Abstract
Training subjects to step-in-place eyes open on a rotating platform while maintaining a fixed body orientation in space [podokinetic stimulation (PKS)] produces a posteffect consisting in inadvertent turning around while stepping-in-place eyes closed [podokinetic after-rotation (PKAR)]. Since the rationale for rehabilitation of curved walking in Parkinson’s disease is not fully known, we tested the hypothesis that repeated PKS favors the production of curved walking in these patients, who are uneasy with turning, even when straight walking is little affected. Fifteen patients participated in 10 training sessions distributed in 3 weeks. Both counterclockwise and clockwise PKS were randomly administered in each session. PKS velocity and duration were gradually increased over sessions. The velocity and duration of the following PKAR were assessed. All patients showed PKAR, which increased progressively in peak velocity and duration. In addition, before and at the end of the treatment, all patients walked overground along linear and circular trajectories. Post-training, the velocity of walking bouts increased, more so for the circular than the linear trajectory. Cadence was not affected. This study has shown that parkinsonian patients learn to produce turning while stepping when faced with appropriate training and that this capacity translates into improved overground curved walking.
Highlights
Gait disturbances are a critical issue in patients with Parkinson’s disease (PD) [1, 2]
We found no difference in the mean cadence between the stepping tasks performed in the three different phases (“control” stepping: 122.6 ± 27.1 steps/min; podokinetic stimulation (PKS): 123.9 ± 29.9; podokinetic after-rotation (PKAR): 126.7 ± 33.4)
We advanced the approach described in Ref. [63] and embarked on a complex study aimed at verifying the hypothesis that parkinsonian patients can improve their production of curved walking by learning the basic features of turning while stepping and can transfer their newly acquired pattern to overground walking along a circular trajectory
Summary
Gait disturbances are a critical issue in patients with Parkinson’s disease (PD) [1, 2]. Motion of the lower limbs is asymmetric, whereby the leg inside the trajectory travels a shorter path than the outside leg [5, 10, 12, 15]. These subtasks are normally performed unconsciously, but PD is associated with impaired gait automaticity, such as reduced arm swing, decreased stride length, overall instability [16], and trunk rigidity [17]. Given the complex coordination and multisensory integration underlying curved walking [17, 18], studies requiring patients with PD to travel both linear and circular pathways have detected additional abnormalities during curved walking [19,20,21,22,23]
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