A new approach toward gait training in patients with Parkinson's Disease

Livia P Carvalho; Kedar K V Mate; Eda Cinar; Ahmed Abou-Sharkh; Anne-Louise Lafontaine; Nancy E Mayo

doi:10.1016/j.gaitpost.2020.06.031

A new approach toward gait training in patients with Parkinson's Disease

Gait Posture. 2020 Sep:81:14-20. doi: 10.1016/j.gaitpost.2020.06.031. Epub 2020 Jun 29.

Authors

Livia P Carvalho¹, Kedar K V Mate², Eda Cinar³, Ahmed Abou-Sharkh⁴, Anne-Louise Lafontaine⁵, Nancy E Mayo⁶

Affiliations

¹ Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada. Electronic address: livia.carvalho@mcgill.ca.
² Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada. Electronic address: kedar.mate@mail.mcgill.ca.
³ Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada. Electronic address: eda.cinar@mail.mcgill.ca.
⁴ Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada. Electronic address: ahmed.abou-sharkh@mail.mcgill.ca.
⁵ McGill Movement Disorder Clinic, McGill University, Montreal, H3A 2B4, Canada. Electronic address: anne-louise.lafontaine@mcgill.ca.
⁶ Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada. Electronic address: nancy.mayo@mcgill.ca.

PMID: 32650238
DOI: 10.1016/j.gaitpost.2020.06.031

Abstract

Background: Typically, people with Parkinson's Disease (PD) progress to develop a gait pattern that is characterized by quick, short and shuffling steps. Gait cycle is altered and lacks definition and fluidity. Gait training combined with a variety of feedback modalities for PD are usually based on non-immediate and externally-based cues but none of these provide real-time feedback on gait quality and acquired gains tend to abate shortly after rehabilitation. Based on principals of motor learning, our team has developed the Heel2Toe sensor to provide real-time auditory feedback during gait training.

Research question: Is a short-term training using the Heel2Toe sensor feasible and efficient to improve gait in people with PD? Our objectives are to identify the extent of the immediate response to the feedback within the same session and the carry-over response to training and; 2) to identify patients' perceived effects, pleasures and challenges of using the Heel2Toe.

Methods: Single-arm, proof-of-concept study. Six people received five sessions of gait training over a 2-3-week period using the Heel2Toe augmented with mobility exercises as an adjunct to gait training. The main outcomes were technically assessed gait parameters collected over a 2-minute walk test, without and with feedback. Heel2Toe signals were analyzed to extract angular velocity(AV), percentage of good steps, average cadence, and AV coefficient of variation(CV).

Results: An immediate response to the Heel2Toe use and a carry-over response to the short-term training with the sensor were observed: an increase in AV with a reduction in CV (better heel strike and gait regularity); an increase in %good steps; and a near-optimal and homogeneous cadence (∼100 steps/min), which is equivalent to a moderate-intensity walking.

Significance: Gait training using the Heel2Toe sensor is feasible and potentially effective for improving gait quality in people with PD. A definitive trial is a logical next step.

Keywords: Angular velocity; Auditory feedback; Physical function; Walking.

MeSH terms

Aged
Aged, 80 and over
Exercise Therapy / methods*
Female
Gait Disorders, Neurologic / rehabilitation*
Humans
Male
Parkinson Disease / rehabilitation*
Proof of Concept Study