Locomotor Function in the Early Stage of Parkinson's Disease

Abstract

The cardinal motor symptoms of Parkinson's disease (PD) have been widely investigated with particular reference to abnormalities of steady-state walking. The great majority of studies, however are related to severe forms of PD patients (phases > = 3 of Hoehn and Yahr scale), where locomotor abnormalities are clearly manifested. Goal of the present study was to quantitatively describe locomotor symptoms in subjects with mild PD. Accordingly, a multitask protocol involving instrumental analysis of steady-state linear walking, initiation of gait, and turning while walking was applied to a group of patients with idiopathic PD in their early clinical stage (phases 1 and 2 of Hoehn and Yahr scale), as well as in age-matched elderly controls. Kinematic, kinetic, and myoelectric measures were obtained by optoelectronic motion analysis, force platform, and telemetric electromyography. Results in PD patients showed a tendency to bradykinetic gait, with reduction of walking speed and cadence. Impairments of gait initiation consisted in reduction of the backward shift of the center of pressure (CoP) and prolongation of the stepping phase. Alterations of the turning task were more consistent and included delayed reorientation of the head toward the new direction, altered head-upper trunk rotational strategy, and adoption of a greater number of steps to complete the turning. It is concluded that patients in the early stage of PD reveal mild alterations of steady-state linear walking and more significant anomalies in the transitional conditions, especially during changes in the travel direction. Quantitative analysis of nonstationary locomotor tasks might be a potentially useful starting point for further studies on the pathophysiology of PD.

Positive effects of auditory cue in locomotor pattern of people with Parkinson’s disease (off and on medication)

“…Discussion e aim of this study was to investigate the e ect of auditory cues and medication on the kinematic, kinetics and EMG parameters, during di erent phases of gait in people with PD. e results of this study are in agreement with literature which has reduced kinematic, kinetic and electromyographic variables, for PD patients compared to elderly 5,[21][22] .…”

“…Positive effects of auditory cue in locomotor pattern of people with Parkinson's disease (off and on medication) e dysfunctions in spatial, temporal, kinetic and electromyographic parameters in the gait of people with Parkinson's disease (PD) have been widely described in literature [1][2][3][4][5] . Dopaminergic medication has a positive e ect on the length and velocity of the stride and on the ability to produce muscle strength [6][7][8][9] , however, cadence and double support does not alter in response to medication 10 .…”

Gait bradykinesia in Parkinson’s disease: a change in the motor program which controls the synergy of gait

“…Numerous studies have addressed instances of gait disturbance in Parkinson's disease subjects and several researchers have examined the initiation of gait (Gantchev et al 1996;Burleigh-Jacob et al 1997;Halliday et al 1998;Carpinella et al 2007), but ultimately disregarded the effect that the EMG off-response has on the termination of the preceding posture/movement. Most studies focused their analyses on steady-state walking, reporting that leg EMG activity is reduced, and that the results are basically consistent with those observed in arm and finger movements (Evarts et al 1981;Wing 1988;Cioni et al 1997;Chee et al 2009).…”

“…In addition, it has been reported that the impairment of gait initiation is associated with the visuospatial cognitive environment (Azulay et al 1999;Cummings and Steven 1992;Naismith et al 2010). Carpinella et al (2007) examined the EMG activity of two antagonist muscles in subjects in the early stage of Parkinson's disease. They reported that the EMG activity in the early stage of Parkinson's disease is basically similar to normal subjects.…”

Changes of Normal Adult Physiological States and Gait Parameters with Treadmill Inclined

“…Bovi et al 8) analyzed differences in kinematic, kinetic and EMG analyses according to age group to produce clinical references. Although the existence of specific lesions can be elucidated from gait analysis, some diseases in their early stages do not affect gait, but become manifest in the later stages 9,10) . Human gait speed is a basic factor to consider and an important indicator to assess 11,12) .…”