Supported Treadmill Training for Gait and Balance in a Patient With Progressive Supranuclear Palsy

Suteerawattananon, Monthaporn; MacNeill, Betty; Protas, Elizabeth J.

doi:10.1093/ptj/82.5.485

Cited by 52 publications

(53 citation statements)

References 47 publications

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“…It is difficult to determine the underlying mechanisms for these improvements. We used a multidirectional gait and step training strategy for training based on the outcomes of a single case study [40]. Morris suggests that visual and auditory cueing as well as attentional strategies can impact gait and balance in PD [21].…”

Section: Discussionmentioning

confidence: 99%

“…We previously demonstrated with a case report that a gait and step training strategy improved gait and balance, and reduced falls in an individual with a parkinsonian syndrome [40]. The purpose of this article is to report the results of a pilot controlled study of gait and step training in individuals with idiopathic PD who had reduced balance, and/or recent problems with falls.…”

Section: Introductionmentioning

confidence: 97%

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Gait and step training to reduce falls in Parkinson's disease

Protas

Mitchell²,

Williams

et al. 2005

NRE

279

187

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Introduction: Frequent falls and risk of injury are evident in individuals with Parkinson's disease (PD) as the disease progresses. There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD. Purpose: Assess the benefit of gait and step perturbation training in individuals with PD. Design: Randomized, controlled trial. Setting: Outpatient research, education and clinical center in a tertiary care Veterans Affairs Medical Center. Outcome measures: Gait parameters, 5-step test, report of falls Subjects: Eighteen men with idiopathic PD in stage 2 or 3 of the Hoehn and Yahr staging Methods: Subjects were randomly assigned to a trained or control group. They were asked about any falls 2 weeks prior to and after an 8 week period. Gait speed, cadence, and step length were tested on an instrumented walkway. Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps. Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety. Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards, backwards, or sideways. Training occurred 1 hour per day, three times per week for 8 weeks. A two-factor (time and group) analysis of variance with repeated measures was used to compare the groups. Results: Substantial reduction occurred in falls in the trained group, but not in the control group. Gait speed increased in the trained group from 1.28 ± 0.33 meters/sec to 1.45 ± 0.37 meters/sec, but not in the control group (from 1.26 to 1.27 m/s). The cadence increased for both groups: from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 steps/min for the control group. Stride lengths increased for the trained group, but not the control group. The 5-step test speed increased in the trained group from 0.40 ± 0.08 steps/sec to 0.51 ± 0.12 steps/sec, and in the control group (0.36 ± 0.11 steps/sec to 0.42 ± 0.11 steps/sec). Conclusion: Gait and step perturbation training resulted in a reduction in falls and improvements in gait and dynamic balance. This is a promising approach to reduce falls for patients with PD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Gait and step training to reduce falls in Parkinson's disease

Protas

Mitchell²,

Williams

et al. 2005

NRE

279

187

View full text Add to dashboard Cite

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“…Physical therapy should be attempted, although evidence of its efficacy for gait and balance is only anecdotal. [99][100][101] Evidence for efficacy of gaze retraining is somewhat more convincing, however. 102 Although prisms are not effective for the vertical gaze palsy, they can be helpful for the symptom of diplopia.…”

Section: Nondrug Treatmentmentioning

confidence: 99%

Progressive Supranuclear Palsy

Golbe

2014

Semin Neurol

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Progressive supranuclear palsy is a disorder of tau protein aggregation. Its clinical spectrum is now known to be wider than originally described, with a phenotype resembling Parkinson disease accounting for a third of cases. However, at least half of the patients with PSP exhibit the classic bradykinesia with disproportionate postural instability, erect posture with nuchal rigidity, frontal behavioral and cognitive changes, vertical gaze palsy, and other disabling brainstem deficits. Nonmendelian genetic risk factors exist, but PSP is almost entirely sporadic, with a prevalence of five to six persons per 100,000, mean onset age of 63, and median survival of 7 years. Clinical diagnostic criteria with excellent specificity and a clinical rating scale sensitive to progression are available. Diagnosis remains clinical, although magnetic resonance imaging and cerebrospinal fluid measures are showing promise as early-stage screening tools. Multiple candidate neuroprotective medications have proven ineffective to date. Treatment remains supportive, although coenzyme Q-10 has shown preliminary symptomatic efficacy and levodopa may provide transient, modest benefit.

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“…50 The use of a treadmill-based physical therapy program is supported by the case study of a single patient with PSP whose falls reduced after an 8-week program. 51 Although this evidence is not definitive, it demonstrates the feasibility of treadmill training in PSP.…”

Section: Nonmedical Approachesmentioning

confidence: 97%

Falls in Progressive Supranuclear Palsy

Brown

Rowe

Passamonti

et al. 2019

Movement Disord Clin Pract

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Background Background: Despite falls being an almost universal clinical feature and central to the presentation and diagnostic criteria of progressive supranuclear palsy, our understanding of falls is surprisingly limited and there are few effective treatment options. Objectives Objectives: To provide an overview of the topic of the impact, assessment, mechanism, and management of falls in progressive supranuclear palsy. Methods Methods: We performed a literature search for "falls" and "progressive supranuclear palsy" and included additional relevant literature known to us. We synthesized this literature with experience from clinical practice. ResultsResults: We review current understanding of the pathophysiology of falls, highlighting the roles of the indirect pathway and the pedunculopontine nucleus. We go on to identify shortcomings in commonly used assessments to measure falls. We discuss medical and nonmedical fall prevention strategies, and finally we discuss balancing falls risk against promoting independence. Conclusion Conclusion: Falls are central to progressive supranuclear palsy presentation and diagnosis. Indirect locomotor and pedunculopontine nucleus dysfunction are thought to be the neural substrate of falls in this condition. Attempts to measure and prevent falls, by medical and nonmedical means, are currently limited. A personalized approach is advocated in the management of falls.

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Supported Treadmill Training for Gait and Balance in a Patient With Progressive Supranuclear Palsy

Cited by 52 publications

References 47 publications

Gait and step training to reduce falls in Parkinson's disease

Gait and step training to reduce falls in Parkinson's disease

Progressive Supranuclear Palsy

Falls in Progressive Supranuclear Palsy

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