TY - JOUR
T1 - Exploring gait adaptations to perturbed and conventional treadmill training in Parkinson's disease
T2 - Time-course, sustainability, and transfer
AU - Steib, Simon
AU - Klamroth, Sarah
AU - Gaßner, Heiko
AU - Pasluosta, Cristian
AU - Eskofier, Björn
AU - Winkler, Jürgen
AU - Klucken, Jochen
AU - Pfeifer, Klaus
N1 - Funding Information:
The work was supported by the Emerging Fields Initiative [EFI Moves, 2 Med 03] of the FAU (Germany) and the German Foundation Neurology (Deutsche Stiftung Neurologie). Study sponsors were not involved in the study design, in the collection, in the analysis, in the interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/4
Y1 - 2019/4
N2 - Background: Gait impairment is a major motor symptom in Parkinson's disease (PD), and treadmill training is an effective non-pharmacological treatment option. Research question: In this study, the time course, sustainability and transferability of gait adaptations to treadmill training with and without additional postural perturbations were investigated. Methods: 38 PD patients (Hoehn & Yahr 1–3.5) were randomly allocated to eight weeks of treadmill training, performed twice-weekly for 40 min either with (perturbation treadmill training [PTT], n = 18) or without (conventional treadmill training [CTT], n = 20) additional perturbations to the treadmill surface. Spatiotemporal gait parameters were assessed during treadmill walking on a weekly basis (T0–T8), and after three months follow-up (T9). Additional overground gait analyses were performed at T0 and T8 to investigate transfer effects. Results: Treadmill gait variability reduced linearly over the course of 8 weeks in both groups (p <.001; Cohen's d (range): −0.53 to −0.84). Only the PTT group significantly improved in other gait parameters (stride length/time, stance-/swing time), with stride time showing a significant between-group interaction effect (Cohen's d = 0.33; p =.05). Additional between-group interactions indicated more sustained improvements in stance (Cohen's d = 0.85; p =.02) and swing time variability in the PTT group (Cohen's d = 0.82; p =.03) at T9. Overground gait improvements at T8 existed only in stance (d = -0.73; p =.04) and swing time (d = 0.73; p =.04). Discussion: Treadmill stride-to-stride variability reduced substantially and linearly, but transfer to overground walking was limited. Adding postural perturbations tended to increase efficacy and sustainability of several gait parameters. However, since between-group effects were small, more work is necessary to support these findings.
AB - Background: Gait impairment is a major motor symptom in Parkinson's disease (PD), and treadmill training is an effective non-pharmacological treatment option. Research question: In this study, the time course, sustainability and transferability of gait adaptations to treadmill training with and without additional postural perturbations were investigated. Methods: 38 PD patients (Hoehn & Yahr 1–3.5) were randomly allocated to eight weeks of treadmill training, performed twice-weekly for 40 min either with (perturbation treadmill training [PTT], n = 18) or without (conventional treadmill training [CTT], n = 20) additional perturbations to the treadmill surface. Spatiotemporal gait parameters were assessed during treadmill walking on a weekly basis (T0–T8), and after three months follow-up (T9). Additional overground gait analyses were performed at T0 and T8 to investigate transfer effects. Results: Treadmill gait variability reduced linearly over the course of 8 weeks in both groups (p <.001; Cohen's d (range): −0.53 to −0.84). Only the PTT group significantly improved in other gait parameters (stride length/time, stance-/swing time), with stride time showing a significant between-group interaction effect (Cohen's d = 0.33; p =.05). Additional between-group interactions indicated more sustained improvements in stance (Cohen's d = 0.85; p =.02) and swing time variability in the PTT group (Cohen's d = 0.82; p =.03) at T9. Overground gait improvements at T8 existed only in stance (d = -0.73; p =.04) and swing time (d = 0.73; p =.04). Discussion: Treadmill stride-to-stride variability reduced substantially and linearly, but transfer to overground walking was limited. Adding postural perturbations tended to increase efficacy and sustainability of several gait parameters. However, since between-group effects were small, more work is necessary to support these findings.
UR - http://www.scopus.com/inward/record.url?scp=85060871690&partnerID=8YFLogxK
U2 - 10.1016/j.humov.2019.01.007
DO - 10.1016/j.humov.2019.01.007
M3 - Article
C2 - 30711905
AN - SCOPUS:85060871690
VL - 64
SP - 123
EP - 132
JO - Human Movement Science
JF - Human Movement Science
SN - 0167-9457
ER -