Peripheral neurostimulation breaks the shuffling steps patterns in Parkinsonian gait: a double blind randomized longitudinal study with automated mechanical peripheral stimulation.

Abstract

The shuffling steps pattern is a typical feature of gait in patients affected by Parkinson's disease (PD), which progressively reduces their quality of life, being related to the risk of falls in this population. Recently, Automated Mechanical Peripheral Stimulation (AMPS) was presented as an integrative rehabilitative treatment based on peripheral stimulation able to improve the gait spatiotemporal parameters in PD patients. The aim of this study was to evaluate the effects of AMPS on shuffling steps pattern by analyzing the kinematic and spatio-temporal gait parameters. Double blind randomized longitudinal study. Outpatients. PD patients. In this double blind randomized longitudinal study, 14 patients with PD were treated with effective-AMPS (AMPS group), while 14 PD patients were treated with placebo-AMPS (SHAM group); 32 healthy subjects were deemed the control group (CG). A dedicated medical device (Gondola™ Medical Technologies, Stabio, Switzerland) was used to deliver both stimulations. Each treatment session lasted about 15 minutes, including preparation (approx. 10 to 13 minutes) and stimulation (approx. 2 minutes). All PD patients were given six AMPS/SHAM treatments sessions, twice a week, delivered during the off-levodopa phase, having withdrawn from dopaminergic medication overnight. We evaluated spatio-temporal and kinematic variables of gait with quantitative 3D-gait analysis as follows: before and after the first intervention (acute phase), then after the sixth session (long term phase). We detected differences in all gait variables immediately after the first session of AMPS treatment and again after the sixth stimulation session. AMPS treatment changes the shuffling steps pattern that is typical of PD subjects, increasing the ROM of hip, knee and ankle joints during the gait cycle. This data presents further evidence that a rehabilitative approach based on the AMPS treatment can induce improvements in the gait pattern of patients affected by PD.