Artikel
Training effects on gait parameters during obstacle negotiation in Parkinson's disease patients: preliminary data
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Autoren
Veröffentlicht: | 18. Dezember 2006 |
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Gliederung
Text
Parkinson’s disease (PD) patients present difficulties in performing sequential tasks such as walking and stepping over an obstacle. However, the influence of regular practice of physical activities on the gait parameters over uneven terrain is less known.
Objective
The aim of this study was to verify the effects of a training program on the gait parameters of the adaptive step over the obstacle.
Methods
Twenty-nine patients with idiopathic PD (18 men and 11 women; 66.8+8.2 year-old; severity stages from 1 to 3 by Hoehn and Yahr Scale) were selected for participation in the study. Spatial parameters of gait while stepping over the obstacle were collected by a digital camcorder at 60Hz. Passive markers were attached at the fifth metatarsal, calcaneus, and lateral malleolus of right limb (leading limb) and first metatarsal, calcaneus, and medial malleolus of the left limb (trailing limb). Participants were invited to walk and step over each one of two personalized obstacles (mid shank and ankle height) that were placed on the middle of a 10m long and 1.4m wide pathway, during 5 trials per condition. This gait protocol was carried out before and after the training program. Fifteen patients have already completed 50 sessions of training that comprised activities equally distributed of resistive training, balance, and locomotion over uneven terrain across the University campus. The following dependent variables were collected at the adaptive step over the obstacle: leading and trailing foot placement before the obstacle; leading and trailing toe clearance; and leading foot placement after the obstacle crossing. Analyses have demanded a significant amount of work on the images (Dvideow 5.1 software) and then we have already finished the data analyses from four patients (total of 80 trials). Repeated measures ANOVA (2 obstacles and 2 training moments) by trial and for each dependent variable was used to verify the influence of obstacle height and training program on gait parameters during obstacle negotiation.
Results
The results revealed that obstacle height did not affect any of the adaptive gait parameters. On the other way, the training program exerts large influence on all gait measures. PD patients increased the leading and trailing foot placement before the obstacle (F1,38=9.742, p<0.004; F1,38=4.632, p<0.039; respectively), the safety margin over the obstacle for both limbs (F1,38=29.881, p<0.001; F1,38=9.764, p<0.004; respectively), and the leading foot placement after the obstacle crossing (F1,38=8.527, p<0.007).
Conclusion
These results revealed a trend in the way that the practice of physical activities in a specific training program comprising activities designed to develop strength, balance, and locomotion can improve the gait parameters during obstacle negotiation, in older people with Parkinson’s disease.
Acknowledgements: FAPESP, FUNDUNESP, CNPq, FNS-MS.