Abstract
Background: The Parkinsonian [i.e., Parkinson's disease (PD)] gait disorder represents a therapeutical challenge with residual symptoms despite the use of deep brain stimulation of the subthalamic nucleus (STN DBS) and medical and rehabilitative strategies. The aim of this study was to assess the effect of different DBS modes as combined stimulation of the STN and substantia nigra (STN+SN DBS) and environmental rehabilitative factors as footwear on gait kinematics.Methods: This single-center, randomized, double-blind, crossover clinical trial assessed shod and unshod gait in patients with PD with medication in different DBS conditions (i.e., STIM OFF, STN DBS, and STN+SN DBS) during different gait tasks (i.e., normal gait, fast gait, and gait during dual task) and compared gait characteristics to healthy controls. Notably, 15 patients participated in the study, and 11 patients were analyzed after a dropout of four patients due to DBS-induced side effects.Results: Gait was modulated by both factors, namely, footwear and DBS mode, in patients with PD. Footwear impacted gait characteristics in patients with PD similarly to controls with longer step length, lower cadence, and shorter single-support time. Interestingly, DBS exerted specific effects depending on gait tasks with increased cognitive load. STN+SN DBS was the most efficient DBS mode compared to STIM OFF and STN DBS with intense effects as step length increment during dual task.Conclusion: The PD gait disorder is a multifactorial symptom, impacted by environmental factors as footwear and modulated by DBS. DBS effects on gait were specific depending on the gait task, with the most obvious effects with STN+SN DBS during gait with increased cognitive load.
Highlights
Gait disorders with freezing of gait (FOG) remain some of the treatment-resistant symptoms in Parkinson’s disease (PD) (Ebersbach et al, 2013; Armstrong and Okun, 2020), which became a focus of interest in terms of precise characterization, clinical phenomenology, treatment effects, and environmental conditions in recent years (Nutt et al, 2011)
In healthy controls, gait velocity was higher (p = 0.003), step length (p = 0.001) and relative single support time (p = 0.033) were longer compared to patients with PD, whereas gait asymmetry (p = 0.052) and gait variability (p = 0.006) were smaller compared to patients with PD in different gait tasks
Cadence (p = 0.004) was higher in healthy controls compared to PD, while base width (p = 0.029) was smaller in the dual-task scenario in controls compared to patients with PD
Summary
Gait disorders with freezing of gait (FOG) remain some of the treatment-resistant symptoms in Parkinson’s disease (PD) (Ebersbach et al, 2013; Armstrong and Okun, 2020), which became a focus of interest in terms of precise characterization, clinical phenomenology, treatment effects, and environmental conditions in recent years (Nutt et al, 2011). In the clinical assessment and rehabilitative setting of the Parkinsonian gait disorder, there remains one simple question regarding environmental conditions: shod or unshod gait, i.e., do they differ, and if so, which one is better in the analysis and training setting in patients with PD?. The Parkinsonian [i.e., Parkinson’s disease (PD)] gait disorder represents a therapeutical challenge with residual symptoms despite the use of deep brain stimulation of the subthalamic nucleus (STN DBS) and medical and rehabilitative strategies. The aim of this study was to assess the effect of different DBS modes as combined stimulation of the STN and substantia nigra (STN+SN DBS) and environmental rehabilitative factors as footwear on gait kinematics
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