Loop ◽  
Narrative Review ◽  
Movement Initiation ◽  
At Home

Progressive gait dysfunction is one of the primary motor symptoms in people with Parkinson’s disease (PD). It is generally expressed as reduced step length and gait speed and as increased variability in step time and step length. People with PD also exhibit stooped posture which disrupts gait and impedes social interaction. The gait and posture impairments are usually resistant to the pharmacological treatment, worsen as the disease progresses, increase the likelihood of falls, and result in higher rates of hospitalization and mortality. These impairments may be caused by perceptual deficiencies (poor spatial awareness and loss of temporal rhythmicity) due to the disruptions in processing intrinsic information related to movement initiation and execution which can result in misperceptions of the actual effort required to perform a desired movement and maintain a stable posture. Consequently, people with PD often depend on external cues during execution of motor tasks. Numerous studies involving open-loop cues have shown improvements in gait and freezing of gait (FoG) in people with PD. However, the benefits of cueing may be limited, since cues are provided in a consistent/rhythmic manner irrespective of how well a person follows them. This limitation can be addressed by providing feedback in real-time to the user about performance (closed-loop cueing) which may help to improve movement patterns. Some studies that used closed-loop cueing observed improvements in gait and posture in PD, but the treadmill-based setup in a laboratory would not be accessible outside of a research setting, and the skills learned may not readily and completely transfer to overground locomotion in the community. Technologies suitable for cueing outside of laboratory environments could facilitate movement practice during daily activities at home or in the community and could strongly reinforce movement patterns and improve clinical outcomes. This narrative review presents an overview of cueing paradigms that have been utilized to improve gait and posture in people with PD and recommends development of closed-loop wearable systems that can be used at home or in the community to improve gait and posture in PD.

scholarly journals Evaluating the Contributions of Dynamic Flow to Freezing of Gait in Parkinson's Disease

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Chad A. Lebold ◽  
Q. J. Almeida
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Optic Flow ◽  
Visual Cues ◽  
Freezing Of Gait ◽  
Underlying Mechanism ◽  
Step Length ◽  
Double Support ◽  
Double Support Time ◽  
Conscious Control

Although visual cues can improve gait in Parkinson's disease (PD), their underlying mechanism is poorly understood. Previous research suggests that cues contribute optical flow that is essential to elicit gait improvement. The present study manipulated how optic flow was provided, and how this might influence freezing of gait (FOG) in PD. Therefore, three groups; 15 PD FOG, 16 PD non-FOG, and 16 healthy controls were tested in 3 narrow doorway conditions; baseline (Narrow), ground lines (Ground), and laser (Laser). Step length indicated that the PD FOG group was only able to improve with ground lines, while the laser increased gait variability and double support time. These results suggest that optic flow in itself is not enough to elicit gait improvement in PD. When PD patients use visual cues, gait becomes less automatically controlled and hence preplanned conscious control may be an important factor contributing to gait improvement.

scholarly journals Camera-based objective measures of Parkinson’s disease gait features

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jannis van Kersbergen ◽  
Karen Otte ◽  
Nienke M. de Vries ◽  
Bastiaan R. Bloem ◽  
Hanna M. Röhling ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Walking Speed ◽  
Rating Scale ◽  
Step Length ◽  
Microsoft Kinect ◽  
Timed Up And Go ◽  
Significant Group ◽  
Age Related ◽  
Gait Features

Abstract Objective Parkinson’s disease is a common, age-related, neurodegenerative disease, affecting gait and other motor functions. Technological developments in consumer imaging are starting to provide high-quality, affordable tools for home-based diagnosis and monitoring. This pilot study aims to investigate whether a consumer depth camera can capture changes in gait features of Parkinson’s patients. The dataset consisted of 19 patients (tested in both a practically defined OFF phase and ON phase) and 8 controls, who performed the “Timed-Up-and-Go” test multiple times while being recorded with the Microsoft Kinect V2 sensor. Camera-derived features were step length, average walking speed and mediolateral sway. Motor signs were assessed clinically using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Results We found significant group differences between patients and controls for step length and average walking speed, showing the ability to detect Parkinson’s features. However, there were no differences between the ON and OFF medication state, so further developments are needed to allow for detection of small intra-individual changes in symptom severity.

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