Gait and trunk kinematics during prolonged turning in Parkinson's disease with freezing of gait

Abstract

INTRODUCTION:Although turning during walking is known to trigger freezing of gait (FOG) in Parkinson's disease (PD), little is known about kinematic strategies used by individuals with PD and FOG while performing prolonged turning. OBJECTIVE:Our aim was to compare gait and trunk kinematics during straight walking and continuous turning over 20-minutes in PD with and without FOG.METHODS: 18 individuals with idiopathic PD (n=9 with FOG, n=9 without FOG), performed two 20-minute walking tasks: straight ahead, and turning, in a laboratory setting in their OFF medication state. Accelerometer-based spatial and temporal gait parameters and trunk kinematics (range of motion, peak velocity, variability of range of motion and peak velocity) were analyzed. RESULTS:During turning, PD with FOG reduced cadence more compared to PD without FOG (P < 0.045), despite similar decline in stride velocity (28-32%) and stride length (24-27%).Participants with FOG had decreased variability of gait speed (P < 0.011), stride length (P < 0.035), frontal trunk range of motion (P <0.040) and peak trunk velocity (P <0.017) compared to PD without FOG during turning, whereas there was no difference between groups during straight walking. Gait speed variability and cadence between these two tasks differentiated the PD groups (sensitivity 89% and specificity 78%). CONCLUSIONS:We demonstrate that PD with FOG decreased cadence and reduced variability of walking speed, stride length, and lateral flexion of the trunk compared to PD without FOG during prolonged turning. These real-life gait markers are observable during lab-based gait that is similar to daily-life.

The turning and barrier course reveals gait parameters for detecting freezing of gait and measuring the efficacy of deep brain stimulation

“…It has been difficult to develop an objective measure of FOG since it is challenging to elicit FOG in the clinic or laboratory where there are few obstacles, tight corners, or narrow door openings [32]. Tasks that have been shown to provoke FOG include rapid clockwise and counterclockwise 360 degree turns in place [33], in combination with walking through doorways [34], walking with dual tasking [14,[35][36][37], and forward walking tasks including straight walking or turning around cones [38]. We previously validated freezing behavior during a stepping in place task on dual force plates with the FOG-Q3 [23].…”

The Effects of Augmented Reality Visual Cues on Turning in Place in Parkinson's Disease Patients With Freezing of Gait

“…Compared to healthy controls, PD patients perform turns more slowly (6)(7)(8), with a wider turning arc (8), shorter step length (8,9), higher step count (6,10), stronger coupling between head and trunk rotation (i.e., turning "en bloc") (10), and less medial shifting of the center of mass (COM) (11). In PD patients with FOG, turn time, cadence, and head-trunk coupling are increased more than in patients without FOG (12,13). The observation that the head-pelvis sequence (meaning that rotation of the head precedes the trunk) is delayed and reduced-or even absent-in trials with FOG (14) suggests a, not necessarily causal, relationship between head-trunk coupling and FOG.…”

Turning Characteristics of the More-Affected Side in Parkinson’s Disease Patients with Freezing of Gait

“…The FOG is most commonly experienced during turning tasks, gait initiation, walking through narrow passages, timed up and go (TUG) tasks, dual tasks, and while approaching a destination or avoiding an obstacle [3]. In particular, PD patients with FOG (freezers) encounter greater challenges and need to pay greater attention when performing turning tasks [4]. They face increased risk of falls caused by the instability of their body because it requires the center of mass (COM) to momentarily shift outside the lateral boundaries of the base of support [5].…”