Abstract
Gait impairments and camptocormia (CC) are common and debilitating in patients with Parkinson's disease (PD). Two types of CC affect patients with PD, but no studies investigated their relative contribution in worsening gait and postural control. Therefore, we investigated spatiotemporal gait parameters, gait variability, and asymmetry and postural control in PD patients (Hoehn & Yahr ≤4) with upper CC and lower CC and patients without CC. This observational cross-sectional study involving patients with PD and upper CC (n=16) and lower CC (n=14) and without CC (n=16). The primary outcome measure was gait speed assessed by the GAITRite System. The secondary outcome measures were other spatiotemporal parameters, gait variability, and asymmetry. Postural control and balance were assessed with posturography and the Mini-BESTest. Patients with lower CC showed a higher H&Y stage (p=0.003), a worse PDQ8 (p=0.042), and a lower Mini-BESTest score (p=0.006) than patients with PD without CC. Patients with lower CC showed a reduced gait speed (p=0.012), stride length, and velocity than patients with PD without CC. Upper CC patients showed a higher stride length than lower CC ones (p=0.007). In the eyes open and closed condition, patients with lower CC showed a higher (worse) velocity of CoP displacement in mediolateral direction and length of CoP than patients with PD without CC. No significant between-group differences were measured in gait variability and asymmetry. In conclusion, lower CC was associated with more severe gait and postural control impairment than patients with upper CC and without CC. Categorizing CC based on the bending fulcrum is compulsory to identify patients with the worst performance and to implement specific rehabilitation programs.
Highlights
Gait impairments and camptocormia (CC) are common and debilitating in patients with Parkinson’s disease (PD) [1,2,3,4,5,6].ey impose substantial disability on these patients, increasing the risk of falling, and related injuries, and reducing the quality of life [1,2,3,4,5,6]
Categorizing CC based on the bending fulcrum is compulsory to identify patients with the worst performance and to implement specific rehabilitation programs
Exclusion criteria were severe dyskinesia or “on-off ” fluctuations; PD medication modification in the 3 months preceding the enrolment; the presence of Pisa syndrome (PS) [3]; a history of major spinal surgery or muscle and/or skeletal spine diseases; need for assistive devices to rise from a chair or bed; other neurological, orthopedic, or cardiovascular comorbidities that could interfere with gait; and ability to walk for at least 10 meters without the use of device
Summary
Gait impairments and camptocormia (CC) are common and debilitating in patients with Parkinson’s disease (PD) [1,2,3,4,5,6]. A consensus has been reached in differentiating forward trunk flexion in lower and upper camptocormias. No studies to date have explored the relative contribution to gait impairment and postural control of the upper and lower CC in patients with PD. E primary aim of this study was to investigate gait speed differences in patients with PD with upper and lower CC and patients with PD without CC. E secondary aim was to investigate changes in the other spatiotemporal gait parameters according to the conceptual models of gait [7] between patients with PD with upper and lower CC and patients with PD without CC. We hypothesized that patients with lower CC would be more affected than other groups in both gait and postural control due to biomechanical constraints to the lumbar/sacral region
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