Mon S. Bryant

Gait variability in Parkinson’s disease: influence of walking speed and dopaminergic treatment

Abstract Objectives: To study the effects of levodopa and walking speed on gait variability in individuals with Parkinson’s disease (PD). Methods: Thirty-three individuals with PD were studied. Their mean age was 70·61±9·23 year. The average time since diagnosis was 9·65±5·80 year. Gait variability was studied while ‘OFF’ and ‘ON’ dopaminergic medication when the subjects walked at their usual and fastest speeds. Results: Variability of step time, double support time, stride length and stride velocity decreased significantly (P=0·037; P=0·037; P=0·022; P=0·043, respectively) after dopaminergic treatment. When subjects increased walking speed, the variability of stride length and stride velocity decreased significantly (P=0·038 and P=0·004, respectively) both while ‘OFF’ and ‘ON’ levodopa. Increasing walking speed did not change the variability of step time and double support time regardless of medication status. Conclusions: Levodopa decreased gait variability in persons with PD. Stride length and stride velocity variability appeared to be speed dependent parameters, whereas, the variability of step time and double support time appeared to be speed independent measures. Levodopa had positive effects on gait stability in PD.

Gait changes with walking devices in persons with Parkinson's disease.

Purpose: To study immediate gait changes in persons with PD when walking with different assistive walking devices. Methods: Ten individuals with idiopathic PD participated in the study. Gait parameters were recorded while walking with a cane and a wheeled walker, and were compared to a free walk without a walking device. Results: Persons with PD walked with slower gait speed when using a cane and a wheeled walker compared to walking without any device (p = 0.007, p = 0.002, respectively). Stride length reduced significantly when walking with a wheeled walker (p = 0.001). Walking with the assistive devices did not affect cadence, double support phase, heel to heel base of support, stride time, and stance period. Conclusion: Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker. The results may lead to more cautious clinical practice in gait rehabilitation using ambulatory assisted devices. Implications for Rehabilitation Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker. Clinicians should be cognizant of these modifications during gait rehabilitation using ambulatory assisted devices.

Relationship of Falls and Fear of Falling to Activity Limitations and Physical Inactivity in Parkinson’s Disease

AIM To investigate the relationships between falls, fear of falling, and activity limitations in individuals with Parkinsons disease (PD). DESIGN/METHODS Cross-sectional study of individuals with mild to moderate PD (N = 83). Associations among demographic data, fall frequency, disease severity, motor impairment, ability to perform activities of daily living (ADL), Activities Balance Confidence Scale, Iowa Fatigue Scale, Comorbidity Index, and Physical Activity Scale for Elders were studied. RESULTS Frequent fallers had more ADL limitations than nonfallers (p < .001) and rare fallers (p = .004). Frequent fallers reported a lower percentage of ability to perform ADL than nonfallers (p = .003). Frequent fallers and rare fallers were less physically active than nonfallers (p = .015 and p = .040, respectively). Frequent fallers and rare fallers reported a higher level of fear of falling than nonfallers (p = .031 and p = .009, respectively). CONCLUSIONS Falls and fear of falling were associated with more ADL limitations and less physical activity after adjusting for physical impairments.

Influence of fear of falling on gait and balance in Parkinson’s disease

Abstract Purpose: To study the relationship of fear of falling (FoF) with gait characteristics and balance in individuals with Parkinsons disease (PD). Method: Seventy-nine non-demented individuals (62 males) with PD were studied. Their mean age was 69.22 ± 8.93 years. The average time since diagnosis was 8.27 ± 5.31 years. FoF was assessed by the Activities-specific Balance Confidence (ABC) Scale in which high scores indicate less FoF. Gait was measured using a computerized walkway. Balance was measured by timed tests including the 5-step test, 360 degree turn, timed sideways walk, and timed up and go test. Participants were divided into two groups based on their ABC score (high FoF, ABC score <69; low FoF, ABC score ≥69). Gait characteristics and balance measures of the two groups were compared. Results: Gait speed and stride length for forward walking (p < 0.0005 for both) and backward walking (p = 0.001 and 0.002, respectively) were lower for those with a high level of FoF compared to those with a low level of FoF. The time to take five steps (p = 0.025), time to turn (p < 0.0005), time to walk sideways (p = 0.001), and time to complete the up and go test (p = 0.003) were longer in those with a high level of FoF than in those with a low level of FoF. Number of steps to complete the turn (p = 0.001) and steps to walk sideways (p = 0.002) were greater in those with a high level of FoF than in those with a low level FoF. Conclusions: Gait and balance of individuals with PD with a high level of FoF were poorer than those with a low level of FoF, regardless of previous fall history. Implications for Rehabilitation The results demonstrates that fear of falling (FoF) is related to gait and balance in individuals with PD. Clinicians should be aware that FoF has a negative impact on gait and balance in individuals with PD.

An evaluation of self-administration of auditory cueing to improve gait in people with Parkinson’s disease

Objective: To evaluate a self-administration of auditory cueing on gait difficulties in people with Parkinson’s disease over a one-week period. Design: Single group pre and post test. Setting: Research lab, community. Participants: Twenty-one individuals with Parkinson’s disease. Interventions: Self-application of an auditory pacer set at a rate 25% faster than preferred cadence. Main outcome measures: Self-selected gait speed, cadence, stride length, and double support time with and without the pacer at the initial visit and after one week of pacer use. Results: During the initial visit, the auditory pacer improved gait speed (79.57 (18.13) cm/s vs. 94.02 (22.61) cm/s, P<0.0005), cadence (102.88 (11.34) step/min vs. 109.22 (10.23) steps/min, P=0.036) and stride length (94.33 (21.31) cm vs. 103.5 (22.65) cm, P =0.012). After one week, preferred gait speed was faster than the initial preferred speed (79.57 (18.13) vs. 95.20 (22.23) cm/s, P<0.0005). Stride length was significantly increased (94.33 (21.31) vs. 107.67 (20.01) cm, P =0.001). Double support time was decreased from 21.73 (5.23) to 18.94 (3.59)% gait cycle, P =0.016. Conclusion: Gait performance in people with Parkinson’s disease improved significantly after walking with the auditory pacer for one week.

Feasibility of Using Cranial Electrotherapy Stimulation for Pain in Persons with Parkinson's Disease

Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinsons disease (PD) with cranial electrotherapy stimulation (CES). Design. Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants. Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention. Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure. Average daily change in pain intensity. Results. Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon Z = −2.20, P = .028). Conclusion. Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided.

Evaluation of a new device to prevent falls in persons with Parkinson's disease.

Purpose. To compare walking characteristics of individuals with Parkinsons disease (PD) using a new walking aid, the WalkAbout, with usual walking. Method. Fifteen subjects with PD were recruited. Subjects walked in their usual fashion and then walked again in the WalkAbout. Gait parameters, 5-min walk, and oxygen consumption were recorded. Results. Stride lengths were shorter when using the WalkAbout. On an average, the distance walked in 5 min and the oxygen uptake was not different when walking with the WalkAbout compared with the usual walk. Eight subjects (responders) walked further with the WalkAbout compared to their usual walk (164.90 ± 55.72 m vs. 140.82 ± 55.94 m). Seven subjects (non-responders) walked a shorter distance while using the WalkAbout compared to their usual walk (241.79 ± 73.06 m vs. 281.24 ± 82.83 m). Compared to non-responders, responders were older, had more severe disability, and were more likely to use an assistive device for walking. Responders walked more slowly, had a shorter stride length, and walked shorter distances in 5 min than non-responders. Conclusion. The WalkAbout may help persons with PD who have more severe disability to walk farther. These data could be beneficial in selecting a helpful walking aid for persons with PD.

Gait Variability in Parkinson's disease: Levodopa and Walking Direction

Levodopa treatment has been shown to improve gait spatio‐temporal characteristics in both forward and backward walking. However, effect of levodopa on gait variability during backward walking compared with forward walking has not been reported.

A pilot study: influence of visual cue color on freezing of gait in persons with Parkinson's disease

Purpose. To investigate the effect of red and green light beams on gait and freezing of gait (FOG) in persons with Parkinsons disease (PD). Methods. Seven persons with PD who experienced FOG participated in the study. Gait and turning performances were studied while walking with canes with red, green, and no light beams while ‘off’ and ‘on’ anti-Parkinsonian medications. Gait speed, cadence, and stride were recorded. Time and number of freezing episodes were recorded during a 50-foot walk and a 360° turn. Results. During ‘off’ medication, compared to no light, stride length improved when using the green light, but not the red. During the 50-foot walk, freezing episodes were reduced when using the green light compared to both the red and no light. During the 360° turn, time, number of steps and number of freezing episodes were reduced using the green light compared to the red and no light. During ‘on’ medication, gait speed and stride length improved more with the green light compared to the red. Neither color showed any effect on cadence during either medication state. Conclusion. A green light improved gait and alleviate FOG in persons with PD better than a red light or no light.

Acute and Long-Term Effects of Multidirectional Treadmill Training on Gait and Balance in Parkinson Disease

Treadmill training has been shown to be a promising rehabilitation strategy for improving gait and balance in persons with Parkinson disease (PD). Most studies have involved only forward walking as an intervention. The effects of multidirectional treadmill (forward, backward, and left and right sideways) on gait and balance have not been reported.