Abstract
The aim of this study was to assess the effect of physical exercise on gait pattern disorders, based on three-dimensional gait analysis in the sagittal plane in a group of people with Parkinson's disease (PD). Thirty-two subjects with PD (14 women and 18 men; age: 50-75 years) were qualified for the study, which ran for 3 weeks and included 18 therapeutic sessions. Thirty-five control subjects were included in the research (13 women and 19 men; age: 52-77 years). Gait analysis using the Vicon 3D system took place in the Biokinetics Laboratory. The research group was tested before and after treatment, and the control group was tested once. Comparing the average peak angle changes and average standard time results (% gait cycle) corresponding with angles of movement in the lumbar spine, cervical spine, elbow joint, and shoulder joint, statistically significant changes were observed. The study results are indicative of differences in spatiotemporal parameters and angular changes in gait for both groups. After therapeutic treatment, we observed improvement in the angular range of changes in thorax tilting, but there were no difference between the most affected and less affected side. For the cervical spine, a significant reduction in flexion during dual support was observed. The angular range of changes in shoulder joint was significant only in less affected shoulder during the initial contact (F1), terminal stance (F4), and terminal stance (F8) phases of gait (p < 0.05). After therapeutic treatment, significant angle and setting changes in the most affected limb of the elbow joint occurred during the initial contact and terminal swing phases (F1, F8). In the terminal stance phase (F4), an increase in range of motion by about ±4° was observed (p < 0.05). Exercise therapy slightly increased the range of movement in the examined joints of PD's patients. Results of pathological walking patterns occurring prior to treatment improved after treatment and moved closer to the physiological gait pattern.
Highlights
Postural instability, bradykinesia, hypokinesia/akinesia, rigidity, and tremors are clinical elements in the diagnosis of Parkinson’s disease (PD) [1]
The inclusion criteria were: idiopathic PD diagnosed according to the UK PD Society Brain Bank criteria, I–III stage of the disease according to the Hoehn and Yahr scale [we used (MA) for most affected side of a body and (LA) for less affected side of the body], continuous pharmacological treatment with no change in doses for the last 3 months, 50–80 years of age, absence of additional neurological disorders or severe musculoskeletal system problems; no contraindications to physical training, capacity to provide written informed consent for participation in the study
The significantly smaller range of angular changes in the most affected shoulder joint during the terminal stance (F4) phase of gait registered before therapy differed by about ±6°, compared with the healthy subjects (p < 0.05, Figure 3)
Summary
Bradykinesia, hypokinesia/akinesia, rigidity, and tremors are clinical elements in the diagnosis of Parkinson’s disease (PD) [1]. Arm swing is an essential component of locomotion, which may influence human gait stability and remain reduced for even several years prior to diagnosis of PD [3,4,5,6]. Elftman [5] reported that arm swing decreases angular momentum around the vertical and vertical ground reaction moment causing a minimization of energy consumption. In this manner, arm swings generate a horizontal torque to the upper trunk, and through the shoulder girdle, they work as a gravitational pendulum. Some studies tried to answer the question whether arm swing is actively controlled (driven by muscle activity) or rather passive [7, 8]. The assumption of a partly passive arm swing arose from the idea of evolution adjustment after a change from quadrupedal to bipedal locomotion
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