The Cost of Gait Slowness: Can Persons with Parkinson’s Disease Save Energy by Walking Faster?

2021 ◽  
Vol 11 (4) ◽  
pp. 2073-2084
Author(s):  
Purnima Padmanabhan ◽  
Keerthana Sreekanth Rao ◽  
Anthony J. Gonzalez ◽  
Alexander Y. Pantelyat ◽  
Vikram S. Chib ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Energy Cost ◽  
Walking Speed ◽  
Patient Specific ◽  
Dopaminergic Medication ◽  
Gait Parameters ◽  
Save Energy ◽  
Walking Speeds ◽  
The Cost

Background: Gait slowing is a common feature of Parkinson’s disease (PD). Many therapies aim to improve gait speed in persons with PD, but goals are often imprecise. How fast should each patient walk? And how do persons with PD benefit from walking faster? There is an important need to understand how walking speed affects fundamental aspects of gait—including energy cost and stability—that could guide individualized therapy decisions in persons with PD. Objective: We investigated how changes in walking speed affected energy cost and spatiotemporal gait parameters in persons with PD. We compared these effects between dopaminergic medication states and to those observed in age-matched control participants. Methods: Twelve persons with PD and twelve control participants performed treadmill walking trials spanning at least five different speeds (seven speeds were desired, but not all participants could walk at the fastest speeds). Persons with PD participated in two walking sessions on separate days (once while optimally medicated, once after 12-hour withdrawal from dopaminergic medication). We measured kinematic and metabolic data across all trials. Results: Persons with PD significantly reduced energy cost by walking faster than their preferred speeds. This held true across medication conditions and was not observed in control participants. The patient-specific walking speeds that reduced energy cost did not significantly affect gait variability metrics (used as proxies for gait stability). Conclusion: The gait slowing that occurs with PD results in energetically suboptimal walking. Rehabilitation strategies that target patient-specific increases in walking speed could result in a less effortful gait.

scholarly journals Effects of Nordic Walking on Gait Symmetry in Mild Parkinson’s Disease

Symmetry ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 1481
Author(s):  
Ana Paula J. Zanardi ◽  
Flávia G. Martinez ◽  
Edson S. da Silva ◽  
Marcela Z. Casal ◽  
Valéria F. Martins ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Generalized Estimating Equations ◽  
Aerobic Training ◽  
Nordic Walking ◽  
Post Intervention ◽  
Gait Symmetry ◽  
Gait Parameters ◽  
Walking Speeds ◽  
Post Hoc

Individuals with Parkinson’s disease (PD) have gait asymmetries, and exercise therapy may reduce the differences between more and less affected limbs. The Nordic walking (NW) training may contribute to reducing the asymmetry in upper and lower limb movements in people with PD. We compared the effects of 11 weeks of NW aerobic training on asymmetrical variables of gait in subjects with mild PD. Fourteen subjects with idiopathic PD, age: 66.8 ± 9.6 years, and Hoehn and Yard stage of 1.5 points were enrolled. The kinematic analysis was performed pre and post-intervention. Data were collected at two randomized walking speeds (0.28 m·s−1 and 0.83 m·s−1) during five minutes on the treadmill without poles. The more affected and less affected body side symmetries (threshold at 5% between sides) of angular kinematics and spatiotemporal gait parameters were calculated. We used Generalized Estimating Equations with Bonferroni post hoc (α = 0.05). Maximal flexion of the knee (p = 0.007) and maximal abduction of the hip (p = 0.041) were asymmetrical pre and became symmetrical post NW intervention. The differences occurred in the knee was less affected and the hip was more affected. We concluded that 11 weeks of NW training promoted similarities in gait parameters and improved knee and hip angular parameters for PD subjects.

Periventricular White Matter Lesions Influence Gait Functions in Parkinson’s Disease

2019 ◽  
Vol 81 (3-4) ◽  
pp. 120-127 ◽  
Author(s):  
Kunio Toda ◽  
Mutsumi Iijima ◽  
Kazuo Kitagawa
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
White Matter ◽  
Frontal Lobe ◽  
Stride Length ◽  
Walking Speed ◽  
White Matter Lesions ◽  
Periventricular White Matter ◽  
Gait Parameters ◽  
Calculation Task

Objective: We quantitatively evaluated the gait of Parkinson’s disease (PD) patients over a 10-m course during normal walking and during dual-task walking while performing a calculation task, and clarified which parts of white matter lesions (WML) influence gait in PD patients. Methods: Gait parameters, including walking speed, gait cycle, stride length, and left-right instability, were measured in 64 PD patients and 20 controls who walked 10 m with normal gait and as they were performing a calculation task. WML on magnetic resonance imaging (MRI) of PD patients were scored according to Scheltens’ criteria, and associations with gait parameters were investigated. Results: Compared to controls, the PD group showed decreased walking speed and narrowed stride (p < 0.05), and the stride length and step time coefficient of variation changed significantly during the calculation task (p < 0.001). Frontal lobe functions correlated positively with walking speed and stride during the calculation task in patients with PD (p < 0.05). The total score for periventricular hyperintensity (PVH) on MRI correlated with walking speed and stride (p < 0.01). Multiple regression analysis revealed significant correlations between walking speed and frontal cap of PVH, and between stride and occipital cap (p < 0.05). Conclusion: Gait of PD patients deteriorated not only due to motor dysfunction but also due to mental burden in association with frontal lobe function and periventricular lesions of cerebral white matter.

scholarly journals Relationship between Gait Parameters and Postural Stability in Early and Late Parkinson's Disease and Visual Feedback-Based Balance Training Effects

2017 ◽  
Vol 5 (2) ◽  
pp. 207-214 ◽  
Author(s):  
Mohieldin M. Ahmed ◽  
Douaa M. Mosalem ◽  
Aziz K. Alfeeli ◽  
Ayyoub B. Baqer ◽  
Doaa Youssry Soliman
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Analysis ◽  
Postural Stability ◽  
Walking Speed ◽  
Balance Training ◽  
Assessment Tools ◽  
Dynamic Posturography ◽  
Gait Parameters ◽  
Group B

BACKGROUND: Gait disorders or postural instability has been done before. However, lack of reviews has addressed the relation between gait and postural stability in Parkinson's disease (PD).AIM: The aim was to evaluate the relation between gait parameters and postural stability in early and late stages of PD.MATERIALS AND METHODS: The forty-one idiopathic PD patients were divided into two groups into a group (A) considered as early PD and group (B) considered as late ambulant PD. They were evaluated for postural stability by computerised dynamic posturography (CDP) device and gait analysis using an 8 m-camera Vicon 612 data capturing system set.RESULTS: There was a statistically significant improvement of composite equilibrium score, the composite latency of motor response, walking speed and cadence after treatment as compared to before training (p < 0.05) in early PD. However, in the late PD, there was a non-significant change of previous parameters after treatment as compared to before training (p > 0.05).There was a significant correlation between UPDRS motor part score, walking speed and composite equilibrium score after training in early PD (p > 0.05).CONCLUSIONS: Both gait analysis and CDP are important quantitative assessment tools of gait and posture instability.

scholarly journals The Effects of Metronome Frequency Differentially Affects Gait on a Treadmill and Overground in People with Parkinson’s Disease

2019 ◽  
Author(s):  
Madelon Wygand ◽  
Guneet Chawla ◽  
Nina Browner ◽  
Michael D Lewek
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Repeated Measures ◽  
Step Length ◽  
Yahr Stage ◽  
Gait Parameters ◽  
Walking Environment ◽  
Stage 1 ◽  
Walking Speeds

AbstractObjectiveTo determine the effect of different metronome cue frequencies on spatiotemporal gait parameters when walking overground compared to walking on a treadmill in people with Parkinson’s diseaseDesignRepeated-measures, within-subject designSettingResearch laboratoryParticipantsTwenty-one people with Parkinson’s disease (Hoehn & Yahr stage 1-3)InterventionsParticipants walked overground and on a treadmill with and without metronome cues of 85%, 100%, and 115% of their baseline cadence for one minute each.Main Outcome MeasuresGait speed, step length, and cadenceResultsAn interaction effect between cue frequency and walking environment revealed that participants took longer steps during the 85% condition on the treadmill only. When walking overground, metronome cues of 85% and 115% of baseline cadence yielded decreases and increases, respectively, in both cadence and gait speed with no concomitant change in step length.ConclusionsThese data suggest that people with PD are able to alter spatiotemporal gait parameters immediately when provided the appropriate metronome cue and walking environment. We propose to target shortened step lengths by stepping to the beat of slow frequency auditory cues while walking on a treadmill, whereas the use of fast frequency cues during overground walking can facilitate faster walking speeds.

scholarly journals Gait parameters of Parkinson’s disease compared with healthy controls: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ana Paula Janner Zanardi ◽  
Edson Soares da Silva ◽  
Rochelle Rocha Costa ◽  
Elren Passos-Monteiro ◽  
Ivan Oliveira dos Santos ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Stride Length ◽  
Walking Speed ◽  
Meta Analysis ◽  
The Self ◽  
Double Support ◽  
Swing Time ◽  
Gait Parameters ◽  
Healthy Control

AbstractWe systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s−1) and on overground (.17 m s−1) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).

scholarly journals Quantifying Spatiotemporal Gait Parameters with HoloLens in Healthy Adults and People with Parkinson’s Disease: Test-Retest Reliability, Concurrent Validity, and Face Validity

Sensors ◽  
2020 ◽  
Vol 20 (11) ◽  
pp. 3216
Author(s):  
Daphne J. Geerse ◽  
Bert Coolen ◽  
Melvyn Roerdink
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Concurrent Validity ◽  
Walking Speed ◽  
Step Length ◽  
Face Validity ◽  
Retest Reliability ◽  
Gait Parameters ◽  
Position Data ◽  
Test Retest Reliability

Microsoft’s HoloLens, a mixed-reality headset, provides, besides holograms, rich position data of the head, which can be used to quantify what the wearer is doing (e.g., walking) and to parameterize such acts (e.g., speed). The aim of the current study is to determine test-retest reliability, concurrent validity, and face validity of HoloLens 1 for quantifying spatiotemporal gait parameters. This was done in a group of 23 healthy young adults (mean age 21 years) walking at slow, comfortable, and fast speeds, as well as in a group of 24 people with Parkinson’s disease (mean age 67 years) walking at comfortable speed. Walking was concurrently measured with HoloLens 1 and a previously validated markerless reference motion-registration system. We comprehensively evaluated HoloLens 1 for parameterizing walking (i.e., walking speed, step length and cadence) in terms of test-retest reliability (i.e., consistency over repetitions) and concurrent validity (i.e., between-systems agreement), using the intraclass correlation coefficient (ICC) and Bland–Altman’s bias and limits of agreement. Test-retest reliability and between-systems agreement were excellent for walking speed (ICC ≥ 0.861), step length (ICC ≥ 0.884), and cadence (ICC ≥ 0.765), with narrower between-systems than over-repetitions limits of agreement. Face validity was demonstrated with significantly different walking speeds, step lengths and cadences over walking-speed conditions. To conclude, walking speed, step length, and cadence can be reliably and validly quantified from the position data of the wearable HoloLens 1 measurement system, not only for a broad range of speeds in healthy young adults, but also for self-selected comfortable speed in people with Parkinson’s disease.

scholarly journals Agreement between the GAITRite® System and the Wearable Sensor BTS G-Walk® for measurement of gait parameters in healthy adults and Parkinson’s disease patients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8835 ◽  
Author(s):  
Slávka Vítečková ◽  
Hana Horáková ◽  
Kamila Poláková ◽  
Radim Krupička ◽  
Evžen Růžička ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Systematic Error ◽  
Stride Length ◽  
Walking Speed ◽  
Inertial Sensor ◽  
Pressure Sensors ◽  
Double Support ◽  
Gait Parameters ◽  
Stride Duration

Background Nowadays, the most widely used types of wearable sensors in gait analysis are inertial sensors. The aim of the study was to assess the agreement between two different systems for measuring gait parameters (inertial sensor vs. electronic walkway) on healthy control subjects (HC) and patients with Parkinson’s disease (PD). Methods Forty healthy volunteers (26 men, 14 women, mean age 58.7 ± 7.7 years) participated in the study and 24 PD patients (19 men, five women, mean age 62.7 ± 9.8 years). Each participant walked across an electronic walkway, GAITRite, with embedded pressure sensors at their preferred walking speed. Concurrently a G-Walk sensor was attached with a semi-elastic belt to the L5 spinal segment of the subject. Walking speed, cadence, stride duration, stride length, stance, swing, single support and double support phase values were compared between both systems. Results The Passing-Bablock regression slope line manifested the values closest to 1.00 for cadence and stride duration (0.99 ≤ 1.00) in both groups. The slope of other parameters varied between 0.26 (double support duration in PD) and 1.74 (duration of single support for HC). The mean square error confirmed the best fit of the regression line for speed, stride duration and stride length. The y-intercepts showed higher systematic error in PD than HC for speed, stance, swing, and single support phases. Conclusions The final results of this study indicate that the G-Walk system can be used for evaluating the gait characteristics of the healthy subjects as well as the PD patients. However, the duration of the gait cycle phases should be used with caution due to the presence of a systematic error.

scholarly journals How deep brain stimulation and levodopa affect gait variability in Parkinson’s disease

2020 ◽  
Author(s):  
Zi Su ◽  
Salil Patel ◽  
Bronwyn Gavin ◽  
Tim Buchanan ◽  
Marko Bogdanovic ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Lower Limb ◽  
Lower Limbs ◽  
Dopaminergic Medication ◽  
Gait Parameters ◽  
Stn Dbs ◽  
Deep Brain

AbstractBackgroundDisorders of gait are a very common feature of Parkinson’s Disease. We examined how deep brain stimulation of the subthalamic nucleus (STN DBS) and dopaminergic medication affect gait and more specifically its rhythmicity.ObjectivesWe accurately quantified multiple gait parameters in Parkinson’s patients during on and off stages of their treatment (levodopa or STN DBS) to compare and contrast the treatment-induced changes in gait.MethodsWe studied 11 patients with STN DBS, 15 patients on levodopa and 42 healthy controls. They all completed the MDS-UPDRS part III along with a gait assessment protocol while wearing six nine-axis inertial measurement units (lumbar, sternal, and all four extremities).ResultsBoth medication and stimulation significantly improved stride length, while medication further significantly increased gait speed. In the lower limbs, both medication and stimulation had a normalising effect on lower limb angles, significantly increasing the foot strike angle and toe-off angle.ConclusionsSTN DBS reduced the step to step variability in a range of lower limb gait parameters in PD, while antiparkinsonian medication had no significant effect. This suggests that STN stimulation, but not dopaminergic medication, has access to circuits that control gait rhythm, and that the resulting effect of stimulation on gait is beneficial. However, the results we observed for movement of the trunk and upper limbs were strikingly different to those seen in the lower limbs. We propose a hypothesis to explain why we observe these results, focusing on cholinergic pedunculopontine projections.

scholarly journals Implications of dopaminergic medication withdrawal in Parkinson’s disease

2021 ◽  
Author(s):  
J. Koschel ◽  
K. Ray Chaudhuri ◽  
L. Tönges ◽  
M. Thiel ◽  
V. Raeder ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dopaminergic Medication ◽  
Medication Withdrawal

scholarly journals Bringing Advanced Therapies for Parkinson’s Disease to the Clinic: The Scientist’s Perspective

2021 ◽  
pp. 1-6
Author(s):  
Mark Tomishima ◽  
Agnete Kirkeby
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Trials ◽  
Phase I Clinical Trials ◽  
Preclinical Models ◽  
Preclinical Development ◽  
Dopaminergic Medication ◽  
Gene Therapies ◽  
Advanced Therapies ◽  
New Phase

After many years of preclinical development, cell and gene therapies have advanced from research tools in the lab to clinical-grade products for patients, and today they constitute more than a quarter of all new Phase I clinical trials for Parkinson’s disease. Whereas efficacy has been convincingly proven for many of these products in preclinical models, the field is now entering a new phase where the functionality and safety of these products will need to stand the test in clinical trials. If successful, these new products can have the potential to provide patients with a one-time administered treatment which may alleviate them from daily symptomatic dopaminergic medication.

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