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

Publication date: Available online 16 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Michael H. Cole, Matthew Sweeney, Zachary J. Conway, Tim Blackmore, Peter A. Silburn
ObjectiveThis 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).DesignCross-sectional cohort study;SettingGeneral communityParticipants84 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.ProtocolSymptom 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 OutcomesThree-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.ResultsHead 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.ConclusionThe results suggest that improved gait dynamics do not necessarily represent improved walking stability and this must be respected when rehabilitating gait in PD patients.



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