Being physically active minimizes the effects of leg muscle fatigue on obstacle negotiation in people with Parkinson's disease

Reliability of Obstacle-Crossing Parameters during Overground Walking in Young Adults

We aimed to evaluate the intra-session relative and absolute reliability of obstacle-crossing parameters during overground walking in young adults, and to determine the number of trials required to ensure reliable assessment. We analysed data from 43 young male adults who were instructed to walk at a self-selected velocity on a pathway and to step over an obstacle (height = 15 cm; width = 80 cm, thickness = 2 cm) three times. Spatial-temporal gait parameters of the approaching and crossing phases (i.e., before and after the obstacle) and obstacle clearance parameters (i.e., vertical and horizontal distance between the foot and the obstacle during crossing) were computed using a three-dimensional motion analysis system. Intraclass correlation coefficients were used to compute the relative reliability, while standard error of measurement and minimal detectable change were used to assess the absolute reliability for all possible combinations between trials. Results showed that most spatial-temporal gait parameters and obstacle clearance parameters are reliable using the average of three trials. However, the mean of the second and third trials ensures the best relative and absolute reliabilities of most obstacle-crossing parameters. Further works are needed to generalize these results in more realistic conditions and in other populations.

Movement strategies during obstacle crossing in people with Parkinson disease: A systematic review with meta-analysis

OBJECTIVE

Navigating obstacles involves adjusting walking patterns, particularly when stepping over them. This task may be particularly challenging for people with Parkinson disease (PD) for several reasons. This review aims to compare the spatiotemporal gait parameters of people with and without PD while stepping over obstacles.

LITERATURE SURVEY

A systematic literature search was conducted in six databases (PubMed, Scopus, Web of Science, EBSCO, Embase, and SciELO) from inception to September 2023.

METHODOLOGY

Studies were selected that evaluated gait parameters of people with and without PD while walking over obstacles. Two independent researchers evaluated the eligibility and extracted gait parameters during obstacle crossing. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Heterogeneity was assessed using I2-tests. Random effects models were determined for effect sizes as standardized mean differences (SMD).

SYNTHESIS

Twenty-five studies were included in the review and 17 in the meta-analysis. Most of the studies (58%) showed a low risk of bias. People with PD exhibit a shorter step when landing after crossing an obstacle (SMD = -0.50 [-0.69 to -0.31]). Compared to people without PD, people with PD also widen their support base (SMD = 0.27 [0.07-0.47]) and reduce gait velocity (SMD = -0.60 [-0.80 to -0.39]) when crossing the obstacle.

CONCLUSIONS

People with PD adopt a more conservative motor behavior during obstacle crossing than those without PD, with a shorter step length when landing after crossing an obstacle, greater step width and lower crossing speed.

The effects of experimentally-induced fatigue on gait parameters during obstacle crossing: A systematic review

Striking an obstacle while walking can be dangerous, reflecting the higher risks of losing one's balance, tripping and falling. Particular situations during which internal resources are limited, such as in a fatigued state, may impair performance when crossing obstacles, enhancing the risks of falls or accidents. Our goal was thus to review the effects of experimentally-induced fatigue (EIF) on gait parameters during obstacle crossing by healthy individuals. We systematically searched PubMed and Web of Science databases using 'fatigue', 'obstacle crossing' and their equivalent terms to extract data from studies investigating this domain. Nine studies were found. First, EIF-related effects on kinetics, EMG and obstacle contacts have been poorly studied. Second, consistent and inconsistent results were found in the kinematic outcomes after EIF. Consistent results included reductions in stride duration and increased step width. Inconsistent results included gait velocity (no-effect vs increased), leading and trailing-foot vertical clearance (reduced vs increased) and horizontal distance from foot to the obstacle before obstacle avoidance (no-effect vs increased). These findings should be interpreted cautiously, however, due to the heterogeneity of the obstacle crossing and EIF protocols.