Does positive pressure body weight-support alter spatiotemporal gait parameters in healthy and parkinsonian individuals?

Single- and dual-task gait performance and their diagnostic value in early-stage Parkinson's disease

Background

Gait parameters are considered potential diagnostic markers of Parkinson's disease (PD). We aimed to 1) assess the gait impairment in early-stage PD and its related factors in the single-task (ST) and dual-task (DT) walking tests and 2) evaluate and compare the diagnostic value of gait parameters for early-stage PD under ST and DT conditions.

Methods

A total of 97 early-stage PD patients and 41 healthy controls (HC) were enrolled at Hwa Mei hospital. Gait parameters were gathered and compared between the two groups in the ST and DT walking test, controlling for covariates. Utilizing the receiver operating characteristic curve, diagnostic parameters were investigated.

Results

In the ST walking test, significantly altered gait patterns could be observed in early-stage PD patients in all domains of gait, except for asymmetry (P < 0.05). Compared to the ST walking test, the early-stage PD group performed poorly in the DT walking test in the pace, rhythm, variability and postural control domain (P < 0.05). Older, heavier subjects, as well as those with lower height, lower level of education and lower gait velocity, were found to have a poorer gait performance (P < 0.05). Stride length (AUC = 0.823, sensitivity, 68.0%; specificity, 85.4%; P < 0.001) and heel strike angle (AUC = 0.796, sensitivity, 71.1%; specificity, 80.5%; P < 0.001) could distinguish early-stage PD patients from HCs with moderate accuracy, independent of covariates. The diagnostic accuracy of gait parameters under ST conditions were statistically noninferior to those under DT conditions(P>0.05). Combining all gait parameters with diagnostic values under ST and DT walking test, the predictive power significantly increased with an AUC of 0.924 (sensitivity, 85.4%; specificity, 92.7%; P < 0.001).

Conclusion

Gait patterns altered in patients with early-stage PD but the gait symmetry remained preserved. Stride length and heel strike angle were the two most prominent gait parameters of altered gait in early-stage of PD that could serve as diagnostic markers of early-stage PD. Our findings are helpful to understand the gait pattern of early-stage PD and its related factors and can be conducive to the development of new diagnostic tools for early-stage PD.

Body Weight Support Gait Training for Patients With Parkinson Disease: A Systematic Review and Meta-analyses

OBJECTIVE

To determine the effectiveness of body weight support (BWS) gait training to improve the clinical severity, gait, and balance in patients with Parkinson disease (PD).

DATA SOURCES

A literature search was conducted until July 2020 in MEDLINE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature.

STUDY SELECTION

Randomized controlled trials that aimed at determining the effectiveness of physical activity interventions with BWS during gait training in patients with PD.

DATA EXTRACTION

The methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool (RoB 2.0). Effect size (ES) and 95% confidence intervals [CIs] were calculated for the Unified Parkinson Disease Rating Scale (UPDRS), the UPDRS section III, the 6-minute walk test (6MWT), gait parameters (ie, velocity, cadence, stride length), and the Berg Balance Scale (BBS).

DATA SYNTHESIS

Twelve studies were included in the systematic review. The pooled ES for the effect of BWS on total UPDRS was -0.35 (95% CI, -0.57 to -0.12; I²=1.9%, P=.418), whereas for UPDRS III it was -0.35 (95% CI, -0.68 to -0.01; I²=66.4 %, P<.001). Furthermore, the pooled ES for 6MWT was 0.56 (95% CI, -0.07 to 1.18; I²=77.1%, P=.002), for gait velocity was 0.37 (95% CI, -0.10 to 0.84); I²=78.9%, P<.001), for cadence was 0.03 (95% CI, -0.25 to 0.30; I²=0.0%, P=.930), for stride length was 1.00 (95% CI, 0.23 to 1.78; I²=79.5%, P=.001), and for BBS was 0.65 (95% CI, 0.30, 0.99; I²=51.8%, P=.042).

CONCLUSIONS

Interventions with BWS could improve the general and motor clinical severity of patients with PD, as well as other parameters such as stride length and balance. However, the effect does not appear to be statistically significant in improving gait parameters such as velocity, cadence, and distance.

Person-centered home-based rehabilitation for persons with Parkinson's disease: A scoping review

BACKGROUND

Due to vague, initial symptoms, persons with Parkinson's disease (PD) usually receive a definitive diagnosis after a prolonged period of time. At the time of diagnosis, they have already experienced limitations in activities of daily living and quality of life and are thus in need of immediate rehabilitation.

OBJECTIVE

To describe the existing knowledge on the rehabilitation of persons with PD suitable to a home environment and to describe the person-centeredness, interprofessionality and clinical effectiveness of existing rehabilitation activities.

SOURCES OF EVIDENCE

67 full-text papers from the EBSCO, CINAHL, Medline, Google and Google Scholar databases, published in English, Swedish or Finnish between January 2010 and October 2018, were charted (type of rehabilitation, sample, instrumentation, reported effects) and summarized.

RESULTS

Rehabilitation through physical activities still appears to be the most common form of rehabilitation, varying from walking to individually tailored exercise programs. The majority of physical rehabilitation activities were conducted outside the home even though they were suitable for a home setting. Physical activities not only improved several physical outcomes but also quality of life, well-being and activities of daily living functions, especially when digital devices were used. Cognitive and psychosocial rehabilitation were much less researched but seen to be an emerging area of research. The focus of rehabilitation seems to lie on persons with PD, not their near-ones. The majority of interventions were planned without discussing in advance with the persons with PD about their preferences, needs or values. Very few interventions were individually tailored or conducted in a home setting, and many studies included patient-recorded outcome measures, but only as secondary to clinical measures. Only a few studies focused on an interprofessional approach to PD rehabilitation, despite the approach being found effective in regard to quality of life for persons with PD.

CONCLUSIONS

There appears to be a focus on physical outcomes and symptom management in the rehabilitation of persons with PD, even though cognitive and psychosocial well-being are often explored as secondary outcomes. Very few rehabilitation interventions were planned with persons or conducted in a home setting, and no interventions were seen that included near-ones. The majority of interventions were planned without the involvement of persons with PD. Still, many of the studies included patient-recorded outcome measures. Digital devices that assist in physical rehabilitation and an interprofessional approach to rehabilitation yield positive clinical outcomes, which in turn promotes a person-centered and holistic approach to rehabilitation.

Body Weight Support Combined With Treadmill in the Rehabilitation of Parkinsonian Gait: A Review of Literature and New Data From a Controlled Study

Background: Gait disorders represent disabling symptoms in Parkinson's Disease (PD). The effectiveness of rehabilitation treatment with Body Weight Support Treadmill Training (BWSTT) has been demonstrated in patients with stroke and spinal cord injuries, but limited data is available in PD. Aims: The aim of the study is to investigate the efficacy of BWSTT in the rehabilitation of gait in PD patients. Methods: Thirty-six PD inpatients were enrolled and performed rehabilitation treatment for 4-weeks, with daily sessions. Subjects were randomly divided into two groups: both groups underwent daily 40-min sessions of traditional physiokinesitherapy followed by 20-min sessions of overground gait training (Control group) or BWSTT (BWSTT group). The efficacy of BWSTT was evaluated with clinical scales and Computerized Gait Analysis (CGA). Patients were tested at baseline (T0) and at the end of the 4-weeks rehabilitation period (T1). Results: Both BWSTT and Control groups experienced a significant improvement in clinical scales as FIM and UPDRS and in gait parameters for both interventions. Even if we failed to detect any statistically significant differences between groups in the different clinical and gait parameters, the intragroup analysis captured a specific pattern of qualitative improvement associated to cadence and stride duration for the BWSTT group and to the swing/stance ratio for the Control group. Four patients with chronic pain or anxious symptoms did not tolerate BWSTT. Conclusions: BWSTT and traditional rehabilitation treatment are both effective in improving clinical motor functions and kinematic gait parameters. BWSTT may represent an option in PD patients with specific symptoms that limit traditional overground gait training, e.g., severe postural instability, balance disorder, orthostatic hypotension. BWSTT is generally well-tolerated, though caution is needed in subjects with chronic pain or with anxious symptoms. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03815409.