Abstract
BackgroundGait disturbance accompanies many neurodegenerative diseases; it is characteristic for Parkinson’s disease (PD). Treatment of advanced PD often includes deep brain stimulation (DBS) of the subthalamic nucleus. Regarding gait, previous studies have reported non-significant or conflicting results, possibly related to methodological limitations.ObjectiveThe objective of this prospective study was to assess the effects of DBS on biomechanical parameters of gait in patients with PD.MethodsTwenty-one patients with advanced PD participated in this prospective study. Gait was examined in all patients using the Zebris FDM-T pressure-sensitive treadmill (Isny, Germany) before DBS implantation and after surgery immediately, further immediately after the start of neurostimulation, and 3 months after neurostimulator activation. We assessed spontaneous gait on a moving treadmill at different speeds. Step length, stance phase of both lower limbs, double-stance phase, and cadence were evaluated.ResultsIn this study, step length increased, allowing the cadence to decrease. Double-stance phase duration, that is, the most sensitive parameter of gait quality and unsteadiness, was reduced, in gait at a speed of 4.5 km/h and in the narrow-based gaits at 1 km/h (tandem gait), which demonstrates improvement.ConclusionThis study suggests positive effects of DBS treatment on gait in PD patients. Improvement was observed in several biomechanical parameters of gait.
Highlights
Gait is a unique, extraordinarily complex motor behavior that is controlled by multiple areas of the central nervous system at the corticosubcortical and brainstem levels
This study suggests positive effects of deep brain stimulation (DBS) treatment on gait in Parkinson’s disease (PD) patients
Improvement was observed in several biomechanical parameters of gait
Summary
Extraordinarily complex motor behavior that is controlled by multiple areas of the central nervous system at the corticosubcortical and brainstem levels. Physiological gait can be achieved through the flawless coordination of three primary components: (1) locomotion, (2) balance, and (3) ability to adapt to the environment (Snijders et al, 2007). Any dysfunction in the musculoskeletal or nervous system can lead to gait alteration. The feared consequences of gait disturbance are usually falls and subsequent injuries. Injuries, and the fear of falling lead to declines in walking ability and increased patient dependency, that is, reliance on the help of others. Impaired mobility or immobility results in insufficient exposure to stimuli from the external environment and often leads to loss of patient interest in the environment and social isolation (Snijders et al, 2007). Gait disturbance accompanies many neurodegenerative diseases; it is characteristic for Parkinson’s disease (PD). Previous studies have reported non-significant or conflicting results, possibly related to methodological limitations
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