scholarly journals A Manipulation of Visual Feedback during Gait Training in Parkinson's Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Quincy J. Almeida ◽  
Haseel Bhatt
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Optic Flow ◽  
Visual Cues ◽  
Step Length ◽  
Gait Training ◽  
Control Group ◽  
Training Interventions ◽  
Visual Cueing ◽  
Walking Velocity

Visual cues are known to improve gait in Parkinson's disease (PD); however, the contribution of optic flow continues to be disputed. This study manipulated transverse line cues during two gait training interventions (6 weeks). PD subjects (N=42) were assigned to one of three groups: treadmill (TG), overground (OG), or control group (CG). Participants walked across lines placed on either treadmills or 16-meter carpets, respectively. The treadmill (TG) offered a reduced dynamic flow from the environment, while lines presented on the ground (OG) emphasized optic flow related to the participant's own displacement. Both interventions significantly improved (and maintained through retention period) step length, thus improving walking velocity. Only the OG improved in the TUG test, while only the TG showed hints of improving (and maintaining) motor symptoms. Since gait improvements were found in both training groups, we conclude that by reducing optic flow, gait benefits associated with visual cueing training can still be achieved.

scholarly journals Gait Training Methods and ChangesiIn Gait Parameters in Parkinson`s Disease (Literature Review)

2020 ◽  
Vol 2 (7) ◽  
Author(s):  
Aušra Stuopelytė ◽  
Rasa Šakalienė
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Step Length ◽  
Gait Training ◽  
Auditory Stimulation ◽  
Training Methods ◽  
Dual Tasking ◽  
Gait Parameters ◽  
Rhythmic Auditory Stimulation ◽  
Walking Velocity

Parkinson’s disease is a chronic progressive neurological disorder that can impact function to a variable degree. Changes in gait parameters are the most common signs of Parkinson’s disease. Patients with Parkinson’s disease walk with a reduced step length, step time, walking velocity and walking cadence, increased stride cycle time, coefficient of variation of the step amplitude and step time and increased risk to fall. So, various gait training methods are applied. The effect of rhythmic auditory stimulation on gait in Parkinson’s disease patients is analysed. We can use various kinds of music, metronome, scansion and clapping as a rhythmic auditory stimulation.One of gait training methods in Parkinson’s disease patients is treadmill training. There are attempts to combine treadmill training with transcranial magnetic stimulation and virtual reality. We can use Nordic walking method and because walking technique requires straight posture, trunk rotation, bigger step and heel stride. More often robot–assisted gait training is used in patients with Parkinson’s disease gait training. The effect of dual–tasking and walking with music methods for gait and balance training in patients with Parkinson’s disease is also analysed. This method requires participants to perform primary and secondary tasks at the same time. The secondary task can be cognitive or motor. Dual–tasking is widely analysed because opinions about applying this method are very controversial. Walking with music method is more often analysed in scientific literature. This method could not be compared to rhythmic auditory stimulation method because the latter requires precise walking to rhythm and walking with music method is oriented to emotional component (music is chosen according patients’ music taste). As these methods are applied, we can see an increase in chosen walking and maximal walking velocities, step length and time, distance covered, and decrease in the coefficient of variation of the step time and turning time.Keywords: Gait impairments, walking velocity, rhythmic auditory stimulation.

scholarly journals Kinematic variables of gait and quality of life in Parkinsonians after different treadmill trainings: a randomized control trial

Motricidade ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 29
Author(s):  
Maira Peloggia Cursino ◽  
Doralice Fernanda Raquel ◽  
Camilla Zamfolini Hallal ◽  
Flávia Roberta Faganello Navega
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Step Length ◽  
Gait Training ◽  
Control Group ◽  
Weight Support ◽  
Partial Body ◽  
And Control

The aim of this study was to analyse and compare the effects of gait training on a treadmill associated with partial body weight support (PBWS) or auditory stimulus (AS) and the kinematic variables of gait and quality of life (QOL) in patients with Parkinson's disease (PD). Twenty-one volunteers with PD participated and were divided into: group with PBWS (GPBWS) with AS (GAS), and control group (CG). Soil step length (SL), SL variability (SLV), step width (SW), SW variability (SWV), gait speed (GS), and QOL were evaluated by the Parkinson’s Disease Questionnaire-39 (PDQ-39). The training was performed for six weeks, with three weekly sessions of 30 minutes. The results showed homogeneity of groups (p> 0.05). There was an increase of SW in the GPBWS (p= 0.006) and GS in the GAS (p= 0.048) and decreased PDQ-39 in the CG (p= 0.005) and GAS (p= 0.006). For groups, regardless of evaluation, there were differences in SWV between the GPBWS and GAS (p= 0.030); for evaluations, independently of groups, there were differences in GS (p= 0.048) and PDQ-39 (p= 0.002). It was concluded that, among the studied conditions, there was a significant improvement for the groups: AS in GS and QOL, CG in QOL and GPBWS did not improve. Thus, considering the clinical effect, treadmill training, independently of the stimuli, is clinically advantageous for gait improvements and QOL. The aim of this study was to analyse and compare the effects of gait training on a treadmill associated with partial body weight support (PBWS) or auditory stimulus (AS) and the kinematic variables of gait and quality of life (QOL) in patients with Parkinson's disease (PD). Twenty-one volunteers with PD participated and were divided into: group with PBWS (GPBWS) with AS (GAS), and control group (CG). Soil step length (SL), SL variability (SLV), step width (SW), SW variability (SWV), gait speed (GS), and QOL were evaluated by the Parkinson’s Disease Questionnaire-39 (PDQ-39). The training was performed for six weeks, with three weekly sessions of 30 minutes. The results showed homogeneity of groups (p> 0.05). There was an increase of SW in the GPBWS (p= 0.006) and GS in the GAS (p= 0.048) and decreased PDQ-39 in the CG (p= 0.005) and GAS (p= 0.006). For groups, regardless of evaluation, there were differences in SWV between the GPBWS and GAS (p= 0.030); for evaluations, independently of groups, there were differences in GS (p= 0.048) and PDQ-39 (p= 0.002). It was concluded that, among the studied conditions, there was a significant improvement for the groups: AS in GS and QOL, CG in QOL and GPBWS did not improve. Thus, considering the clinical effect, treadmill training, independently of the stimuli, is clinically advantageous for gait improvements and QOL.

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 Opposite Effects of Visual Cueing During Writing-Like Movements of Different Amplitudes in Parkinson’s Disease

2015 ◽  
Vol 30 (5) ◽  
pp. 431-439 ◽  
Author(s):  
Evelien Nackaerts ◽  
Alice Nieuwboer ◽  
Sanne Broeder ◽  
Bouwien C. M. Smits-Engelsman ◽  
Stephan P. Swinnen ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Visual Cues ◽  
Fine Motor ◽  
Motor Tasks ◽  
Visual Cueing ◽  
Dependent Variables ◽  
Size Variability ◽  
The Difference ◽  
Accuracy Constraints

Background. Handwriting is often impaired in Parkinson’s disease (PD). Several studies have shown that writing in PD benefits from the use of cues. However, this was typically studied with writing and drawing sizes that are usually not used in daily life. Objective. This study examines the effect of visual cueing on a prewriting task at small amplitudes (≤1.0 cm) in PD patients and healthy controls to better understand the working action of cueing for writing. Methods. A total of 15 PD patients and 15 healthy, age-matched controls performed a prewriting task at 0.6 cm and 1.0 cm in the presence and absence of visual cues (target lines). Writing amplitude, variability of amplitude, and speed were chosen as dependent variables, measured using a newly developed touch-sensitive tablet. Results. Cueing led to immediate improvements in writing size, variability of writing size, and speed in both groups in the 1.0 cm condition. However, when writing at 0.6 cm with cues, a decrease in writing size was apparent in both groups ( P < .001) and the difference in variability of amplitude between cued and uncued writing disappeared. In addition, the writing speed of controls decreased when the cue was present. Conclusions. Visual target lines of 1.0 cm improved the writing of sequential loops in contrast to lines spaced at 0.6 cm. These results illustrate that, unlike for gait, visual cueing for fine-motor tasks requires a differentiated approach, taking into account the possible increases of accuracy constraints imposed by cueing.

scholarly journals Technology-Assisted Rehabilitation of Writing Skills in Parkinson’s Disease: Visual Cueing versus Intelligent Feedback

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Evelien Nackaerts ◽  
Alice Nieuwboer ◽  
Elisabetta Farella
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Visual Cues ◽  
Healthy Controls ◽  
Short Term ◽  
Future Studies ◽  
Visual Cueing ◽  
Sensory Modalities ◽  
Larger Sample

Recent research showed that visual cueing can have both beneficial and detrimental effects on handwriting of patients with Parkinson’s disease (PD) and healthy controls depending on the circumstances. Hence, using other sensory modalities to deliver cueing or feedback may be a valuable alternative. Therefore, the current study compared the effects of short-term training with either continuous visual cues or intermittent intelligent verbal feedback. Ten PD patients and nine healthy controls were randomly assigned to one of these training modes. To assess transfer of learning, writing performance was assessed in the absence of cueing and feedback on both trained and untrained writing sequences. The feedback pen and a touch-sensitive writing tablet were used for testing. Both training types resulted in improved writing amplitudes for the trained and untrained sequences. In conclusion, these results suggest that the feedback pen is a valuable tool to implement writing training in a tailor-made fashion for people with PD. Future studies should include larger sample sizes and different subgroups of PD for long-term training with the feedback pen.

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 Effects of dance on gait and dual-task gait in Parkinson’s disease

2019 ◽  
Author(s):  
Nadeesha Kalyani Hewa Haputhanthirige ◽  
Karen Sullivan ◽  
Gene Moyle ◽  
Sandy Brauer ◽  
Erica Rose Jeffrey ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Verbal Fluency ◽  
Large Scale ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Step Length ◽  
Gait Velocity ◽  
Control Group

Abstract Background Gait impairments in Parkinson’s disease (PD) limit independence and quality of life. While dance based interventions could improve gait, further studies are needed to determine if the benefits generalise to different terrains and when dual-tasking. The aim was to perform a feasibility study of the effects of a dance intervention, based on the Dance for PD®(DfPD®) program, on gait under different dual-tasks (verbal fluency, serial subtraction) and surfaces (even, uneven), and to determine if a larger scale follow-up RCT is warranted.Methods A dance group (DG; n = 17; age = 65.8 ± 11.7 years) and a control group (CG: n = 16; age = 67.0 ± 7.7 years) comprised of non-cognitively impaired (Addenbrooke’s score: DG = 93.2 ± 3.6, CG = 92.6 ± 4.3) independently locomoting people with PD (Hoehn & Yahr I-III) participated in the study. The DG undertook a one-hour DfPD®based class, twice weekly for 12 weeks. The CG had treatment as usual. Gait analysis was performed at baseline and post-intervention while walking on two surfaces (even, uneven) under three conditions (regular walking; dual-task: verbal-fluency, serial-subtraction). The data was analysed by means of a linear mixed model. ResultsThe DG improved significantly compared to the CG in gait velocity, cadence, step-length, and stride-length when even surface walking, with and without a dual-task. On the uneven surface the DG walked more cautiously during regular walking but had improved gait velocity, cadence and step-length when performing serial-subtractions. Conclusions DfPD®-based classes produced clinically significant improvement on spatiotemporal gait parameters under dual-task conditions and on uneven surfaces. This could arise from improved movement confidence and coordination; emotional expression; cognitive skills (planning, multitasking), and; utilisation of external movement cues. A large-scale RCT of this program is warranted.Trial registration A protocol for this study has been registered retrospectively at Australian New Zealand Clinical Trials Registry on 12.11.2018. Identifier: ACTRN12618001834246.

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 Long-Term Gait Training Using Visual Cues in an Individual With Parkinson Disease

2006 ◽  
Vol 86 (2) ◽  
pp. 186-194 ◽  
Author(s):  
Ben Sidaway ◽  
Jennifer Anderson ◽  
Garth Danielson ◽  
Lucas Martin ◽  
Garth Smith
Keyword(s):  
Motor Control ◽  
Parkinson Disease ◽  
Lower Limb ◽  
Gait Speed ◽  
Visual Cues ◽  
Step Length ◽  
Gait Training ◽  
Visual Cueing ◽  
Gait Phase

Background and Purpose. In an attempt to improve the gait of people with Parkinson disease (PD), researchers have examined the effect of visual cues placed on the floor. These studies typically have used a single session of training with such cues and have not examined the long-term carryover of such training. In the present study, therefore, gait was analyzed during uncued, cued, and retention phases, each lasting 1 month. Subject. A 78-year-old woman who had been diagnosed with PD 12 years previously (Hoehn and Yahr classification of disability, stage III) volunteered for the study. Methods. During the initial uncued gait phase, the subject was required to walk a distance of 10 m as many times as she could in 30 minutes, 3 times per week for 4 weeks. During the 4-week cued gait phase, visual cues were placed on the floor along the 10-m walkway. The cues were initially 110% of the uncued step length and were later increased to 120%. Following this cued gait phase, the subject’s gait was recorded periodically for 1 month without cues available. Step length, gait speed, and 2-dimensional lower-limb kinematics were compared within and across the 3 experimental phases. Celeration lines were calculated for the initial uncued phase and then extrapolated across the cued training and uncued retention phases. Binomial tests were used to analyze the significance of changes from the initial phase of the experiment. Results. Step length (0.53–0.56 m) and gait speed (0.77–0.82 m·s−1) were essentially unchanged during uncued gait training after the first day; however, during the cued gait phase, gait speed improved, from 0.87 m·s−1 to 1.13 m·s−1, as step length was increased with visual cues. Improvements in step length (0.68 m) and gait speed (1.08 m·s−1) were still evident 1 month following the removal of the cues. Analyses of angle-angle diagrams and phase-plane portraits revealed that training with visual cues increased hip and knee range of motion and engendered more stable motor control of the lower limb. Discussion and Conclusion. In contrast to previous studies in which the benefits of visual cueing were relatively short-lived, in this study, 1 month of gait training with visual cues was successful in establishing a lasting improvement in gait speed and step length while increasing the stability of the underlying motor control system. [Sidaway B, Anderson J, Danielson G, et al. Effects of long-term gait training using visual cues in an individual with Parkinson disease.

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