Analysis of parallel and transverse visual cues on the gait of individuals with idiopathic Parkinson’s disease

Abstract

Idiopathic Parkinson's disease (IPD) has been defined as a chronic progressive neurological disorder with characteristics that generate changes in gait pattern. Several studies have reported that appropriate external influences, such as visual or auditory cues may improve the gait pattern of patients with IPD. Therefore, the objective of this study was to use three-dimensional (3D) analysis to evaluate the effects of parallel (PVC) and transverse visual spatial cues (TVCs) on gait variables (spatiotemporal and kinematic) of individuals with IPD. Twelve IPD patients were recruited from the Neurology Clinic, Medical School Hospital, Unicamp. The patients were initially evaluated using a modified Hoehn and Yahr Scale and subsection III of the Unified Parkinson's Disease Rating Scale. A 3D analysis system consisting of six infrared cameras and 18 markers (with a sampling rate of 240 Hz) was used for gait evaluation at the Laboratory for Rehabilitation and Biomechanics of the Locomotor System - Unicamp. Patients were asked to walk down a walkway under the following circumstances: baseline condition (BC, without visual cues), TVCs (20 pieces of white adhesive tape, 5 cm width and 50 cm length, placed 45 cm apart) and PVCs (two adhesive white tapes, 30 cm distance between them, 5 cm width each tape, along the walkway). Compared with the patients without visual cues, gait velocity was higher with the aid of visual cues (PVCs and TVCs, P=0.003), and the percentage of leg stance time was smaller when cues were used (this value was significant for the right leg, P=0.008). In addition, stride length was significantly higher with the use of TVCs (P=0.006) compared with BC and PVCs. Regarding kinematic variables, TVCs resulted in smaller ranges of motion in knee joint flexion at initial contact and higher maximal amplitudes of knee flexion during the oscillatory phase compared with BC and PVCs. In conclusion, The use of TVCs on the gait evaluation results in improved gait variables compared with BC and PVCs. Therefore, the use of TVCs in a rehabilitation plan would be ideal for a physiotherapeutic treatment with emphasis on gait alterations.