Effects of levodopa on forward and backward gait patterns in persons with Parkinson's disease

Bryant, Mon S.; Rintala, Diana H.; Hou, Jyh Gong; Lai, Eugene C.; Protas, Elizabeth J.

doi:10.3233/nre-2011-0700

Cited by 52 publications

(55 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Levodopa treatment has been shown to improve gait spatio-temporal characteristics in both forward and backward walking, with a lesser extent of improvement in backward walking than the forward walking (8). These findings lead us to hypothesize that the effect of levodopa on gait variability might be different between the two walking directions.…”

Section: Introductionmentioning

confidence: 99%

Gait variability in Parkinson's disease: levodopa and walking direction

et al. 2015

Self Cite

View full text Add to dashboard Cite

Background Levodopa treatment has been shown to improve gait spatio-temporal characteristics in both forward and backward walking. However, effect of levodopa on gait variability during backward walking compared to forward walking has not been reported. Aims of Study To study the effects of levodopa on gait variability of forward and backward walking in individuals with Parkinson's disease (PD). Methods Forty individuals with PD were studied. Their mean age was 68.70 ± 7.46 yr. The average time since diagnosis was 9.41 ± 5.72 yr. Gait variability was studied while ‘OFF’ and ‘ON’ levodopa when the participants walked forward and backward at their usual speed. Variability in step time, swing time, stride length, double support time and stride velocity were compared between medication condition and walking direction. Results Variability of step time, swing time, stride length and stride velocity decreased significantly during forward and backward walks (p < .001; p < .001; p = .003, p =.001, respectively) after levodopa administration. Variability of double support time was not changed after levodopa administration (p = .054). Conclusions Levodopa had positive effects on gait variability of forward and backward walking in individuals with PD. However, variability in double support time was not affected by the levodopa.

show abstract

Section: Introductionmentioning

confidence: 99%

Gait variability in Parkinson's disease: levodopa and walking direction

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Gait disturbance is a cardinal feature of Parkinson's disease (PD) and a significant cause of disability. Dopaminergic medications are used widely to target gait impairments and have a powerful effect . Despite this, significant gait impairment remains, and indeed some features of gait (such as gait‐related postural control) are refractory to l ‐dopa medications, suggesting that they are underpinned by non‐dopaminergic pathology .…”

mentioning

confidence: 99%

“…Dopaminergic medications are used widely to target gait impairments and have a powerful effect . Despite this, significant gait impairment remains, and indeed some features of gait (such as gait‐related postural control) are refractory to l ‐dopa medications, suggesting that they are underpinned by non‐dopaminergic pathology . This may be more evident for a motor phenotype associated with greater postural instability and gait disorder (PIGD), which carries a greater risk of motor and cognitive decline compared with a tremor‐dominant phenotype (TD) .…”

mentioning

confidence: 99%

Progression of gait dysfunction in incident Parkinson's disease: Impact of medication and phenotype

et al. 2014

View full text Add to dashboard Cite

Gait impairment in Parkinson's disease (PD) persists despite the use of dopaminergic therapy. Motor phenotype associated with greater postural instability and gait difficulty is related to a greater risk of motor decline and may be influenced by non-dopaminergic pathology. This study documents the progression of gait impairment over 18 months in an incident cohort of PD with regard to phenotype and medication. Gait characteristics were measured in 121 PD and 184 controls, and 18 months later in 108 PD participants. Sixteen gait characteristics were examined with respect to five broad domains for PD and motor phenotype. Correlations between change in levodopa (l-dopa) equivalent daily dose and gait were used to identify dopa-responsive and nonresponsive characteristics. Pace and rhythm deteriorated over 18 months in people with PD, with other gait domains remaining stable. People with a postural instability and gait difficulty phenotype had more impaired gait at baseline compared with a tremor-dominant phenotype, which was most evident in temporal characteristics. In contrast, pace and variability deteriorated over the subsequent 18 months in the tremor-dominant phenotype only. Weak but statistically significant correlations were found between increased l-dopa medication and less deterioration in pace and asymmetry. Significant gait impairment is evident in very early disease despite optimal medication. Change over 18 months is subtle and discrete, and is more pronounced in the tremor-dominant phenotype. Some features of gait are refractory to dopaminergic therapy, implicating a non-dopaminergic contribution. This may explain more temporal gait disturbance in the postural instability and gait difficulty phenotype.

show abstract

“…According to our results, regardless of medication state, forward MSLT performance is greater than both backward and lateral directions. This finding is not surprising given that people with PD are known to have difficulty with postural responses 21,22 and gait 23,24 in the backward direction 12 . Our findings extend this previous work by demonstrating people with PD have greater voluntary stepping hypokinesia in the backward direction when compared to forward.…”

Section: Discussionmentioning

confidence: 92%

“…We had several hypotheses. First, MSLT distances would be shorter in the backward direction compared to forward given that people with PD tend to have more difficulty with movement in the backward direction 12 . Second, MSLT performance would be worse in the OFF-medication condition compared to ON-medication in people with PD because movement is known to be more difficult in PD without dopamine replacement therapy 13 .…”

Section: Introductionmentioning

confidence: 99%

Maximum Step Length Test Performance in People With Parkinson Disease: A Cross-sectional Study

Duncan

McNeely

Earhart

2017

Journal of Neurologic Physical Therapy

View full text Add to dashboard Cite

Background and Purpose The Maximum Step Length Test (MSLT), a measure of one’s capacity to produce a large step, has been studied in older adults, but not in people with Parkinson disease (PD). We characterized performance and construct validity of the MSLT in PD. Methods Forty participants (mean age: 65.12±8.20; 45% female) with idiopathic PD completed the MSLT while OFF and ON anti-PD medication. Construct validity was investigated by examining relationships between MSLT and measures of motor performance. The following measures were collected: Mini-BESTest, ABC scale, gait velocity, 6MWT, MDS-UPDRS III, and TUG. A repeated measures ANOVA tested for main effects of medication and stepping direction and the interaction between the two. Pearson or Spearman correlations were used to assess the relationships between MSLT and motor performance measures (α=0.05). Results Regardless of medication status, participants stepped further in the forward direction compared to the backward and lateral directions (p<0.001). Participants increased MSLT performance when ON-medication compared to OFF-medication (p=0.004). Regardless of medication status, MSLT was moderately to strongly related to Mini-BESTest, TUG, and 6MWT. Discussion and Conclusions People with PD stepped furthest in the forward direction when performing the MSLT. Increased MSLT performance was observed ON-medication compared to OFF-medication; however, the small increase may not be clinically meaningful. Given the relationships between the MSLT and the Mini-BESTest, 6MWT, and TUG, MSLT performance appears to associated with balance and gait hypokinesia in people with PD. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1).

show abstract

Effects of levodopa on forward and backward gait patterns in persons with Parkinson's disease

Cited by 52 publications

References 17 publications

Gait variability in Parkinson's disease: levodopa and walking direction

Gait variability in Parkinson's disease: levodopa and walking direction

Progression of gait dysfunction in incident Parkinson's disease: Impact of medication and phenotype

Maximum Step Length Test Performance in People With Parkinson Disease: A Cross-sectional Study

Contact Info

Product

Resources

About