Abstract
Background: Gait disorders represent disabling symptoms in Parkinson's Disease (PD). The effectiveness of rehabilitation treatment with Body Weight Support Treadmill Training (BWSTT) has been demonstrated in patients with stroke and spinal cord injuries, but limited data is available in PD.Aims: The aim of the study is to investigate the efficacy of BWSTT in the rehabilitation of gait in PD patients.Methods: Thirty-six PD inpatients were enrolled and performed rehabilitation treatment for 4-weeks, with daily sessions. Subjects were randomly divided into two groups: both groups underwent daily 40-min sessions of traditional physiokinesitherapy followed by 20-min sessions of overground gait training (Control group) or BWSTT (BWSTT group). The efficacy of BWSTT was evaluated with clinical scales and Computerized Gait Analysis (CGA). Patients were tested at baseline (T0) and at the end of the 4-weeks rehabilitation period (T1).Results: Both BWSTT and Control groups experienced a significant improvement in clinical scales as FIM and UPDRS and in gait parameters for both interventions. Even if we failed to detect any statistically significant differences between groups in the different clinical and gait parameters, the intragroup analysis captured a specific pattern of qualitative improvement associated to cadence and stride duration for the BWSTT group and to the swing/stance ratio for the Control group. Four patients with chronic pain or anxious symptoms did not tolerate BWSTT.Conclusions: BWSTT and traditional rehabilitation treatment are both effective in improving clinical motor functions and kinematic gait parameters. BWSTT may represent an option in PD patients with specific symptoms that limit traditional overground gait training, e.g., severe postural instability, balance disorder, orthostatic hypotension. BWSTT is generally well-tolerated, though caution is needed in subjects with chronic pain or with anxious symptoms.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03815409
Highlights
Gait disorders in Parkinson’s Disease (PD) are due to dopaminergic nigrostriatal pathways degeneration and represent important components of the disability [1].In PD, gait is characterized by a significant reduction of stride length [2]
Body Weight Support Treadmill Training (BWSTT) may represent an option in PD patients with specific symptoms that limit traditional overground gait training, e.g., severe postural instability, balance disorder, orthostatic hypotension
In line with this result, Functional Independence Measure (FIM) significantly improved at T1 in both groups of patients (BWSTT group: T0 = 99.5 ± 12.3, T1 = 107.0 ± 10.4; p = 0.01; Control group: T0 = 99.6 ± 16.2, T1 = 110.1 ± 15.5; p = 0.01)
Summary
Gait disorders in Parkinson’s Disease (PD) are due to dopaminergic nigrostriatal pathways degeneration and represent important components of the disability [1].In PD, gait is characterized by a significant reduction of stride length [2]. Body weight supported treadmill training (BWSTT) represents a promising rehabilitative approach for gait impairment in PD [10, 11]. In PD, many data in literature show how treadmill training, acting as a sensory cue, improves kinetic and kinematic parameters, studied with computerized gait analysis (CGA), more than physiotherapy alone. Most of the data recorded with computerized movement analysis derived from BWSTT delivered with robotic devices [19,20,21,22]. A limited number of studies has instead investigated the effect of non-robotic BWSTT on gait kinetic and kinematic data. The effectiveness of rehabilitation treatment with Body Weight Support Treadmill Training (BWSTT) has been demonstrated in patients with stroke and spinal cord injuries, but limited data is available in PD
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