Objective impairment of tandem gait in Parkinson's disease patients increases with disease severity. (November 2019)

• Record Type: Journal Article
• Authors: Sharma, Rohan; Pillai, Lakshmi; Glover, Aliyah; Virmani, Tuhin
• Is Part Of: Parkinsonism & related disorders. Volume 68(2019)
• Page Start: 33
• Page End: 39
• Publication Date: 2019-11
• Subjects: Tandem gait -- Falls -- Parkinson's disease -- Freezing of gait; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2019.09.023
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Introduction: Tandem gait abnormalities have been reported to increase with advancing age, play a role in fall-prediction in Parkinson's disease, and distinguish it from atypical parkinsonism. Tandem gait has been scored based on the number of side steps off a straight line in these studies. Objective measurement of spatiotemporal tandem gait parameters in Parkinson's disease has not been previously reported. Methods: Subjects (74 Parkinson's disease and 28 controls) were enrolled after IRB approval. Those with more than 1 fall/day or a Montreal Cognitive Assessment score <10 were excluded. Subjects tandem walked ("heel to toe") on a 20 foot pressure-sensor mat. Data was collected and analyzed using PKMAS software (Protokinetics). Results: Compared to controls, on tandem gait, Parkinson's subjects had increased step width, stride width and path width, with a slower stride velocity and an increased time spent in all phases of the gait cycle. Parkinson's subjects also applied greater pressure with each step and had greater step-to-step variability in tandem gait measures. While Hoehn & Yahr stage 1 subjects were not significantly different from controls, stage 2 and 2.5 + groups were different. Parkinson's subjects with freezing of gait also walked with a wider base compared to those without gait freezing. Tandem gait spatiotemporal parameters were not correlated with fall frequency. Conclusions: Tandem gait is impaired in Parkinson's disease in a stage-dependent manner, with wider base and increased step-to-step variability, which could suggest involvement of cerebellar and mediolateral balance pathways. Highlights: Objective tandem gait abnormalities can be measured in Parkinson's disease patients. Parkinson's patients took wider and slower steps than age matched controls. Tandem step-to-step variability was also increased in Parkinson's disease patients. Spatiotemporal tandem measures worsened with increasing Hoehn & Yahr disease stage. Parkinson's patients with freezing of gait took wider steps than non-freezers.