Gait Re-education in Parkinson's: Difference between revisions
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Coupled with these gait impairments are an increased risk and rate of falling. Increased probability of falls not only increases the risk of injury such as hip fracture, but also affects an individual's independence and ability to interact within the community. Additionally, fear of falling has psychological consequences and can lead to self-isolation and depression.<ref>Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord. 2004;19:871–884</ref> | Coupled with these gait impairments are an increased risk and rate of falling. Increased probability of falls not only increases the risk of injury such as hip fracture, but also affects an individual's independence and ability to interact within the community. Additionally, fear of falling has psychological consequences and can lead to self-isolation and depression.<ref>Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord. 2004;19:871–884</ref> | ||
== Gait kinematics<br> == | === Gait kinematics<br> === | ||
The changes in gait kinematics include changes in excursion of the hip and ankle joint .Instead of a heel-toe progression, the patient may have a flat-footed or. with disease progression, a toe-heel sequence. The patient with Parkinson's disease appears to have lost the adult gait pattern and is using a more primitive pattern. The flat-footed gait decreases the abillity to step over Obstacles or walk on carpeted surfaces. The use of three-dimensional gait analysis bas shown a decrease in plantar flexion at terminal stance. Changes are also seen in hip flexion, which may alter ankle excursion. However, qualitative aspects of the timing of joint excursion appear intact. <br> | The changes in gait kinematics include changes in excursion of the hip and ankle joint .Instead of a heel-toe progression, the patient may have a flat-footed or. with disease progression, a toe-heel sequence. The patient with Parkinson's disease appears to have lost the adult gait pattern and is using a more primitive pattern. The flat-footed gait decreases the abillity to step over Obstacles or walk on carpeted surfaces. The use of three-dimensional gait analysis bas shown a decrease in plantar flexion at terminal stance. Changes are also seen in hip flexion, which may alter ankle excursion. However, qualitative aspects of the timing of joint excursion appear intact. <br> | ||
Revision as of 18:00, 1 March 2015
Original Editor - Irene Leahy Purnima Shrivastava
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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]
People with PD often experience increased gait impairments as the disease progresses and symptoms become more severe [4] Impairments include [5] [6] [7]
- hypokinesia (decreased step length with decreased speed),
- decreased coordination,
- festination (decreased step length with increased cadence),
- freezing of gait (the inability to produce effective steps at the initiation of gait or the complete cessation of stepping during gait), and
- difficulty with dual tasking during gait.
Coupled with these gait impairments are an increased risk and rate of falling. Increased probability of falls not only increases the risk of injury such as hip fracture, but also affects an individual's independence and ability to interact within the community. Additionally, fear of falling has psychological consequences and can lead to self-isolation and depression.[8]
Gait kinematics
[edit | edit source]
The changes in gait kinematics include changes in excursion of the hip and ankle joint .Instead of a heel-toe progression, the patient may have a flat-footed or. with disease progression, a toe-heel sequence. The patient with Parkinson's disease appears to have lost the adult gait pattern and is using a more primitive pattern. The flat-footed gait decreases the abillity to step over Obstacles or walk on carpeted surfaces. The use of three-dimensional gait analysis bas shown a decrease in plantar flexion at terminal stance. Changes are also seen in hip flexion, which may alter ankle excursion. However, qualitative aspects of the timing of joint excursion appear intact.
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.[9]
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
- ↑ Gray P, Hildebrand K. Fall risk factors in Parkinson's disease. J Neurosci Nurs. 2000;32:222–228
- ↑ Morris M, Iansek R, Galna B. Gait festination and freezing in Parkinson's disease: pathogenesis and rehabilitation. Mov Disord. 2008;23:S451–S460
- ↑ Plotnik M, Giladi N, Hausdorff JM. Bilateral coordination of gait and Parkinson's disease: the effects of dual tasking. J Neurol Neurosurg Psychiatry. 2009;80:347–350
- ↑ Yogev G, Plotnik M, Peretz C, et al. Gait asymmetry in patients with Parkinson's disease and elderly fallers: when does the bilateral coordination of gait require attention? Exp Brain Res. 2007;177:336–346
- ↑ Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord. 2004;19:871–884
- ↑ 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
