Spatiotemporal Gait Patterns During Overt and Covert Evaluation in Patients With Parkinson´s Disease and Healthy Subjects: Is There a Hawthorne Effect? (original) (raw)
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Physiotherapy Research International, 2013
Background. Gait initiation is a major motor problem for patients with Parkinson's disease (PD). To understand the gait initiation in patients with PD, fluctuation on the first three steps of initiation was examined Methods. Force distribution measurement platform was used to record gait initiation in 10 patients with PD and healthy participants. Step length, step time and step width, as well as its coefficient of variation (CV) were investigated Results. The findings demonstrated significant main effect of group on step length (p < 0.001), step time (p = 0.034) and step width (p = 0.002), significant main effect of step on step time (p < 0.001) and step width (p < 0.001). No interaction between group and step (p > 0.05) was found on the variables. Compared with healthy participants, patients with PD showed significantly shorter step length in the first (p < 0.001), second (p = 0.001) and third (p = 0.001) steps and longer step time in the second step (p < 0.001). No difference in CV (p > 0.05) of the variables between groups comparison. Both groups had significant longer step time in the first step compared with the second step (PD, p < 0.001; healthy participants, p < 0.001) and the third steps (PD, p < 0.001; healthy participants, p < 0.001). They demonstrated significant wider step width in the first step when compared with the second step (PD, p = 0.043; healthy participants, p < 0.001) and the third steps (PD, p = 0.002; healthy participants, p < 0.001). Conclusion. Patients with PD showed shorter step length of all steps, longer step time in the second step and similar step width when compared with healthy participants. Among the three steps, both groups demonstrated longer step time and wider step width in the first step when compared with other two step.
Gait & Posture, 2013
Background: Despite the widespread use of gait variability in research and clinical studies, testing protocols designed to optimise its reliability have not been established. This study evaluates the impact of testing protocol and pathology on the reliability of gait variability. Objective: To (i) estimate the reliability of gait variability during continuous and intermittent walking protocols in older adults and people with Parkinson's disease (PD), (ii) determine optimal number of steps for acceptable levels of reliability of gait variability and (iii) provide sample size estimates for use in clinical trials. Methods: Gait variability was measured twice, one week apart, in 27 older adults and 25 PD participants. Participants walked at their preferred pace during: (i) a continuous 2 min walk and (ii) 3 intermittent walks over a 12 m walkway. Gait variability was calculated as the within-person standard deviation for step velocity, length and width, and step, stance and swing duration. Results: Reliability of gait variability ranged from poor to excellent (intra class correlations .041-.860; relative limits of agreement 34-89%). Gait variability was more reliable during continuous walks. Control and PD participants demonstrated similar reliability. Increasing the number of steps improved reliability, with most improvement seen across the first 30 steps. Conclusions: In this study, we identified testing protocols that improve the reliability of measuring gait variability. We recommend using a continuous walking protocol and to collect no fewer than 30 steps. Early PD does not appear to impact negatively on the reliability of gait variability. ß
Biosensors, 2019
This study investigated the difference in the gait of patients with Parkinson’s disease (PD), age-matched controls and young controls during three walking patterns. Experiments were conducted with 24 PD, 24 age-matched controls and 24 young controls, and four gait intervals were measured using inertial measurement units (IMU). Group differences between the mean and variance of the gait parameters (stride interval, stance interval, swing interval and double support interval) for the three groups were calculated and statistical significance was tested. The results showed that the variance in each of the four gait parameters of PD patients was significantly higher compared with the controls, irrespective of the three walking patterns. This study showed that the variance of any of the gait interval parameters obtained using IMU during any of the walking patterns could be used to differentiate between the gait of PD and control people.
Neurology International
This study aimed to investigate possible differences in spatio-temporal gait parameters of people with Parkinson’s Disease (pwPD) when they are tested either in laboratory using 3D Gait Analysis or in a clinical setting using wearable accelerometers. The main spatio-temporal gait parameters (speed, cadence, stride length, stance, swing and double support duration) of 31 pwPD were acquired: i) using a wearable accelerometer in a clinical setting while wearing shoes (ISS); ii) same as condition 1, but barefoot (ISB); iii) using an optoelectronic system (OES) undressed and barefoot. While no significant differences were found for cadence, stance, swing and double support duration, the experimental setting affected speed and stride length that decreased (by 17% and 12% respectively, P<0.005) when passing from the clinical (ISS) to the laboratory (OES) setting. These results suggest that gait assessment should be always performed in the same conditions to avoid errors, which may lead ...
Temporal stability of gait in Parkinson's disease
Physical Therapy
BACKGROUND AND PURPOSE. Evaluation of physical therapy for gait disorders in patients with Parkinson's disease (PD) requires an under-standing of how the patients' medication cycle affects function. Four experiments were conducted to investigate stability of gait variables. METHODS AND RESULTS. In experiment 1, 15 subjects with idiopathic PD and 15 subjects without PD performed two sets of gait trials spaced 30 minutes apart, with the initial trial conducted with the subjects at a peak dose of medication. Strong correlations, as determined by intraclass correlation coefficients (ICC[2,1]), occurred between repeat measures of speed (ICC = .92), cadence (ICC = .92), stride length (ICC = .94), and time spent in double support (DS) (ICC = .93). In experiment 2, 16 subjects with PD were tested at the same time on two consecutive days. There was good repeatability for speed (ICC = .88), cadence (ICC = .85), stride length (ICC = .84), and DS (ICC = .80). When we assessed the repeat...
Journal of neuroengineering and rehabilitation, 2005
The ability to maintain a steady gait rhythm is impaired in patients with Parkinson's disease (PD). This aspect of locomotor dyscontrol, which likely reflects impaired automaticity in PD, can be quantified by measuring the stride-to-stride variability of gait timing. Previous work has shown an increase in both the variability of the stride time and swing time in PD, but the origins of these changes are not fully understood. Patients with PD also generally walk with a reduced gait speed, a potential confounder of the observed changes in variability. The purpose of the present study was to examine the relationship between walking speed and gait variability. Stride time variability and swing time variability were measured in 36 patients with PD (Hoehn and Yahr stage 2-2.5) and 30 healthy controls who walked on a treadmill at four different speeds: 1) Comfortable walking speed (CWS), 2) 80% of CWS 3) 90% of CWS, and 4) 110% of CWS. In addition, we studied the effects of walking slow...
Scientific Reports
We 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 treadm...
Reliability of the Non-Instrumented Walk Test in Persons with Parkinson’s disease
Disability and Rehabilitation, 2012
Purpose-To study the reliability of a Non-Instrumented Walk Test in individuals with Parkinson's disease (PD). Method-Thirty individuals (21 Males) with PD were studied. Their mean age was 68.90 ± 9.28 years. The average time since diagnosis was 8.75 ± 5.68 years. The reliability of the manual Non-Instrumented Walk Test was studied while "OFF" and "ON" dopaminergic medication. Subjects walked at their self-selected, usual speed during a Non-Instrumented Walk Test and while walking on a computerized instrumented walkway. Intraclass correlation coefficients (ICCs) were calculated and means were compared for three gait parameters as measured by the two methods. Results-During "OFF" medication testing, ICCs between the Non-Instrumented Walk Test and the instrumented measures for gait speed, cadence and stride length were 0.96 (p < 0.0005), 0.72 (p = 0.001) and 0.97 (p < 0.0005), respectively. During "ON" medication testing, the ICCs were 0.96 (p < 0.0005), 0.86 (p < 0.0005) and 0.96 (p < 0.0005), respectively. The means of the noninstrumented measures tended to be lower than those obtained on the instrumented walkway. Conclusions-The Non-Instrumented Walk Test is a quick, simple and inexpensive gait evaluation for individuals with PD. The method is sufficiently reliable to be used clinically in this population during different medication cycles.
Fisioterapia em Movimento, 2017
Introduction: Gait impairments are one of the earliest signs reported by patients with Parkinson's disease (PD) and cause an increased number of falls and decreased quality of life among these patients. Objective: To compare the effectiveness of three physical therapy interventions using Rhythmic Cues (RC), Swiss Ball (SB) and Dual Task (DT), with an emphasis on gait treatment (step and stride length, duration and velocity), in individuals with PD. Methods: Quasi-randomized clinical trial addressing a sample composed of 45 individuals assigned to three groups. The individuals were assessed before and after the intervention protocol using the following: Modified Hoehn and Yahr Scale (HY), Unified Parkinson's Disease Rating Scale (UPDRS), Footprint analysis, Video Gait analysis, and Timed Up and Go Test (TUG). The groups were homogeneous concerning age, HY and UPDRS. Statistical analysis was performed using SPSS, version 20.0. Results: Statistically significant differences were found in all the variables analyzed in the RC and SB groups when compared in the pre-and post-intervention. With the exception of the TUG variable, the DT group presented statistically significant differences in all the remaining variables. Conclusion: The three interventions were effective for the outcomes under study, but the SB group presented the greatest magnitude of