Comparison between forward and backward gait retraining for mobility in individuals with mild to moderate Parkinson's disease

[摘要] ENGLISH ABSTRACT : BackgroundDysfunctional gait and transitional movements are the most disabling features of Parkinson'sdisease (PD) and often relates to falls. Due to executive dysfunction in PD, dual tasking (DT) isdetrimental to already impaired mobility parameters. Backwards walking (BW) might be a usefultraining alternative to improve aberrant PD gait and transitional movements to consequentlyimprove the quality of complex, multi-directional daily activities, which most often involve DT.Over ground BW gait retraining has shown to be beneficial for neurological gait rehabilitation;however, has not yet been investigated in PD. Training in complex, novel tasks may induceenhanced cortical activity for movement preparation that is beyond training in automatic tasks.PurposeThis study aimed to compare the effect of an eight-week forward and backwards gait retrainingprogram on gait parameters, postural transitions and turning in PD individuals as well as therelated percentage DT interference (%DTC).MethodsThis randomized controlled trial was performed as a staggered design in the Western Cape.Twenty-nine PD individuals (34.5% women) with disease severity of 38.1±12.3 (MovementDisorder Society – Unified Parkinson‟s Disease Rating Scale; UPDRS III) were randomlyassigned into a forward (FWG) or backward (BWG) walking group by means of concealed,simple randomization (1:1 ratio). The FWG included 14 participants (aged: 70±11 years; Hoehnand Yahr (H&Y): 2.7±0.5; disease duration: 7±6 years) and was compared to 15 participants ofsimilar age (72±6 years), H&Y (2.7±0.9) and disease duration (5±3 years) in the BWG. Groupsperformed a 24-session (3x/week for eight weeks) over ground gait retraining program of thesame tasks in opposite directions. Descriptive measures at baseline included body mass index,experiences of daily living (UPDRS II), global cognition (Montreal Cognitive Assessment),depression (Patient Health Questionnaire-9) and freezing status (Freezing of Gait Questionnaire).Participants completed an instrumented (APDM®) 10m-Walk (i10mWT), a Five-times-Sit-toStand(i5xSTS) and Timed-Up-and-Go (iTUG) test under both single task (ST) and DT(cognitive, arrhythmic) conditions before and after the intervention. Participants were blinded tothe primary outcome measures, which were selected gait variables (i10mWT), sit-to-stand(i5xSTS) and stand-to-sit (iTUG) transitions as well as turning variables (iTUG), together with%DTC of each variable. Secondary outcome measures included functional capacity (FC, Six Minute-Walk test), balance confidence (Activity-specific Balance Confidence scale) and diseaserelated quality of life (Parkinson‟s Disease Questionnaire-39; PDQ-39).ResultsBoth groups improved ST walking velocity (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57), STturning velocity (FWG: p=0.04, d=0.28; BWG: p=0.05, d=0.28), FC (FWG: d=0.82; BWG:d=1.06; p<0.01) and MDS-UPDRS III scores (FWG: p=0.02, d=0.45; BWG: p=0.03, d=0.62).Additionally, the BWG improved individual PDQ-39 domains (p=0.01, d=0.41), i10mWTST time(p<0.01, d=0.45), gait cycle time (p=0.01, d=0.00), stride length (SL; p=0.02, d=0.39) andcadence (p<0.01, d=0.67); however worsened SL variability (p=0.04, d=0.83) under STconditions. The BWG also improved %DTC for percentage double support (%DS) variability(p=0.05, d=0.57); however deteriorated %DTC for %DS (p=0.05, d=0.45) and swing time gaitasymmetry (p=0.02, d=0.61). The FWG improved UPDRS II scores (p=0.03, d=0.44), i5xSTSSTduration (p<0.01, d=0.52), iTUG duration (ST: p<0.01, d=0.71; DT: p=0.02, d=0.54), turningangle (ST: p=0.02, d=0.52; DT: p=0.01, d=0.62) and %DTC for SL (p=0.02, d=0.67).ConclusionBoth FW and BW over ground gait retraining can be beneficial for PD mobility. Even thoughmost outcomes are training direction specific, findings illustrates that the ability to learn remainsintact in mild to moderate PD. Considering that both interventions yielded individual benefits,BW should not replace, but rather be added to a FW gait retraining program. Albeit FW can be abeneficial non-pharmacological method to improve mobility aspects, BW is an interestingalternative for rehabilitative purposes in mild to moderate PD.

[发布机构] Stellenbosch University