Gait abnormalities of COPD are not directly related to respiratory function

Morlino, Paola; Balbi, Bruno; Guglielmetti, Simone; Giardini, Marica; Grasso, Margherita; Giordano, Chiara; Schieppati, Marco; Nardone, Antonio

doi:10.1016/j.gaitpost.2017.08.020

Cited by 41 publications

(65 citation statements)

References 32 publications

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“…We would also put forward the notion that walking problems in PD depend on, or are very closely related to, balance impairment. This extends to PD the idea that walking velocity is affected by postural instability, very much as it has been suggested for cerebellar and neuropathic diseases [ 58 , 59 , 99 ] or patients with stroke [ 100 ] or COPD [ 101 ]. To our knowledge, this is the first study that shows improvement in gait induced by mere balance training in patients with PD.…”

Section: Discussionmentioning

confidence: 59%

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

et al. 2018

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We hypothesised that rehabilitation specifically addressing balance in Parkinson's disease patients might improve not only balance but locomotion as well. Two balance-training protocols (standing on a moving platform and traditional balance exercises) were assessed by assigning patients to two groups (Platform, n = 15, and Exercises, n = 17). The platform moved periodically in the anteroposterior, laterolateral, and oblique direction, with and without vision in different trials. Balance exercises were based on the Otago Exercise Program. Both platform and exercise sessions were administered from easy to difficult. Outcome measures were (a) balancing behaviour, assessed by both Index of Stability (IS) on platform and Mini-BESTest, and (b) gait, assessed by both baropodometry and Timed Up and Go (TUG) test. Falls Efficacy Scale-International (FES-I) and Parkinson's Disease Questionnaire (PDQ-8) were administered. Both groups exhibited better balance control, as assessed both by IS and by Mini-BESTest. Gait speed at baropodometry also improved in both groups, while TUG was less sensitive to improvement. Scores of FES-I and PDQ-8 showed a marginal improvement. A four-week treatment featuring no gait training but focused on challenging balance tasks produces considerable gait enhancement in mildly to moderately affected patients. Walking problems in PD depend on postural instability and are successfully relieved by appropriate balance rehabilitation. This trial is registered with ClinicalTrials.gov NCT03314597.

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Section: Discussionmentioning

confidence: 59%

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

et al. 2018

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“…A reasonable alternative, the shorter Mini-BESTest recommended by the international balance core outcomes panel 26 and developed based on the full BESTest, has only been used recently in two small studies of patients with COPD. 45,46 Preliminary data from these studies support the construct validity of the Mini-BESTest and its reliability in people with COPD; however, further study with larger sample sizes and longitudinal evaluation is needed.…”

Section: Evidence To Date On Balance Assessment In People With Copdmentioning

confidence: 82%

Balance assessment in people with COPD: An evidence-based guide

Beauchamp

2018

Chron Respir Dis

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Balance problems and an increased rate and risk of falls are common in people with chronic obstructive pulmonary disease (COPD). Although a balance assessment is now recommended by clinical practice guidelines for pulmonary rehabilitation, specific tests have yet to be suggested. The purpose of this review is to provide an evidence-based synthesis of balance measurement in older adults and in people with COPD, to guide practice in this area. An overview of best practices for assessing balance and fall risk in older adults is provided along with a practical synthesis of evidence to date on common balance measures used in people with COPD such as the Timed Up and Go, Single Leg Stance, Berg Balance, and Mini and Full Balance Evaluation Systems Tests. Finally, two clinical scenarios are described to illustrate the process of evidence-based clinical decision-making with respect to balance assessment in people with COPD. Ultimately, the selection of balance test and its interpretation will depend on the purpose of the assessment, available data on psychometric properties, the patient’s individual characteristics, and the resources available to the clinician.

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“…We would note that poor postural control is common in most PD patients, and can interfere with walking [ 124 , 125 ]. In other diseases, walking problems are strongly dependent on impaired balance control, as in peripheral neuropathies [ 126 ], stroke [ 98 ], cerebellar syndromes [ 127 ] and COPD [ 128 ]. On the one hand, these links between balance and gait would be compromised in PD during sharp turning [ 118 , 129 ].…”

Section: Discussionmentioning

confidence: 99%

Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed

et al. 2018

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BackgroundSeveral patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases?MethodsWe compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated.ResultsWalking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase.ConclusionThe spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.

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Gait abnormalities of COPD are not directly related to respiratory function

Cited by 41 publications

References 32 publications

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

Balance assessment in people with COPD: An evidence-based guide

Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed

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