Absent Arm Swing and Dual Tasking Decreases Trunk Postural Control and Dynamic Balance in People With Parkinson's Disease.

Tarique Siragy,Julie Nantel

doi:10.3389/fneur.2020.00213

Abstract

Introduction: Falling during walking is a common occurrence in people with Parkinson's disease and is closely associated with severe social and medical consequences. Recent evidence demonstrates that arm swing affects dynamic balance in healthy young adults; however, it remains unexamined what its effect is in people with Parkinson's disease, particularly when combined with a secondary dual task.Methods: Twenty people with Parkinson's disease (63.78 ± 8.97) walked with two arm swing conditions (absent and normal) with and without a secondary dual task. Data were collected on a split-belt treadmill CAREN Extended-System (Motek Medical, Amsterdam, NL). Average and standard deviations for trunk linear and angular velocity were calculated along with their instantaneous values (during foot strikes) in all three axes. Averages and coefficient of variations for step length, time, and width; margin of stability; and harmonic ratios were also calculated.Results: Compared with normal arm swing, absent arm swing reduced the least affected leg's average step length and increased its step length coefficient of variation while increasing step time coefficient of variation in the most affected leg. Further, absent arm swing reduced trunk anteroposterior instantaneous angular velocity (least affected leg) and reduced anteroposterior instantaneous linear velocity (bilaterally). For the vertical axis, absent arm swing increased the trunk's average angular velocity but reduced its instantaneous linear velocity and angular velocity standard deviation (least affected leg). Additionally, the margin of stability increased when the arms were absent (least affected leg). Alternatively, dual tasking reduced average step time (most affected leg) and increased the step width coefficient of variation (bilaterally). Additionally, dual tasking increased the mediolateral average angular velocity, instantaneous linear velocity standard deviation (bilaterally), and instantaneous angular velocity standard deviation (least affected leg). For the vertical axis, dual tasking increased average linear and angular velocity standard deviation as well as instantaneous angular velocity standard deviation (bilaterally).Conclusion: Findings suggest that participants attempted to control extraneous trunk movement (due to absent arm swing) through compensatory responses in both lower and upper extremities. However, participants appeared to predominately compensate on their least affected side. Contrastingly, modifying mediolateral foot placement appeared to be the main means of maintaining walking stability while dual tasking.

Highlights

Falling during walking is a common occurrence in people with Parkinson’s disease and is closely associated with severe social and medical consequences
As the center of mass (COM) is located in the upper extremity and the lower extremity adapts foot placement to modify the base of support, each is an integral component for maintaining dynamic balance [19, 20]
Dynamic balance (HRs, margin of stability (MOS), and coefficient of variation (COV)) measures are reported in Table 1A, whereas spatiotemporal averages are reported

Summary

Introduction

Falling during walking is a common occurrence in people with Parkinson’s disease and is closely associated with severe social and medical consequences. Parkinson’s disease (PD) is the second most common neurodegenerative disease worldwide and is caused by progressive neurodegeneration within the basal ganglia of dopaminergic neurons [1, 2] In addition to causing PD’s cardinal symptoms (bradykinesia, rigidity, and tremor), the basal ganglia’s impaired function disrupts the gait pattern in people with PD (pwPD) [1]. This is concerning, as falling during walking is a debilitating threat that is closely associated with reduced autonomy and quality of life, hip fractures, and morbidity [3, 4]. As the center of mass (COM) is located in the upper extremity and the lower extremity adapts foot placement to modify the base of support, each is an integral component for maintaining dynamic balance (defined as maintaining the COM within a moving base of support) [19, 20]

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Discussion

Conclusion