Parkinson’s Case Study 2: Gait Analysis and Treatment of Maureen

Original Editor - Merinda Rodseth

Top Contributors - Merinda Rodseth, Kim Jackson and Tarina van der Stockt  

Gait Analysis

Dr Ramaswamy’s analysis of Maureen’s gait can be seen in the table below.

Parameters	Forward and backward walking pre-treatment	Forward and backward walking post-treatment
Walking speed and cadence	Forwards: 14 steps over an 8m distance in 8 seconds. Cadence:105 steps/minute Backwards: 17 steps over an 8m distance	Similar cadence, slightly slower walking speed due to fatigue
Step/stride length	Forwards: stride length over 50cm - good for age and condition	Similar step length
Step width	Backwards: Increased adduction of the leg	Less adduction of the hips and a more consistent step width
Floor clearance	Each foot clears the floor, no concerns
Posture and biomechanics	Backward walking: Increased trunk rotation to adapt for limited hip extension Increased knee flexion to pull the leg back, placing the toes on the floor and then extending the leg over that - not a normal pattern Poor loading over the left hip Posture: Thoracic kyphosis and forward stoop Neck hinge following the kyphosis Increased extension of the arms to accommodate for the kyphosis and forward stoop	Backward walking: Improved activity in the extensors of the body Less rotation of the trunk Improved hip extension More freedom of movement of the right arm Using less knee flexion to get the leg back Better loading over the left hip as she shifts weight Better control of walking

Treatment

It is essential to keep the patient’s goals in mind when considering choices for treatment. Maureen’s goals when attending this session was to:

• Recover/improve her activity levels
• Improve the wheezing in her chest
• Reduce the occurrence of drooling

To improve Maureen’s activity levels, Dr Ramaswamy aimed to loosen Maureen’s body so that it will be in a good starting position for her to quickly recruit the muscles and joints while also working to improve the loading through her left side, which is more affected by the Parkinson’s. Any trunk rotation movement gained would also aid to improve Maureen’s wheezing. Treatment included:

• Mobilisation of the trunk and the shoulder girdle on both sides
• Weight transfers in sitting by elongating the trunk side-to-side
• Exercises using the battle ropes – incorporating chest extension and arm mobility while the legs are working into both flexion and extension as she goes into a squat.