Improving gait and promoting retention in individuals with Parkinson’s disease: a pilot study

Abstract

We examined intensive walking practice using two instructional strategies on gait in Parkinson's disease (PD) before and after training and on delayed retention tests. During four training sessions (15 practice trials of walking per session), subjects (N = 6 per group) were given either verbal instruction (VI) to "take a big step" or VI plus augmented feedback (FB). For FB, videotape performance-feedback (from prior trial) supplemented by performance-cues (for subsequent trial) was given after each trial. On pre- and posttests (1 week after training), the only instructions were to "walk as well as you can." For available subjects (N = 7), retention was tested at 3, 6, or 12 months after training. Gait parameters were derived from kinematic analysis of walking during training and testing. From pre- to posttests, stride length, walking velocity and shoulder excursion increased significantly, with no change in cadence. Improvements in stride length and gait velocity above pretest levels were maintained on retention tests. During training and testing, no effects of VI versus VI + FB were found. Although the two instructional strategies did not differ, intensive practice walking with VI improved the gait pattern of individuals with PD and these gait improvements were maintained over an extended period of time.

A novel cognitive cueing approach to gait retraining in Parkinson’s disease: A pilot study

“…The changes in gait kinematics observed in this study suggest that individuals with mild to moderate PD are capable of cognitively using verbal instructional cueing strategies to improve gait, and that after a two-week period of active practice these PD to self-cue, a prospect that has previously been raised by Werner and Gentile (2010).…”

“…Despite the neuropathology of the disease, evidence suggests that individuals with PD are capable of improving their gait via motor learning strategies (Felix et al, 2012;Fok, Farrell, McMeeken, & Kuo, 2011;Pendt, Reuter, & Müller, 2011;Rochester et al, 2010;Werner & Gentile, 2010), as evidenced by the fact that exercise and movement strategy training have been found collectively to contribute to improvements in gait (Rochester, Nieuwboer, & Lord, 2011). For example, research focused on the nonpharmacological management of gait impairment in PD has found that the use of external cues is generally effective (Morris, Iansek, Matyas, & Summers, 1996;Rochester et al, 2010;Rochester et al, 2005;Spaulding et al, 2012).…”

“…Building on the promising findings of this aforementioned research, Werner and Gentile (2010) examined two instructional strategies during intensive walking practice. One treatment group (n = 6) received verbal instructions to "take big steps," and a second treatment group (n = 6) received the same verbal instructions with video feedback and performance cues between each of the 15 walking performances.…”

“…Though the authors did not identify differences between the two training groups, both groups showed improvement in stride length and gait velocity pre to posttraining, and all of the participants assessed in longer-term retention tests (i.e., three, six, or 12 months) maintained stride length and gait velocity improvement above pretraining levels. The purpose of this study was to examine the feasibility and utility of delivering a home-based gait retraining intervention, similar to the one adopted by Werner and Gentile (2010), that combines cognitive cueing techniques and motor learning principals aimed at improving kinematic variables of gait and functional mobility among individuals with PD.…”

Augmented Feedback Using Visual Cues for Movement Smoothness during Gait Performance of Individuals with Parkinson’s Disease

“…Previous studies have investigated various rehabilitation strategies using sensory cues for their impact on gait and falls of PD patients 4) . Studies have shown short-term improvements in parkinsonian gait when external cues are provided (visual or auditory) or when verbal instructions to increase step length are given 5) . However, few studies have investigated the effect of these factors on movement smoothness during gait performance.…”