Imposed faster and slower walking speeds influence gait stability differently in Parkinson fallers

Michael H. Cole, Matthew Sweeney, Zachary J. Conway, Tim Blackmore, Peter A. Silburn

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Abstract

Objective - This cross-sectional study sought to evaluate the effect of imposed faster and slower walking speeds on postural stability in people with Parkinson’s disease (PD).

Design - Cross-sectional cohort study.

Setting - General community.

Participants - 84 PD patients (51 with a falls history; 33 without) and 82 age-matched controls were invited to participate via neurology clinics and pre-existing databases. Of those contacted, 99 did not respond (PD=36; controls=63) and 27 were not interested (PD=18; controls=9). Following screening, a further 10 patients were excluded; 5 had deep brain stimulation surgery and 5 could not accommodate to the treadmill. The remaining 30 patients completed all assessments and were sub-divided in PD fallers (n=10), PD Non-Fallers (n=10) and age-matched controls (n=10) based on falls history.

Protocol - Symptom severity, balance confidence and medical history were established prior to participants walking on a treadmill at 70%, 100% and 130% of their preferred speed.

Main Outcomes - Three-dimensional accelerometers assessed head and trunk accelerations and allowed calculation of harmonic ratios (HRs) and root mean square (RMS) accelerations to assess segment control and movement amplitude.

Results - Head and trunk control was lower for PD Fallers than PD Non-Fallers and Older Adults. Significant interactions indicated head and trunk control increased with speed for PD Non-Fallers and Older Adults, but did not improve at faster speeds for PD Fallers. Vertical head and trunk accelerations increased with walking speed for PD Non-Fallers and Older Adults, while the PD Fallers demonstrated greater anteroposterior RMS accelerations compared with both other groups.

Conclusion - The results suggest that improved gait dynamics do not necessarily represent improved walking stability and this must be respected when rehabilitating gait in PD patients.
Original languageEnglish
Pages (from-to)639-648
JournalArchives of Physical Medicine and Rehabilitation
Volume98
Issue number4
Early online date16 Dec 2016
DOIs
Publication statusPublished - 1 Apr 2017

Keywords

  • Gait
  • Segmental Control
  • Harmonic Ratio
  • Parkinson Disease
  • Falls

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