Abstract
BackgroundGait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson’s disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters.AimTo evaluate the effect of 3D visual cues and STN-DBS on gait in PD group.MethodsWe enrolled 35 PD patients treated with DBS of nucleus subthalamicus (STN-DBS). Twenty-five patients (5 females; mean age 58.9 ±6.3) and 25 sex- and age-matched controls completed the gait examination. The gait in 10 patients deteriorated in OFF state. The severity of PD was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY). The PD group filled the Falls Efficacy Scale-International (FES) and Freezing of Gait Questionnaire (FOGQ). Gait was examined using the GaitRite Analysis System, placed in the middle of the 10m marked path. The PD group was tested without dopaminergic medication with and without visual cueing together with the DBS switched ON and OFF. The setting of DBS was double-blind and performed in random order.ResultsThe UPDRS was 21.9 ±9.5 in DBS ON state and 41.3 ±13.7 in DBS OFF state. HY was 2.5 ±0.6, FES 12.4 ±4.1 and FOGQ 9.4 ±5.7. In the DBS OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls. The walking speed and step length increased in the DBS ON state. The double support phase was reduced with 3D visual cueing and DBS; the combination of both cueing and DBS was even more effective.ConclusionCueing with 3D visual stimuli shortens the double support phase in PD patients treated with DBS-STN. The DBS is more effective in prolonging step length and increasing gait speed. We conclude that 3D visual cueing can improve walking in patients with DBS.
Highlights
People with Parkinson’s disease (PD) in advanced stages suffer frequently from gait disturbances, which could be partly influenced by dopaminergic medication
In the deep brain stimulation (DBS) OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls
We aimed to evaluate the effect of 3D visual cues and STN-DBS on gait in patients with advanced PD
Summary
People with Parkinson’s disease (PD) in advanced stages suffer frequently from gait disturbances, which could be partly influenced by dopaminergic medication. Gait impairment in PD is characterized by hypokinesia with lower speed, shortened step length, narrow step width, reduced counter-rotation of the trunk and decreased arm swing [1]. With the loss of dopaminergic neurons, some gait parameters (speed, stride length) [4] respond to dopaminergic medication, whereas temporal parameters (cadence, step and swing duration, double support time) improve to a lesser extent [5] or not at all [6]. Gait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson’s disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters
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