Visual cues combined with treadmill training to improve gait performance in Parkinson’s disease: a pilot randomized controlled trial

Schlick, Cornelia; Ernst, Alina; Bötzel, Kai; Plate, Andreas; Pelykh, Olena; Ilmberger, J.

doi:10.1177/0269215515588836

Cited by 55 publications

(102 citation statements)

References 29 publications

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“…Use of visual cues, on the other hand, consistently improved step/stride length [49][50][51]70,71,73] with or without increasing walking speed or cadence. Plausible explanations for these acute effects could be that visual cues may help fill in for the motor set deficiency by providing visual-spatial data [17,82] and help in focusing attention on gait [57,73].…”

Section: Benefits Of Open-loop Cueing On Gait In Pdmentioning

confidence: 94%

“…In contrast with open-loop cues, closed-loop cueing provides feedback on the user's performance in real-time which can facilitate modifying one's performance to achieve the desired movements. Real-time feedback of step length [67][68][69][70] and uprightness of posture [69] have been investigated for targeting PD-specific gait and posture deficits. However, these studies used treadmill-based cueing systems and, therefore, are not suitable for overground locomotion during free-living conditions.…”

Section: Cueing For Rehabilitation In Pdmentioning

confidence: 99%

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Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Muthukrishnan

Abbas

Shill

et al. 2019

Sensors

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Progressive gait dysfunction is one of the primary motor symptoms in people with Parkinson's disease (PD). It is generally expressed as reduced step length and gait speed and as increased variability in step time and step length. People with PD also exhibit stooped posture which disrupts gait and impedes social interaction. The gait and posture impairments are usually resistant to the pharmacological treatment, worsen as the disease progresses, increase the likelihood of falls, and result in higher rates of hospitalization and mortality. These impairments may be caused by perceptual deficiencies (poor spatial awareness and loss of temporal rhythmicity) due to the disruptions in processing intrinsic information related to movement initiation and execution which can result in misperceptions of the actual effort required to perform a desired movement and maintain a stable posture. Consequently, people with PD often depend on external cues during execution of motor tasks. Numerous studies involving open-loop cues have shown improvements in gait and freezing of gait (FoG) in people with PD. However, the benefits of cueing may be limited, since cues are provided in a consistent/rhythmic manner irrespective of how well a person follows them. This limitation can be addressed by providing feedback in real-time to the user about performance (closed-loop cueing) which may help to improve movement patterns. Some studies that used closed-loop cueing observed improvements in gait and posture in PD, but the treadmill-based setup in a laboratory would not be accessible outside of a research setting, and the skills learned may not readily and completely transfer to overground locomotion in the community. Technologies suitable for cueing outside of laboratory environments could facilitate movement practice during daily activities at home or in the community and could strongly reinforce movement patterns and improve clinical outcomes. This narrative review presents an overview of cueing paradigms that have been utilized to improve gait and posture in people with PD and recommends development of closed-loop wearable systems that can be used at home or in the community to improve gait and posture in PD.

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Section: Benefits Of Open-loop Cueing On Gait In Pdmentioning

confidence: 94%

Section: Cueing For Rehabilitation In Pdmentioning

confidence: 99%

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Muthukrishnan

Abbas

Shill

et al. 2019

Sensors

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“…A wide-angle projector (beamer) situated in front of the belt projects stepping targets for the purpose of visual gait training. The Zebris treadmill has been successfully used for gait rehabilitation in patients with Parkinson’s disease [32]The C-Mill treadmill: this treadmill (MotekForce Link, Doorn, The Netherlands) is equipped with an embedded 70 × 300 cm vertical force platform. The long walking surface allows users to exercise gait agility in varying positions along the belt.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Visually-guided gait training in paretic patients during the first rehabilitation phase: study protocol for a randomized controlled trial

Rossano

Terrier

2016

Trials

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BackgroundAfter a lesion to the central nervous system, many patients suffer from reduced walking capability. In the first rehabilitation phase, repeated walking exercises facilitate muscular strength and stimulate brain plasticity and motor relearning. However, marked limping, an unsteady gait, and poor management of obstacle clearance may persist, which increases a patient’s risk of falling. Gait training with augmented reality has been recommended to improve gait coordination. The objective of this study is to test whether a gait rehabilitation program using augmented reality is superior to a conventional treadmill training program of equivalent intensity.Methods/designThe GASPAR trial (Gait Adaptation for Stroke Patients with Augmented Reality) is a pragmatic, parallel-arm, single-center, nonblind, superiority randomized control trial in neurorehabilitation. The setting is a rehabilitation clinic in Switzerland. The planned number of participants is 70–100. The intervention uses instrumented treadmills equipped with projectors that display shapes on the walking surface. The principle is that patients must adapt their gait to the image that unfolds in front of them. Specific exercises for gait symmetry, coordination enhancement, and gait agility are provided. The program includes twenty 30-min sessions spanning 4 weeks. The comparator group receives standard treadmill training of a similar frequency and intensity. The main outcome to be measured in the trial is walking speed, which is assessed with the 2-min Walk Test. Moreover, gait parameters are recorded during the gait training sessions. Other outcomes are balance control (Berg Balance Scale) and the fear of falling (Falls Efficacy Scale). The statistical analyses will compare the baseline assessment for each participant (before the intervention) with a post-intervention assessment (taken a few days after the end of the program). Furthermore, a follow-up assessment will take place 3 months after discharge.DiscussionThe study results will provide new knowledge about recovery in neurological patients and will contribute to the design of better rehabilitation programs to accompany this process. The findings will also help health care funders to decide whether treadmills equipped with augmented reality capabilities are a worthwhile investment.Trial registrationClinicalTrials.gov ID: NCT02808078, registered on 16 June 2016.

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“…Visual cueing was also explored as a technique to improve gait performance in PD. Schlick et al (2015) run an experiment with PD patients (N = 20, follow-up N=13) to evaluate the effects of visual cues combined with treadmill training on gait performance comparing it with the training on the treadmill without visual cues [275]. After the training period, gait speed and stride length had increased in both groups (p ≤ 0.05).…”

Section: Rehabilitation and Exercisementioning

confidence: 99%

A holistic approach to assess the feasability of telehealth for Parkinson's disease management

González¹

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Visual cues combined with treadmill training to improve gait performance in Parkinson’s disease: a pilot randomized controlled trial

Abstract: This pilot study suggests that visual cues combined with treadmill training have more beneficial effects on gait than pure treadmill training in patients with a moderate stage of Parkinson's disease. A large-scale study with longer follow-up is required.

Cited by 55 publications

References 29 publications

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Visually-guided gait training in paretic patients during the first rehabilitation phase: study protocol for a randomized controlled trial

A holistic approach to assess the feasability of telehealth for Parkinson's disease management

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