Gait Re-education in Parkinson's: Difference between revisions
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== Introduction<br> == | |||
Parkinson disease (PD) [[Parkinsons_Disease]] is a progressive neurodegenerative movement disorder caused by a lack of dopamine production in the substantia nigra. The cardinal features of this disorder include bradykinesia, gait disturbance, rigidity, and tremor <ref name="bennett">Bennett DA, Beckett LA, Murray AM, et al. Prevalence of parkinsonian signs and associated mortality in a community population of older people. N Engl J Med. 1996;334:71–76</ref> Impairments of balance and postural stability likely contribute to the increased risk of falls and fractures found in this patient population <ref name="johnell">Johnell O, Melton LJ, III, Atkinson EJ, O’Fallon WM, Kurland LT. Fracture risk in patients with parkinsonism: A population-based study in Olmsted County, Minnesota. Age Ageing. 1992;21:32–38.</ref>. In response to perturbations of balance with backward waist pull, individuals with PD demonstrated differences in weight shift, use a modified ankle joint motion before liftoff, and land with weight shifted posteriorly compared with healthy age-matched controls <ref name="mcvey">McVey MA, Stylianou AP, Luchies CW, et al. Early biomechanical markers of postural instability in Parkinson’s disease. Gait Posture. 2009;30:538–542</ref> .<br> | |||
== Typical gait pattern in Parkinson's Disease (PD) == | == Typical gait pattern in Parkinson's Disease (PD) == | ||
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*Speed and stride length decrease further when there is other tasks added | *Speed and stride length decrease further when there is other tasks added | ||
This leads to an increased risk of falls. | This leads to an increased risk of falls. | ||
== Intervention aimed at improving gait == | == Intervention aimed at improving gait == | ||
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Introduction
[edit | edit source]
Parkinson disease (PD) Parkinsons_Disease is a progressive neurodegenerative movement disorder caused by a lack of dopamine production in the substantia nigra. The cardinal features of this disorder include bradykinesia, gait disturbance, rigidity, and tremor [1] Impairments of balance and postural stability likely contribute to the increased risk of falls and fractures found in this patient population [2]. In response to perturbations of balance with backward waist pull, individuals with PD demonstrated differences in weight shift, use a modified ankle joint motion before liftoff, and land with weight shifted posteriorly compared with healthy age-matched controls [3] .
Typical gait pattern in Parkinson's Disease (PD)[edit | edit source]
- Short, shuffling steps
- Uneven and shortened step length
- Flexed posture
- Akinesia
- Freezing especially when turning
- Increased time in double stance phase to increase stability
- Speed and stride length decrease further when there is other tasks added
This leads to an increased risk of falls.
Intervention aimed at improving gait[edit | edit source]
- Increase speed by increasing stride length not cadence
- Interventions must combine strength, flexibility and balance
- Progression should include dual tasks, stepping backwards, negotiation of obstacles
- Cueing and attentional strategies
- Cognitive strategies
Cueing and attentional strategies[edit | edit source]
External cues can be auditory or visual.
Attentional strategies are consciously concentrating on a specific aspect of gait.
By using cueing and attentional strategies the defective basal ganglia are being bypassed. They no longer automatically have to control the movement as it has now become a cognitive task.
Evidence:
A sytematic review of 24 studies showed that there was strong evidence that auditory cueing increased speed but there was insufficient evidence for visual and somatosensory cueing.[4]
References[edit | edit source]
- ↑ Bennett DA, Beckett LA, Murray AM, et al. Prevalence of parkinsonian signs and associated mortality in a community population of older people. N Engl J Med. 1996;334:71–76
- ↑ Johnell O, Melton LJ, III, Atkinson EJ, O’Fallon WM, Kurland LT. Fracture risk in patients with parkinsonism: A population-based study in Olmsted County, Minnesota. Age Ageing. 1992;21:32–38.
- ↑ McVey MA, Stylianou AP, Luchies CW, et al. Early biomechanical markers of postural instability in Parkinson’s disease. Gait Posture. 2009;30:538–542
- ↑ Lim, I., Van Wegen, E., de Goede, C., Deutekom, M., Nieuwboer,A., Willems, A., Jones, D., Rochester, L and Kwakkel.G. (2005) 'Effects of external rhythmical cueing on gait in patients with Parkinson's Disease: a systematic review', Clinical Rehabilitation, 19(7), 695-713
