Metabolic and kinematic parameters during walking with poles in Parkinson's disease

Do poles really "save the legs" during uphill pole walking at different intensities?

PURPOSE

In sky- and trail-running competitions, many athletes use poles. The aims of this study were to investigate whether the use of poles affects the force exerted on the ground at the feet (Ffoot), cardiorespiratory variables and maximal performance during uphill walking.

METHODS

Fifteen male trail runners completed four testing sessions on different days. On the first two days, they performed two incremental uphill treadmill walking tests to exhaustion with (PWincr) and without poles (Wincr). On the following days, they performed submaximal and maximal tests with (PW80 and PWmax) and without (W80 and Wmax) poles on an outdoor trail course. We measured cardiorespiratory parameters, the rating of perceived exertion, the axial poling force and Ffoot.

RESULTS

When walking on the treadmill, we found that poles reduced maximum Ffoot (- 2.8 ± 6.4%, p = 0.03) and average Ffoot (- 2.4 ± 3.3%, p = 0.0089). However, when outdoors, we found pole effect only for average Ffoot (p = 0.0051), which was lower when walking with poles (- 2.6 ± 3.9%, p = 0.0306 during submaximal trial and - 5.21 ± 5.51%, p = 0.0096 during maximal trial). We found no effects of poles on cardiorespiratory parameters across all tested conditions. Performance was faster in PWmax than in Wmax (+ 2.5 ± 3.4%, p = 0.025).

CONCLUSION

The use of poles reduces the foot force both on the treadmill and outdoors at submaximal and maximal intensities. It is, therefore, reasonable to conclude that the use of poles "saves the legs" during uphill without affecting the metabolic cost.

Automated mechanical peripheral stimulation for gait rehabilitation in Parkinson's disease: A comprehensive review

Background

Automated Mechanical Peripheral Stimulation (AMPS) has emerged as a potential rehabilitative intervention for gait abnormalities in Parkinson's disease (PD). However, the long-term effects and combined therapy with physical exercise remain unclear. This review aimed to explore the effects of automated mechanical peripheral stimulation (AMPS) on gait and motor performance in individuals with Parkinson's disease (PD).

Methods

A research was conducted in relevant databases to identify studies investigating the effects of AMPS on gait and motor outcomes in PD patients. Inclusion criteria were set based on Population, Concept, and Context (PCC) criteria. Data extraction and analysis were performed to synthesize the findings.

Results

Ten studies met the inclusion criteria and were included in the review. The studies collectively demonstrated positive effects of AMPS on gait parameters, such as walking velocity, stride length, and walking stability. Some studies also reported improvements in functional performance and muscle activation during walking.

Conclusions

The findings suggest that AMPS holds promise as a potential intervention to improve gait and motor performance in individuals with PD. However, the evidence is limited, and further well-designed randomized controlled trials are needed to establish the long-term efficacy and optimal protocols for AMPS in PD rehabilitation.

Gait performance and non-motor symptoms burden during dual-task condition in Parkinson's disease

INTRODUCTION

Impaired gait is observed in patients with Parkinson's disease (PD) in both single-task (ST) and dual-task (DT) conditions. Non-motor symptoms (NMSs), another vital symptom future experienced along the PD disease trajectory, contribute to gait performance in PD. However, whether DT gait performance is indicative of NMS burden (NMSB) remains unknown. This study investigated correlation between NMS and DT gait performance and whether NMSB is reflected in the DT effects (DTEs) of gait parameters in PD.

METHODS

Thirty-three idiopathic PD participants were enrolled in this study; the median H-Y staging was 2.5. NMSB was assessed by Non-motor Symptoms Scale (NMSS). Spatiotemporal gait parameters under ST and DT conditions were evaluated by wearable sensors. Gait parameters under ST and DT conditions and DTEs of gait parameters were compared across NMSB groups. The associations between NMS and DTEs of gait parameters were analyzed by correlation analysis and linear regression models.

RESULTS

Compared to PD patients with mild-moderate NMSB, the severe-very severe NMSB group showed slower gait speed and shorter stride length under both ST and DT conditions (p < 0.05). DT had significantly negative effect on gait parameters in PD patients, including gait speed, stride length, and gait cycle duration (p < 0.05). PD patients with mild-moderate NMSB showed larger DTEs of cadence and bilateral gait cycle duration (p < 0.05). DTEs of bilateral gait cycle duration and swing phase on the more affected (MA) side were significantly correlated with NMSS scores (∣rSp∣ ≥ 0.3, p < 0.05). Gait cycle duration on the less affected (LA) side explained 43% of the variance in NMSS scores, when accounting for demographic and clinical confounders (β =  - 1.095 95% CI - 4.061 ~  - 0.058, p = 0.044; adjusted R² = 0.434).

CONCLUSION

DT gait performance could reflect NMSB in PD patients at early stage, and gait cycle duration is a valuable gait parameter to further investigate and to provide more evidence for PD management.

Effects of automatic mechanical peripheral stimulation on gait biomechanics in older adults with Parkinson's disease: a randomized crossover clinical trial

BACKGROUND

Automated mechanical peripheral stimulation (AMPS) is a rehabilitation technique suggested to correct gait abnormalities on Parkinson's disease. Although previous studies have suggested increments in functional performance and gait speed after AMPS intervention, little is known about its effect on gait biomechanics.

OBJECTIVE

To analyze the effect of an AMPS session on functional performance and gait biomechanics in subjects with Parkinson's disease.

METHODS

Twenty-eight subjects aged 67±3 years old participated in this study. Kinematics and muscle activation were recorded during walking at a preferred gait speed before and after AMPS and sham interventions. Footswitches sensors were used to record the kinematic parameters. Electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius lateralis (GL) were recorded. Timed up and go (TUG) test and Short Physical Performance Battery (SPPB) were performed to assess functional performance.

RESULTS

GL activation increased after AMPS intervention before and after heel strike (p = 0.04; p < 0.01) and before and after toe-off (p = 0.013; p = 0.038). Also, after AMPS intervention, TA activation increased after heel strike (p = 0.007); and after sham intervention, TA activation reduced before and after heel strike (p = 0.038; and p = 0.007) and before toe-off (p = 0.013). The time of TUG test was shorter after AMPS intervention (p = 0.015).

CONCLUSION

AMPS intervention changed the EMG activation of ankle muscles during walking and functional performance. However, AMPS intervention did not change gait kinematics.

Biomechanical responses of Nordic walking in people with Parkinson's disease

In healthy adults, Nordic walking (NW) is known to increase the external mechanical energy fluctuations, though the external work is unaltered due to an improved pendulum-like recovery in comparison with free walking (FW). We aimed to compare mechanical, pendulum-like, and spatiotemporal parameters of gait at different speeds with and without NW poles in people with Parkinson's disease and healthy controls. The study included 11 people (aged 65.6 ± 7.0 years) with idiopathic Parkinson's disease, scoring between 1 and 1.5 on the Hoehn and Yahr scale (H&Y), and nine healthy controls (aged 70.0 ± 5.6 years). All the people were experienced Nordic walkers. Walking tests were performed at 1.8 km h^-1 and 4.7 km h^-1 , on eight 3D force platforms on a walkway. We found greater pendulum-like energy recovery (p < 0.05) in the Parkinson group during NW than in FW, while external mechanical work remained similar (p > 0.05). People with Parkinson's disease showed a major increase in vertical and forward energy fluctuations using poles than in healthy controls. In addition, the Parkinson group showed increased stride frequency and reduced stride length compared to controls in the NW and FW conditions. Our findings partly justify the lower walking economy in Parkinson's disease due to reduced pendulum-like mechanism at commonly used speeds. NW alters gait mechanics similarly in Parkinson group and healthy control, increasing the total mechanical work. Therefore, NW can be a compelling strategy for rehabilitation because of its potential for improving functional mobility, increasing pendulum-like mechanism in Parkinson's disease.

Acute effects of acupuncture in balance and gait of Parkinson disease patients - A preliminary study

INTRODUCTION

Balance and gait disorders are relevant symptoms in the quality of life of Parkinson's patients. Currently, there is no therapy to reverse or treat this condition. Acupuncture treatment is believed to improve motor ability through the cortico-basal-thalamus-cortical-ganglia.

AIM

To investigate qualitatively the acute effect of acupuncture on balance and gait in Parkinson's disease in 7 patients.

METHODS

This is a randomized and controlled crossover study. The same individual patient was part of both, experimental (real acupuncture) and control group (false acupuncture/sham), and the sequence was randomized. Balance and gait parameters were measured at two different moments, before and after treatment, using four force platforms as well as the collection of 3D markers positions taken by 11 cameras. Images were analyzed using Qualisys Track Manager software that let us extract data related to the quality of gait and balance.

RESULTS

Statistically significant differences were found in gait speed (p = 0.016), gait cadence (p = 0.006), support base width (p = 0.0001), medio-lateral oscillation (p = 0.017), left-right step length (p = 0.0002), and stride length: right-right (p = 0.0000) and left-left (p = 0.0018), time of left support phase (p = 0.029), right support phase (p = 0.025) and double support phase (p = 0.015), between the initial and final moments for the experimental group. Differences in right-left stride length were found for both groups.

CONCLUSION

Our results suggest that the acupuncture protocol used objectively could improve gait in Parkinson disease patients. A deep research involving a statistical evaluation supported on a larger number of voluntaries should be accomplished to confirming these promising preliminary results.

Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review

Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.

Leverage mechanical alterations during walking at self-selected speed in patients with Parkinson's disease

Individuals with Parkinson's disease (PD) show poor walking performance compared to healthy adults. Leverage changes may provide insight into this walking abnormality, since they have important effects on both biomechanical and physiological variables. Hence, we investigated the differences in internal and external moment arms at the knee and ankle joints, as well as the effective mechanical advantage during walking at self-selected speed. Furthermore, the effects on walking of a simultaneous cognitive task were analysed. Kinetic (resultant ground reaction force and joint moments), kinematic (movement speed) and mechanical leverage (internal and external moment arms) parameters of 10 mild-to-moderate PD patients and 10 age-matched controls were measured in single and dual task condition. Finally, effective mechanical advantage was calculated as the ratio between internal and external moment arm for each joint. PD patients had a slower walking and showed larger and lower values of knee and ankle joint moments, respectively. No difference in force among groups was recorded. External moment arms were larger (in both joints) for PD, whereas slight changes were observed for internal moment arms. Consequently, effective mechanical advantage values seemed to be lower for PD. Surprisingly, leverage difference among groups was reduced during the dual task condition, resulting in a "more effective" walking strategy for PD. These findings suggest that during single task PD patients have several leverage disadvantages, which could affect the joint assessment. On the contrary, during dual task they reduced these mechanical negative effects by positively obtaining normal values of effective mechanical advantage.

Parkinson's Disease-Mild Cognitive Impairment (PD-MCI): A Useful Summary of Update Knowledge

Mild cognitive impairment (MCI) is a common feature in Parkinson's Disease (PD), even at the time of diagnosis. Some levels of heterogeneity in nature and severity of cognitive impairment and risk of conversion to Parkinson's Disease Dementia (PDD) exist. This brief overview summarized the current understanding of MCI in PD, by considering the following major points: historical development of the clinical entity, evaluation, epidemiology, predictors and outcomes, neuroimaging findings, pathophysiology, treatment, and pharmacological and non-pharmacological intervention. MCI in PD represents a concept in evolution and plays a pivotal role in advancing our understanding of the disease mechanisms, with the ultimate goal of building effective strategies to prevent conversion into PDD. Challenges for future research are also discussed.