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

Original Editor - Merinda Rodseth based on the course by Bhanu Ramaswamy

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

Gait Analysis[edit | edit source]

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[edit | edit source]

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.