Postural Instability and Gait Impairment During Obstacle Crossing in Parkinson's Disease

Stegemöller, Elizabeth L.; Buckley, Thomas A.; Pitsikoulis, Chris; Barthélemy, Ernest J.; Roemmich, Ryan T.; Hass, Chris J.

doi:10.1016/j.apmr.2011.11.004

Cited by 72 publications

(80 citation statements)

References 46 publications

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“…In addition, breakdown in motor planning can result in riskier situations. For example, the time needed to step over the obstacle is longer, resulting in more time spent standing on one leg [44, 47]. Also, the typical foot placement relative to the obstacle is smaller in PD patients than in healthy subjects, increasing the risk of collision [42, 44, 45].…”

Section: Gait Deficits In Parkinson's Diseasementioning

confidence: 99%

Pharmacological treatment in Parkinson's disease: Effects on gait

Smulders

Dale

Carlson‐Kuhta

et al. 2016

Parkinsonism & Related Disorders

134

129

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Gait impairments are a hallmark of Parkinson's disease (PD), both as an early symptom and an important cause of disability later in the disease course. Although levodopa has been shown to improve gait speed and step length, the effect of dopamine replacement therapy on other aspects of gait is less well understood. In fact, falls are not reduced and some aspects of postural instability during gait are unresponsive to dopaminergic treatment. Moreover, many medications, other than dopaminergic agents, can benefit or impair gait in people with PD. We review the effects of pharmacological interventions used in PD on gait, discriminating, whenever possible, among effects on four components of everyday mobility: straight walking, gait initiation, turning, gait adaptability. Additionally, we summarize the effects on freezing of gait. There is substantial evidence for improvement of spatial characteristics of simple, straight-ahead gait with levodopa and levodopa-enhancing drugs. Recent work suggests that drugs aiming to enhance the acetylcholine system might improve gait stability measures. There is a lack of well-designed studies to evaluate effects on more complex, but highly relevant walking abilities such as turning and flexible adjustments of gait. Finally, paucity in the literature exists on detrimental effects of drugs used in PD that are known to worsen gait and postural stability in the elderly population.

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Section: Gait Deficits In Parkinson's Diseasementioning

confidence: 99%

Pharmacological treatment in Parkinson's disease: Effects on gait

Smulders

Dale

Carlson‐Kuhta

et al. 2016

Parkinsonism & Related Disorders

134

129

View full text Add to dashboard Cite

show abstract

“…Maintenance of balance during standing may worsen when on levodopa, possibly due to levodopa-induced dyskinesia (18,22). Lateral control of balance is particularly affected in people with PD, as lateral trunk sway is especially elevated during quiet stance (1,85) and while walking with and without obstacles (42,134). While some amount of lateral motion is necessary for stability and optimized energetics (79), too much lateral motion is likely detrimental and is related to increased falls (120).…”

Section: Poor Postural Controlmentioning

confidence: 99%

Neural Control of Walking in People with Parkinsonism

2016

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People with Parkinson's disease exhibit debilitating gait impairments, including gait slowness, increased step variability, and poor postural control. A widespread supraspinal locomotor network including the cortex, cerebellum, basal ganglia, and brain stem contributes to the control of human locomotion, and altered activity of these structures underlies gait dysfunction due to Parkinson's disease.

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“…While persons with PD demonstrate difficulty altering the locomotor system during transitional periods such as turning (Bloem et al, 2011), obstacle clearing (Stegemöller et al, 2012), and gait initiation (Hass et al, 2005), abilities to adapt steady-state gait and store adapted gait patterns have not been well-studied. Only one study has examined SBT walking in PD, demonstrating that persons with PD reactively adapted over a similar number of strides when compared to controls (Dietz et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Locomotor adaptation and locomotor adaptive learning in Parkinson’s disease and normal aging

Roemmich

Nocera

Stegemöller

et al. 2014

Clinical Neurophysiology

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Objective Locomotor adaptation enables safe, efficient navigation among changing environments. We investigated how healthy young (HYA) and older (HOA) adults and persons with Parkinson’s disease (PD) adapt to walking on a split-belt treadmill, retain adapted gait parameters during re-adaptation, and store aftereffects to conventional treadmill walking. Methods Thirteen PD, fifteen HYA, and fifteen HOA walked on a split-belt treadmill for ten minutes with one leg twice as fast as the other. Participants later re-adapted to the same conditions to assess retention of the split-belt gait pattern. After re-adaptation, we assessed aftereffects of this pattern during conventional treadmill walking. Results Persons with PD exhibited step length asymmetry throughout many adaptation and adaptive learning conditions. Early adaptation was similar across groups, though HYA and HOA continued to adapt into late adaptation while PD did not. Despite pervasive step length asymmetry among conditions which were symmetric in HYA and HOA, persons with PD demonstrated significant step length aftereffects during conventional treadmill walking after split-belt walking. Conclusions Though they may exhibit a default asymmetry under various walking conditions, persons with PD can adapt and store new walking patterns. Significance Locomotor adaptation therapy may be effective in ameliorating asymmetric gait deficits in persons with PD.

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Postural Instability and Gait Impairment During Obstacle Crossing in Parkinson's Disease

Cited by 72 publications

References 46 publications

Pharmacological treatment in Parkinson's disease: Effects on gait

Pharmacological treatment in Parkinson's disease: Effects on gait

Neural Control of Walking in People with Parkinsonism

Locomotor adaptation and locomotor adaptive learning in Parkinson’s disease and normal aging

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