Gait and step training to reduce falls in Parkinson's disease

Abstract

Introduction: Frequent falls and risk of injury are evident in individuals with Parkinson's disease (PD) as the disease progresses. There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD. Purpose: Assess the benefit of gait and step perturbation training in individuals with PD. Design: Randomized, controlled trial. Setting: Outpatient research, education and clinical center in a tertiary care Veterans Affairs Medical Center. Outcome measures: Gait parameters, 5-step test, report of falls Subjects: Eighteen men with idiopathic PD in stage 2 or 3 of the Hoehn and Yahr staging Methods: Subjects were randomly assigned to a trained or control group. They were asked about any falls 2 weeks prior to and after an 8 week period. Gait speed, cadence, and step length were tested on an instrumented walkway. Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps. Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety. Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards, backwards, or sideways. Training occurred 1 hour per day, three times per week for 8 weeks. A two-factor (time and group) analysis of variance with repeated measures was used to compare the groups. Results: Substantial reduction occurred in falls in the trained group, but not in the control group. Gait speed increased in the trained group from 1.28 ± 0.33 meters/sec to 1.45 ± 0.37 meters/sec, but not in the control group (from 1.26 to 1.27 m/s). The cadence increased for both groups: from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 steps/min for the control group. Stride lengths increased for the trained group, but not the control group. The 5-step test speed increased in the trained group from 0.40 ± 0.08 steps/sec to 0.51 ± 0.12 steps/sec, and in the control group (0.36 ± 0.11 steps/sec to 0.42 ± 0.11 steps/sec). Conclusion: Gait and step perturbation training resulted in a reduction in falls and improvements in gait and dynamic balance. This is a promising approach to reduce falls for patients with PD.

Walking can be more effective than balance training in fall prevention among community‐dwelling older adults

“…6 However, the majority of the analyzed studies recruited high-risk participants, such as frail nursing home residents, patients with Parkinson's disease, osteoporosis or stroke, or those with a recent history of fractures. [7][8][9][10][11] Okubo et al reported that the harmful association between walking and fall history was observed only among high-risk participants (adjusted odds ratio 4.61, 95% CI 1.32-16.09), and a beneficial relationship between walking and a lower fall history was observed among low-risk participants (adjusted odds ratio 0.44, 95% CI 0.20-0.97). 12 A similar modifying effect of frailty or having a high risk of falling on the association between walking and falls has been reported in longitudinal and intervention studies.…”

“…6 The majority of the participants included in the metaanalysis were "high-risk" participants, such as frail nursing home residents, patients with Parkinson's disease, osteoporosis or stroke, or patients with a recent history of fractures. [7][8][9][10][11] A cross-sectional study by Okubo et al showed that among high-risk older people, habitual walking was significantly related to a greater history of falls. 12 In contrast, among the general population who were not at high risk, habitual walking was significantly correlated with a lower history of falls.…”

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

“…Three studies have examined the effects of PBT on the incidence of falls in daily life among older adults with Parkinson's disease. [35][36][37] We do not discuss the abovedetailed study of Shimada et al here, as only a proportion of the participants had a neurological disorder. 33 Protas et al investigated the effects of 8 weeks' PBT, in combination with gait training, in nine men with mildto-moderate idiopathic Parkinson's disease, and showed a significant reduction of falls in the 2 weeks after the training period, in comparison with the 2 weeks before the training.…”

Adaptation to large-magnitude treadmill-based perturbations: improvements in reactive balance response

“…Previous research suggests that perturbation-based training in stance through motorized platform translations improved reactive balance by reducing the number of compensatory steps and mediolateral base of support (BOS) (Mansfield et al 2010). Other researchers have also shown the potential of motorized treadmill-based perturbation training for reducing falls among younger and older adults (Shimada et al 2004;Grabiner et al 2012;Yang et al 2013) and in individuals with Parkinson's disease (Protas et al 2005). Although previous studies provide some evidence supporting use of experimenter-controlled perturbations for improvement in the reactive balance control and fall outcomes, the exact mechanism of adaption to such per-turbations (change over trials) has not been examined and is not completely understood yet.…”