Abstract
BackgroundGait impairments including shuffling gait and hesitation are common in people with Parkinson’s disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD.ObjectiveThis study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS).MethodsA total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated.ResultsThe results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=–0.60, P<.001; dual task: r=–0.52, P<.001), initial step angle (single task: r=–0.35, P=.006; dual task: r=–0.35, P=.01), and last step angle (single task: r=–0.43, P=.001; dual task: r=–0.41, P=.002).ConclusionsThis pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.
Highlights
Gait impairment, which is induced by diminished locomotor control [1], is highly prevalent in Parkinson’s disease (PD) [2]
This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics http://mhealth.jmir.org/2020/3/e16650/
We aimed to explore if the angular characteristics of gait, especially in the sagittal plane, are sensitive to the clinical and functional characteristics of PD by measuring the step angles using wearable sensors fixed on the ankles
Summary
Gait impairment, which is induced by diminished locomotor control [1], is highly prevalent in Parkinson’s disease (PD) [2]. People with PD often suffer from multiple symptoms of gait impairment, including freezing of gait, hesitation at the beginning of walking, festination, and difficulty in stopping at the end of walking [3]. These gait impairments often lead to increased risk of falls, loss of functional independence in daily life, and even increased risk of morbidity and mortality [4]. Studies have linked the subtle changes in PD gait to other diseases and conditions such as dementia and history of head trauma [5] It is of great clinical significance to measure and characterize the gait in PD, which will provide insights into the pathophysiology of PD and help optimize the therapeutic strategies such as deep brain stimulation (DBS). Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
