Olalla Bello

Treadmill walking in Parkinson's disease patients: Adaptation and generalization effect

We examined the adaptation and generalization effect of one familiarization treadmill walking session on gait in patients with Parkinsons disease (PD) with different degrees of disease severity. Eight moderate PD patients (Hoehn and Yahr stage 2–2.5), eight advanced PD patients (Hoehn and Yahr 3), and eight matched control subjects participated in this study. Subjects first walked overground on a 10‐m walkway at a self‐selected speed (pretreadmill). They then performed a 20‐min treadmill training session, followed by three trials of overground walking (Post1, Post2, Post3). Cadence, step length, speed, and coefficient of variation of stride time (CV) were recorded. During the treadmill session the advanced PD patients significantly decreased their cadence (t = 3.9, P ≤ 0.01) and increased their step length (t = 4.27, P ≤ 0.01) compared with pretreadmill walking. After the treadmill, all subjects walked overground significantly faster (F = 16.51 P ≤ 0.001) and with a larger step length (F = 13.03 P ≤ 0.01) than pretreadmill walking. The present study shows a specific adaptation to walk over the treadmill for the advanced PD patients. Moreover, this confirms the potential therapeutic use of the treadmill for PD gait rehabilitation since a single familiarization session lead to an increase in the step length and thus to the improvement of the main gait impairment in PD.

The effects of treadmill or overground walking training program on gait in Parkinson's disease

BACKGROUND Gait impairment in Parkinsons disease (PD) patients is characterized by the inability to generate appropriate stride length. Treadmill training has been proposed as a therapeutic tool for PD patients. However, it remains unknown whether treadmill training effects are different from overground walking training. Thus, our goal was to explore the effects of two training programs, walking on a treadmill and walking overground, in PD patients. METHODS 22 PD patients were randomly assigned to a treadmill or overground training group. The training program consisted of 5 weeks (3 sessions/week). Before and after the program we evaluated gait kinematics during walking at preferred and maximal speed; Timed Up and Go (TUG); static posturography and knee extensors strength. Gait parameters were reevaluated in the treadmill training group one month after the cessation of the training. RESULTS Preferred speed walking improved in both groups after the training program. The treadmill training program, but not the overground, led to an improvement in the stride length at the preferred and maximal walking speed in the PD patients. In addition, the treadmill training group showed improvement of the TUG and static posturography tests. The improvement in gait parameters was maintained one month after the cessation of the treadmill training. CONCLUSIONS This study provides evidence of a specific therapeutic effect of treadmill training on Parkinsonian gait and balance. Walking on a treadmill may be used as an easy, effective and accessible way to improve the stride length and balance in PD patients.

Mechanisms involved in treadmill walking improvements in Parkinson's disease

Patients with Parkinsons disease (PD) improve gait after treadmill training and while they are walking over the treadmill. However, the mechanisms of these improvements have not been addressed. We designed a treadmill simulator without a belt that could move on a walkway in a constant speed, in order to explore the mechanism underlying treadmill walking improvements in PD. All subjects were tested in three different sessions (treadmill, simulator(assisted) and simulator(not assisted)). In each session, subjects first walked overground and then walked using the treadmill or simulator with the hands over the handrails (simulator(assisted)) or with the hands free (simulator(not assisted)). Step length, cadence, double support time, swing time, support time and the coefficient of variation (CV) of step time and double support time were recorded. Over the treadmill PD patients increased their step length and reduced significantly their cadence and CV of double support time in comparison with overground walking. In the simulator(assisted) condition PD patients reduced significantly the CV of double support time in comparison with overground walking. With the simulator(not assisted) both groups decreased their step length and increased their cadence and CV of double support time, compared with walking overground. These findings suggest that the step length improvement observed in PD patients, walking over a treadmill, is due to the proprioceptive information generated by the belt movement, since no improvement was reported when patients using a treadmill simulator.

How does the treadmill affect gait in Parkinson's disease?

Parkinsons disease (PD) is clinically characterized by symptoms of akinesia, rigidity, and resting tremor, which are related to a dopaminergic deficiency of the nigrostriatal pathway. Disorders of gait are common symptoms of PD that affect the quality of life in these patients. One of the main focuses of physical rehabilitation in PD is to improve the gait deficits in the patients. In the last decade, a small number of studies have investigated the use of the treadmill for the rehabilitation of gait in PD patients. Although, the results of these studies are promising, the mechanisms underlying the therapeutic effect of the treadmill in PD are still largely unknown. This paper reviews 10 years of investigation of treadmill training in PD, focusing on the possible mechanisms involved in the therapeutic effect of the treadmill. Understanding these mechanisms may improve the prescription and design of physical therapy programs for PD patients.

Spatiotemporal parameters of gait during treadmill and overground walking in Parkinson's disease

Despite the increasing number of studies that have examined the therapeutic effect of treadmill training programs in Parkinsons disease (PD), there has been little research to evaluate the modifications of gait induced by treadmill walking. We investigated spatiotemporal differences between treadmill and overground walking in patients with PD. PD patients significantly increased their step length and step height; and reduced their cadence, step width and step width variability on the treadmill in comparison with walking overground. PD patients are able to attenuate their short shuffling steps when walking on a treadmill.

The effects of auditory startle and nonstartle stimuli on step initiation in Parkinson's disease†‡§

Auditory external cues enhance step initiation in Parkinsons disease (PD) patients. We wanted to explore whether a startle reaction has a comparable effect on step initiation in PD.

Treadmill Training Improves Overground Walking Economy in Parkinson’s Disease: A Randomized, Controlled Pilot Study

Gait disturbances are one of the principal and most incapacitating symptoms of Parkinson’s disease (PD). In addition, walking economy is impaired in PD patients and could contribute to excess fatigue in this population. An important number of studies have shown that treadmill training can improve kinematic parameters in PD patients. However, the effects of treadmill and overground walking on the walking economy remain unknown. The goal of this study was to explore the walking economy changes in response to a treadmill and an overground training program, as well as the differences in the walking economy during treadmill and overground walking. Twenty-two mild PD patients were randomly assigned to a treadmill or overground training group. The training program consisted of 5 weeks (3 sessions/week). We evaluated the energy expenditure of overground walking, before and after each of the training programs. The energy expenditure of treadmill walking (before the program) was also evaluated. The treadmill, but not the overground training program, lead to an improvement in the walking economy (the rate of oxygen consumed per distance during overground walking at a preferred speed) in PD patients. In addition, walking on a treadmill required more energy expenditure compared with overground walking at the same speed. This study provides evidence that in mild PD patients, treadmill training is more beneficial compared with that of walking overground, leading to a greater improvement in the walking economy. This finding is of clinical importance for the therapeutic administration of exercise in PD.

The effects of startle and non-startle auditory stimuli on wrist flexion movement in Parkinson's disease

Startle stimuli lead to shorter reaction times in control subjects and Parkinsons disease (PD) patients. However, non-startle stimuli also enhance movement initiation in PD. We wanted to examine whether a startle-triggered movement would retain similar kinematic and EMG-related characteristics compared to one induced by a non-startle external cue in PD patients. In this study we investigated the electromyography pattern and the reaction time during a wrist flexion movement in response to three different stimuli: a visual imperative stimulus; visual stimulus simultaneous with a non-startle auditory stimulus and with a startle auditory stimulus. Ten PD patients and ten aged matched controls participated in this study. The reaction times were faster for startle and non-startle stimuli in comparison with the visual imperative stimulus, in both patients and control subjects. The startle cue induced a faster reaction than the non-startle cue. The electromyography pattern remained unchanged across the conditions. The results suggest that the startle reaction effect for upper limb movements are unimpaired in PD patients and has different characteristics than the effect of non-startle stimuli.

Effect of Treadmill Walking on Leg Muscle Activation in Parkinson's Disease

Treadmills are often used as rehabilitation devices to improve gait in Parkinsons disease (PD). Kinematic differences between treadmill and overground gait have been reported. However, electromyographic (EMG) patterns during treadmill and overground walking have not been systematically compared. The aim of this study was to assess the effects of treadmill gait on the magnitude of the EMG activity of the lower limb muscles in PD. We measured EMG activity of the tibialis anterior, gastrocnemius medialis, vastus lateralis, and biceps femoris of nine individuals with PD and nine healthy matched controls. Comparisons between walking overground with walking on a treadmill and with walking with a treadmill simulator were carried out. The treadmill simulator is a device that simulates treadmill conditions with the exception of the belt. Our results have shown that treadmill walking is associated with several EMG differences compared with overground walking. The key finding of the study is that coactivation of the thigh muscles was significantly decreased (37%; p = 0.008) in PD subjects when walking on the treadmill in comparison with overground walking. The changes observed in the coactivation level may be related to the belt movement, since no changes were reported during walking with the treadmill simulator. Understanding the differences between treadmill and overground gait as well as the mechanisms that result in improvement of gait disturbances may optimize rehabilitative protocols for patients with PD.