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

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.

Differential responses to measures of gait performance among healthy and neurologically impaired individuals.

OBJECTIVES: To compare gait during a 5-minute walk among healthy individuals, persons with spinal cord injury (SCI), and stroke survivors and to investigate whether simultaneous measures of oxygen consumption enhance information about performance. DESIGN: Descriptive study. SETTING: Veterans Affairs medical center. PARTICIPANTS: Thirty-nine healthy individuals, 10 persons with SCI, and 20 stroke survivors. INTERVENTIONS: Participants were fitted with a portable gas analyzer and walked on a 5-m walkway for 5 minutes. MAIN OUTCOME MEASURES: Measures of walk distance, gait speed, gait energy expenditure (GEE), and gait cost were obtained, along with measures of ventilation (.Ve), ventilation and carbon dioxide production slope (.Ve . .VCo2), oxygen pulse, and heart rate. RESULTS: The SCI group (127.65+/-81.74m) walked less than the stroke survivors (148.80+/-64.3m) or the healthy group (268.90+/-35.01m) but had higher energy demands, as shown by GEE (SCI group, 13.28+/-3.23mL.kg(-1).min(-1); stroke group, 10.18+/-2.14mL.kg(-1).min(-1); healthy group, 9.61+/-1.90mL.kg(-1).min(-1)) and by gait cost (SCI group,.57+/-.40 mL.kg(-1).m(-1); stroke group,.40+/-.52mL.kg(-1).m(-1); healthy group,.18+/-.02mL.kg(-1).m(-1)). Compared with the healthy group, the stroke group had higher .Ve (stroke group, 22.34+/-5.20L/min vs healthy group, 16.11+/-3.22L/min) and .Ve . .VCo2 slope (24.22+/-8.80 vs 18.73+/-5.44, respectively). CONCLUSION: Use of metabolic assessment during the 5-minute walk was feasible and provided further information for evaluating gait performance with the subjects studied.

Performance-based gait tests for acute stroke patients.

OBJECTIVE: Qualitative measures may not differentiate severity of deficits after an acute or subacute stroke. The aim of this study was to contrast the utility of performance-based gait tests with qualitative measures in a sample of acute stroke patients. DESIGN: Twenty acute stroke subjects had their performance-based gait measured by gait speed, walking distance, gait energy expenditure, and gait energy cost. They were also qualitatively evaluated for cognition, functional outcomes, motor impairment, and Functional Ambulation Category. RESULTS: Strong and significant correlations were observed among performance-based gait tests. Qualitative scales indicated moderate to minimal deficits in each domain evaluated, although they were not correlated among themselves, except for Functional Ambulation Category and FIM and FIM and Mini-Mental State Exam. Functional Ambulation Category correlated with performance-based gait tests. CONCLUSIONS: Performance-based gait tests are feasible to conduct during early recovery after a stroke and allow better discrimination among the patients than qualitative measures.

Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study.

OBJECTIVE: To investigate gait outcomes with supported treadmill ambulation training (STAT) associated with regular rehabilitation in acute stroke survivors. DESIGN: Randomized controlled trial, pilot study. SETTING: Rehabilitation medicine service at a Veterans Affairs medical center. PARTICIPANTS: Seven acute stroke survivors assigned to regular intervention group and 6 patients assigned to STAT intervention. INTERVENTIONS: Regular intervention consisted of 3 hours daily of physical therapy, kinesiotherapy, and occupational therapy. STAT group received regular rehabilitation with STAT substituted for usual gait training. Participants were tested at baseline, treated for an average of 3 weeks, and retested on discharge. The analysis of covariance procedure was used to test for differences between the 2 approaches. MAIN OUTCOME MEASURES: Functional Ambulation Category Scale, gait speed, walking distance, gait energy expenditure, and gait energy cost. RESULTS: The small sample size did not generate enough power to detect significant differences in any variable. However, medium to large effect sizes of 0.7 and 1.16 standard deviation units were observed for gait energy cost and walk distance, respectively. CONCLUSIONS: This pilot study indicated that STAT is a safe, feasible, and promising intervention for acute stroke survivors. A larger trial is warranted for statistical relevance.