scholarly journals Objective Gait and Balance Impairments Relate to Balance Confidence and Perceived Mobility in People With Parkinson Disease

2016 ◽  
Vol 96 (11) ◽  
pp. 1734-1743 ◽  
Author(s):  
Carolin Curtze ◽  
John G. Nutt ◽  
Patricia Carlson-Kuhta ◽  
Martina Mancini ◽  
Fay B. Horak
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson Disease ◽  
Disease Severity ◽  
Gait Speed ◽  
Stride Length ◽  
Inertial Sensors ◽  
Patient Perception ◽  
Objective Measures ◽  
Mobility Disability ◽  
Balance Confidence

Abstract Background Body-worn, inertial sensors can provide many objective measures of balance and gait. However, the objective measures that best reflect patient perception of mobility disability and clinician assessment of Parkinson disease (PD) are unknown. Objective The purposes of this study were: (1) to determine which objective measures of balance and gait are most related to patient perception of mobility disability and disease severity in people with PD and (2) to examine the effect of levodopa therapy on these correlates. Design This was an experimental correlation study. Methods One hundred four people with idiopathic PD performed 3 trials of the Instrumented Stand and Walk Test (ISAW) in the “on” and “off” medication states. The ISAW consists of quiet standing (30 seconds), gait initiation, straight walking (7 m), and turning (180°), yielding 34 objective measures of mobility from body-worn inertial sensors. Patient perception of mobility disability was assessed with the Activities-specific Balance Confidence (ABC) scale and the mobility subscale of the Parkinson's Disease Questionnaire (PDQ-39). Disease severity was assessed with the Unified Parkinson's Disease Rating Scale, part III (motor UPDRS). Spearman correlations were used to relate objective measures of mobility to patient perception and disease severity. Results Turning speed, gait speed, and stride length were most highly correlated to severity of disease and patient perception of mobility disability. The objective measures of mobility in the off-medication state were more indicative of patient perception of mobility disability and balance confidence compared with on-medication state measures. Limitations Causation is an inherent problem of correlation studies. Conclusion Physical therapists should evaluate mobility in people with PD in the off-medication state because the off-medication state is more related to disease severity and patient perception of mobility disability than the on-medication state mobility. Assessment and treatment of mobility in people with PD should target specific measures (ie, turning, gait speed, and stride length) because these measures best reflect patients' quality of life and balance confidence.

scholarly journals Predictors of Gait Speeds and the Relationship of Gait Speeds to Falls in Men and Women with Parkinson Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Samuel T. Nemanich ◽  
Ryan P. Duncan ◽  
Leland E. Dibble ◽  
James T. Cavanaugh ◽  
Terry D. Ellis ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Disease Severity ◽  
Gait Speed ◽  
Balance Confidence ◽  
The Difference ◽  
Walking Speeds ◽  
Relationship Of ◽  
The Relationship ◽  
Insight Into

Gait difficulties and falls are commonly reported in people with Parkinson disease (PD). Reduction in gait speed is a major characteristic of Parkinsonian gait, yet little is known about its underlying determinants, its ability to reflect an internal reservation about walking, or its relationship to falls. To study these issues, we selected age, disease severity, and nonmotor factors (i.e., depression, quality of life, balance confidence, and exercise beliefs and attitudes) to predict self-selected (SELF), fast-as-possible (FAST), and the difference (DIFF) between these walking speeds in 78 individuals with PD. We also examined gender differences in gait speeds and evaluated how gait speeds were related to a retrospective fall report. Age, disease severity, and balance confidence were strong predictors of SELF, FAST, and, to a lesser extent, DIFF. All three parameters were strongly associated with falling. DIFF was significantly greater in men compared to women and was significantly associated with male but not female fallers. The results supported the clinical utility of using a suite of gait speed parameters to provide insight into the gait difficulties and differentiating between fallers in people with PD.

scholarly journals Acute and Chronic Effect of Acoustic and Visual Cues on Gait Training in Parkinson’s Disease: A Randomized, Controlled Study

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Roberto De Icco ◽  
Cristina Tassorelli ◽  
Eliana Berra ◽  
Monica Bolla ◽  
Claudio Pacchetti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Gait Speed ◽  
Visual Cues ◽  
Stride Length ◽  
Gait Training ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Acoustic Cues ◽  
Chronic Effect ◽  
Randomized Controlled

In this randomized controlled study we analyse and compare the acute and chronic effects of visual and acoustic cues on gait performance in Parkinson’s Disease (PD). We enrolled 46 patients with idiopathic PD who were assigned to 3 different modalities of gait training: (1) use of acoustic cues, (2) use of visual cues, or (3) overground training without cues. All patients were tested with kinematic analysis of gait at baseline (T0), at the end of the 4-week rehabilitation programme (T1), and 3 months later (T2). Regarding the acute effect, acoustic cues increased stride length and stride duration, while visual cues reduced the number of strides and normalized the stride/stance distribution but also reduced gait speed. As regards the chronic effect of cues, we recorded an improvement in some gait parameters in all 3 groups of patients: all 3 types of training improved gait speed; visual cues also normalized the stance/swing ratio, acoustic cues reduced the number of strides and increased stride length, and overground training improved stride length. The changes were not retained at T2 in any of the experimental groups. Our findings support and characterize the usefulness of cueing strategies in the rehabilitation of gait in PD.

scholarly journals Comparison of Laboratory and Daily-Life Gait Speed Assessment during ON and OFF States in Parkinson’s Disease

Sensors ◽  
2021 ◽  
Vol 21 (12) ◽  
pp. 3974
Author(s):  
Marta Francisca Corrà ◽  
Arash Atrsaei ◽  
Ana Sardoreira ◽  
Clint Hansen ◽  
Kamiar Aminian ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Inertial Sensors ◽  
Motor Fluctuations ◽  
Accurate Assessment ◽  
Moderate Correlation ◽  
Complementary Information ◽  
Speed Distribution ◽  
Laboratory Measures

Accurate assessment of Parkinson’s disease (PD) ON and OFF states in the usual environment is essential for tailoring optimal treatments. Wearables facilitate measurements of gait in novel and unsupervised environments; however, differences between unsupervised and in-laboratory measures have been reported in PD. We aimed to investigate whether unsupervised gait speed discriminates medication states and which supervised tests most accurately represent home performance. In-lab gait speeds from different gait tasks were compared to home speeds of 27 PD patients at ON and OFF states using inertial sensors. Daily gait speed distribution was expressed in percentiles and walking bout (WB) length. Gait speeds differentiated ON and OFF states in the lab and the home. When comparing lab with home performance, ON assessments in the lab showed moderate-to-high correlations with faster gait speeds in unsupervised environment (r = 0.69; p < 0.001), associated with long WB. OFF gait assessments in the lab showed moderate correlation values with slow gait speeds during OFF state at home (r = 0.56; p = 0.004), associated with short WB. In-lab and daily assessments of gait speed with wearables capture additional integrative aspects of PD, reflecting different aspects of mobility. Unsupervised assessment using wearables adds complementary information to the clinical assessment of motor fluctuations in PD.

Dual-Task Costs of Quantitative Gait Parameters While Walking and Turning in People with Parkinson’s Disease: Beyond Gait Speed

2020 ◽  
pp. 1-12
Author(s):  
Rodrigo Vitorio ◽  
Naoya Hasegawa ◽  
Patricia Carlson-Kuhta ◽  
John G. Nutt ◽  
Fay B. Horak ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Range Of Motion ◽  
Disease Severity ◽  
Outcome Measures ◽  
Dual Task ◽  
Gait Speed ◽  
Disease Duration ◽  
Healthy Individuals ◽  
Foot Strike ◽  
Strike Angle

Background: There is a lack of recommendations for selecting the most appropriate gait measures of Parkinson’s disease (PD)-specific dual-task costs to use in clinical practice and research. Objective: We aimed to identify measures of dual-task costs of gait and turning that best discriminate performance in people with PD from healthy individuals. We also investigated the relationship between the most discriminative measures of dual-task costs of gait and turning with disease severity and disease duration. Methods: People with mild-to-moderate PD (n = 144) and age-matched healthy individuals (n = 79) wore 8 inertial sensors while walking under single and dual-task (reciting every other letter of the alphabet) conditions. Outcome measures included 26 objective measures within four gait domains (upper/lower body, turning and variability). The area under the curve (AUC) from the receiver-operator characteristic plot was calculated to compare discriminative ability of dual-task costs on gait across outcome measures. Results: PD-specific, dual-task interference was identified for arm range of motion, foot strike angle, turn velocity and turn duration. Arm range of motion (AUC = 0.73) and foot strike angle (AUC = 0.68) had the largest AUCs across dual-task costs measures and they were associated with disease severity and/or disease duration. In contrast, the most commonly used dual-task gait measure, gait speed, showed an AUC of only 0.54. Conclusion: Findings suggest that people with PD rely more than healthy individuals on executive-attentional resources to control arm swing, foot strike, and turning, but not gait speed. The dual-task costs of arm range of motion best discriminated people with PD from healthy individuals.

scholarly journals Rehabilitation of Falls in Parkinson’s Disease: Self-Perception vs. Objective Measures of Fall Risk

2021 ◽  
Vol 11 (3) ◽  
pp. 320
Author(s):  
Kishoree Sangarapillai ◽  
Benjamin M. Norman ◽  
Quincy J. Almeida
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Fall Risk ◽  
Objective Measures ◽  
Term Care ◽  
Balance Impairment ◽  
Balance Confidence ◽  
Limited Effectiveness

Falls are an important cause of injury and increased hospital/long-term care facility stays and has been reported in 70% of people with Parkinson’s disease (PD), yet there is limited effectiveness of medications for reducing falls. As an adjunct, many exercise therapies succeed in objectively reducing the number of falls, but this may not translate to improved quality of life (QOL). Importantly, self-perceived fall risk has a greater influence on activities of daily living and QOL, making it important to evaluate in the rehabilitation of PD. The purpose of this study was to examine the influence of a 10-week exercise intervention (PD SAFE × TM) on self-perceived (according to balance confidence measures) and objective measures of gait that are commonly linked to fall risk in PD. Participants (N = 44) with PD completed PD SAFE × TM. Pre-/post-assessment involved the Activities-specific Balance Confidence Scale (perception), objective falls characteristics (stride time, stride width, stride length, and stride variability), and symptom severity (Unified Parkinson’s Disease Rating Scale motor subsection III (UPDRS-III)) after participants were stratified into a mild (no-balance impairment) vs. severe (balance impairment) groups. Overall disease severity (F (1, 43) = 8.75, p < 0.003) and all objective fall parameters improved (p < 0.05) in both groups, yet self-perceived fall risk improved in only the severe PD group F (1, 43) = 9.86, p < 0.022. Given that self-perceived fall risk and objective fall risk both play a role in the quality of life, identifying strategies to improve both aspects may be important in improving the overall quality of life.

scholarly journals Relationship between Sensorimotor Inhibition and Mobility in Older Adults with and without Parkinson’s Disease

2020 ◽  
Author(s):  
Douglas N Martini ◽  
Rosie Morris ◽  
Tara M Madhyastha ◽  
Thomas J Grabowski ◽  
John Oakley ◽  
...  
Keyword(s):  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Stride Length ◽  
Inertial Sensors ◽  
Postural Sway ◽  
Single Task ◽  
Immediate Recall ◽  
Foot Strike

Abstract Background Reduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson’s disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sensorimotor inhibition relates to impairments in mobility and cognition in people with PD and OAs. Methods Cortical sensorimotor inhibition was characterized with short-latency afferent inhibition (SAI) in 81 people with PD and 69 OAs. Six inertial sensors recorded single- and dual-task gait and postural sway characteristics during a two-minute walk and a one-minute quiet stance. Cognition was assessed across the memory, visuospatial, executive function, attention, and language domains. Results SAI was significantly impaired in the PD compared to the OA group. The PD group preformed significantly worse across all gait and postural sway tasks. In PD, SAI significantly correlated with single-task foot strike angle and stride length variability, sway area, and jerkiness of sway in the coronal and sagittal planes. In OAs, SAI significantly related to single-task gait speed and stride length, dual-task stride length, and immediate recall (memory domain). No relationship among mobility, cognition, and SAI was observed. Conclusions Impaired SAI related to slower gait in OA and to increased gait variability and postural sway in people with PD, all of which have been shown to be related to increased fall risk.

scholarly journals Gait parameters of individuals with Parkinson disease decline during one-year period

2020 ◽  
Vol 25 ◽  
pp. 7-18
Author(s):  
Kadri Medijainen ◽  
Mati Pääsuke ◽  
Aet Lukmann ◽  
Pille Taba
Keyword(s):  
Parkinson Disease ◽  
Gait Speed ◽  
Stride Length ◽  
Rating Scale ◽  
Double Support ◽  
Healthy Elderly ◽  
Gait Characteristics ◽  
Gait Parameters ◽  
Gait Function ◽  
One Year

Parkinson’s disease (PD) is a neurodegenerative disease, influencing mainly elderly. The key motor factor affecting the level of participation in activities of daily living is the gait function, which is known to be progressively impaired in PD. However, gait characteristics also worsen due to normal aging. The main aim of this study was to investigate whether gait parameters decline in individuals with PD in an interval of one year compared to healthy elderly. Selected gait characteristics were recorded using 3-D optoelectronic movement analysis system ELITE in 13 patients with mild-to-moderate PD and 13 age- and gender-matched controls. Hoehn and Yahr Scale and Unified Parkinson Disease Rating Scale were used for clinical assessment. It was found that PD patients walk with significantly shorter steps and stride and reduced gait speed. In one year, the stride length initiated with right foot and stride walk ratio further decrease in PD patients. On re-evaluation the percentages of stance, swing and double support phase differed significantly between groups. In second measurement, control subjects walked with reduced step width. It was concluded that gait speed and stride length decline in patients with PD in a period of one year, whereas no indication of deterioration of gait function is evident in healthy controls.

scholarly journals Repeated Gait Perturbation Training in Parkinson's Disease and Healthy Older Adults: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 15 ◽  
Author(s):  
Femke Hulzinga ◽  
Veerle de Rond ◽  
Britt Vandendoorent ◽  
Moran Gilat ◽  
Pieter Ginis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Stride Length ◽  
Meta Analysis ◽  
Gait Training ◽  
Healthy Older Adults ◽  
Perturbation Training

Background: Gait impairments are common in healthy older adults (HOA) and people with Parkinson's disease (PwPD), especially when adaptations to the environment are required. Traditional rehabilitation programs do not typically address these adaptive gait demands in contrast to repeated gait perturbation training (RGPT). RGPT is a novel reactive form of gait training with potential for both short and long-term consolidation in HOA and PwPD. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term.Methods: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Included studies tested the effects of any form of repeated perturbations during gait in HOA and PwPD on gait speed, step or stride length. Studies using balance scales or sway measures as outcomes were included in a secondary analysis. Effects of randomized controlled trials (RCT) on RGPT were pooled using a meta-analysis of final measures.Results: Of the 4421 studies, eight studies were deemed eligible for review, of which six could be included in the meta-analysis, totaling 209 participants (159 PwPD and 50 HOA). The studies were all of moderate quality. The meta-analysis revealed no significant effects of RGPT over non-RGPT training on gait performance (SMD = 0.16; 95% CI = −0.18, 0.49; Z = 0.92; P = 0.36). Yet, in some individual studies, favorable effects on gait speed, step length and stride length were observed immediately after the intervention as well as after a retention period. Gait variability and asymmetry, signifying more direct outcomes of gait adaptation, also indicated favorable RGPT effects in some individual studies.Conclusion: Despite some promising results, the pooled effects of RGPT on gait and balance were not significantly greater as compared to non-RGPT gait training in PwPD and HOA. However, these findings could have been driven by low statistical power. Therefore, the present review points to the imperative to conduct sufficiently powered RCT's to verify the true effects of RGPT on gait and balance in HOA and PwPD.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php? Identifier: CRD42020183273.

scholarly journals How to Select Balance Measures Sensitive to Parkinson’s Disease from Body-Worn Inertial Sensors—Separating the Trees from the Forest

Sensors ◽  
2019 ◽  
Vol 19 (15) ◽  
pp. 3320 ◽  
Author(s):  
Naoya Hasegawa ◽  
Vrutangkumar V. Shah ◽  
Patricia Carlson-Kuhta ◽  
John G. Nutt ◽  
Fay B. Horak ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Inertial Sensors ◽  
Objective Measures ◽  
Healthy Controls ◽  
Postural Responses ◽  
Highly Correlated ◽  
Automatic Postural Responses ◽  
Dynamic Posture ◽  
Fold Cross Validation

This study aimed to determine the most sensitive objective measures of balance dysfunction that differ between people with Parkinson’s Disease (PD) and healthy controls. One-hundred and forty-four people with PD and 79 age-matched healthy controls wore eight inertial sensors while performing tasks to measure five domains of balance: standing posture (Sway), anticipatory postural adjustments (APAs), automatic postural responses (APRs), dynamic posture (Gait) and limits of stability (LOS). To reduce the initial 93 measures, we selected uncorrelated measures that were most sensitive to PD. After applying a threshold on the Standardized Mean Difference between PD and healthy controls, 44 measures remained; and after reducing highly correlated measures, 24 measures remained. The four most sensitive measures were from APAs and Gait domains. The random forest with 10-fold cross-validation on the remaining measures (n = 24) showed an accuracy to separate PD from healthy controls of 82.4%—identical to result for all measures. Measures from the most sensitive domains, APAs and Gait, were significantly correlated with the severity of disease and with patient-related outcomes. This method greatly reduced the objective measures of balance to the most sensitive for PD, while still capturing four of the five domains of balance.

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