Investigation of factors impacting mobility and gait in Parkinson disease

Abstract

Mobility and gait limitations are major issues for people with Parkinson disease (PD). Identification of factors that contribute to these impairments may inform treatment and intervention strategies. In this study we investigated factors that predict mobility and gait impairment in PD. Participants with mild to moderate PD and without dementia (n=114) were tested in one session ‘off’ medication. Mobility measures included the 6-Minute Walk test and Timed-Up-and-Go. Gait velocity was collected in four conditions: forward preferred speed, forward dual task, forward fast as possible and backward walking. The predictors analyzed were age, gender, disease severity, balance, balance confidence, fall history, self-reported physical activity, and executive function. Multiple regression models were used to assess the relationships between predictors and outcomes. The predictors, in different combinations for each outcome measure, explained 55.7% to 66.9% of variability for mobility and 39.5% to 52.8% for gait velocity. Balance was the most relevant factor (explaining up to 54.1% of variance in mobility and up to 45.6% in gait velocity). Balance confidence contributed to a lesser extent (2.0% to 8.2% of variance) in all models. Age explained a small percentage of variance in mobility and gait velocity (up to 2.9%). Executive function explained 3.0% of variance during forward walking only. The strong predictive relationships between balance deficits and mobility and gait impairment suggest targeting balance deficits may be particularly important for improving mobility and gait in people with PD, regardless of an individual’s age, disease severity, fall history, or other demographic features.

Postural instability in subjects with Parkinson’s disease undergoing different sensory pitfalls

“…Our findings demonstrated a worse bal- a combination of motor changes due to the disease, agerelated issues, and sedentary life style [3]. Our study proved that sedentary older adults (with and without PD) had a hazardous variability of balance.…”

“…Motor and cognitive functions, in particular, have been extensively studied. The combination of age-related changes and disease-related issues explains the difficulty of movement that people with PD experience [3]. Pathological and compensatory changes in a variety of locomotor brain regions occur in PD, leading to increased asymmetry, poor postural control, bradykinesia, and rigidity [4].…”

Somatosensory Focused Balance Training without cues can improve balance and gait in early Parkinson’s disease – a randomised pilot study

“…That balance training is important for gait and mobility in PD was highlighted by Christofoletti et al 82 . They found a strong predictive relationship between balance, gait and mobility limitations, regardless age, disease severity, fall history, or other demographic aspects.…”

Identificación de marcadores clínicos, cognitivos y motores en pacientes con enfermedad de Parkinson en estadios tempranos: evaluación clínica complementada con un dispositivo de análisis del movimiento

“…Los análisis de la velocidad global estratificados por edad arrojaron diferencias significativas en el grupo de 60 a 66 años en ambas extremidades. Estos hallazgos están de acuerdo con investigadores [221] que plantean que la velocidad está afectada por: los años de enfermedad, las puntuaciones altas en la MDS-UPDRS, la alteración en el balance dinámico (GDI) y la presencia de episodios de congelamiento (FOGQ). Un punto importante a tener en cuenta es la edad, pues los resultados en los grupos de entre 67 y 88 años no arrojaron diferencias significativas.…”