Contribution of Axial Motor Impairment to Physical Inactivity in Parkinson Disease.

OBJECTIVE: The objective of this study was to investigate the relationships between motor symptoms of Parkinson disease (PD) and activity limitations in persons with PD. DESIGN/METHODS: This is a cross-sectional study of persons with mild to moderate PD (N = 90). Associations among axial motor features, limb motor signs, the Physical Activity Scale for the Elderly, the ability to perform Activities of Daily Living (ADLs), and level of ADL dependency were studied. A composite score of axial motor features included the following Unified Parkinson Disease Rating Scale items: speech, rigidity of the neck, arising from chair, posture, gait, and postural stability. A composite score of limb motor signs included the following Unified Parkinson Disease Rating Scale items: tremor at rest of all extremities, action tremor, rigidity of all extremities, finger taps, hand movement, rapid alternating hand movements, and foot tapping. RESULTS: Axial motor features of PD were significantly correlated with physical inactivity (P \u3c 0.001), decreased ADL (P \u3c 0.001), and increase in ADL dependency (P \u3c 0.001). Limb motor signs significantly correlated with decreased ADL (P \u3c 0.001) and level of ADL dependency (P = 0.035) but did not correlate with physical inactivity. After controlling for age, sex, disease duration, and comorbidity, axial motor features contributed significantly to physical inactivity, decreased ADL, and increase in ADL dependency, whereas the limb motor signs did not. CONCLUSIONS: Axial motor impairment contributed to physical inactivity and decreased ability to perform ADLs in persons with PD

Predictive ability of functional tests for postural instability and gait difficulty in Parkinson’s disease

The objective of this study is to identify clinical determinants for postural instability and gait difficulty in persons with Parkinson’s disease (PD). Ninety-one persons (68 males; 74.7%) with PD were studied. Their mean age was 68.73 ± 8.74 years. The average time since diagnosis was 7.69 ± 5.23 years. The average Hoehn and Yahr stage was 2.43 ± 0.44. Age, gender, disease duration, disease severity and motor impairment were recorded. Participants were asked to perform timed clinical mobility tests that included a 5-step test, turns, forward walk, backward walk, and a sideways walk. The mobility tests were investigated for their contribution to predict the postural instability and gait difficulty (PIGD) score (falling, freezing, walking, gait and postural stability) of the Unified Parkinson Disease Rating Scale (UPDRS). PIGD score was significantly correlated with age, disease duration, Hoehn and Yahr score, comorbidity, UPDRS motor score, gait speed of forward, backward and sideways walks, and time to turn. PIGD score was marginally significantly correlated with timed 5-step test. After controlling for age, disease duration, disease severity, comorbidity, and motor impairment, sideway gait speed (β = − 0.335; p = 0.024), timed 5-step test (β = − 0.397; p = 0.003) and time to turn (β = 0.289; p = 0.028) significantly predicted postural instability and gait difficulty. Walking sideways, 5-step test, and turning are significant predictors of PIGD score. These simple mobility tests can be quickly applied in clinical practice to determine postural instability and gait problems in persons with PD

Treadmill exercise tests in persons with Parkinson\u27s disease: responses and disease severity.

BACKGROUND AND AIMS: There is a paucity of information on cardiovascular responses with regard to the disease stage of Parkinson\u27s disease (PD) when using an exercise test. Our purpose was to examine whether cardiovascular responses to the treadmill exercise test differed among persons with PD who have different disease severity. METHODS: Forty-five subjects with PD were studied (34 men and 11 women). The subjects underwent a treadmill exercise test using a modified Bruce protocol. Resting heart rate (HR), resting blood pressure (BP), maximal HR, maximal BP, exercise duration, maximum percentage HR and METs achieved after the treadmill exercise test were studied. RESULTS: Seventeen subjects were in Hoehn and Yahr Staging Scale (HY) 2, 16 were in HY 2.5, and 12 were in HY 3. HR increased significantly in all three stages. Systolic BP increased significantly in the HY 2 and 2.5, but not the HY 3. Diastolic BP did not change in any stage. Resting HR was lower in the HY 2 compared to the HY 3 and resting systolic BP was higher in HY 2 compared to the HY 2.5. The three HY stages were not different in exercise duration, HR and BP responses, maximum percentage HR achieved, and METs achieved. Fatigue was a primary reason to discontinue the test. There were no fall incidents in any of the tests. CONCLUSIONS: Cardiovascular responses to the treadmill exercise test did not vary with disease severity. Treadmill exercise tests were safe to perform in persons with PD

Relationship Falls and Fear of Falling to Activity Limitations and Physical Inactivity in Parkinson\u27s Disease.

Aim: To investigate the relationships between falls, fear of falling, and activity limitations in individuals with Parkinson\u27s disease (PD). Design/methods: Cross-sectional study of individuals with mild to moderate PD (N = 83). Associations among demographic data, fall frequency, disease severity, motor impairment, ability to perform activities of daily living (ADL), Activities Balance Confidence Scale, Iowa Fatigue Scale, Comorbidity Index, and Physical Activity Scale for Elders were studied. Results: Frequent fallers had more ADL limitations than nonfallers (p \u3c .001) and rare fallers (p = .004). Frequent fallers reported a lower percentage of ability to perform ADL than nonfallers (p = .003). Frequent fallers and rare fallers were less physically active than nonfallers (p = .015 and p = .040, respectively). Frequent fallers and rare fallers reported a higher level of fear of falling than nonfallers (p = .031 and p = .009, respectively). Conclusions: Falls and fear of falling were associated with more ADL limitations and less physical activity after adjusting for physica

Acute and Long-Term Effects of Multidirectional Treadmill Training on Gait and Balance in Parkinson Disease.

BACKGROUND: Treadmill training has been shown to be a promising rehabilitation strategy for improving gait and balance in persons with Parkinson disease (PD). Most studies have involved only forward walking as an intervention. The effects of multidirectional treadmill (forward, backward, and left and right sideways) on gait and balance have not been reported. OBJECTIVE: To investigate the acute and long-term effects of multidirectional treadmill training (MDTT) on gait and balance in persons with PD, and to determine the optimal training duration. DESIGN: Single group, repeated-measures design. SETTING: Research laboratory in a hospital. PARTICIPANTS: Ten persons with PD (mean age 65.9 ± 7.4 years; average disease duration 3.90 ± 2.18 years). INTERVENTIONS: MDTT was used. Participants walked forward, backward, and left and right sideways for 5-7 minutes in each direction at their fastest tolerated speed. The training was 3 days per week continuously for 8 weeks. MAIN OUTCOME MEASUREMENTS: Gait speed, cadence, and stride length of forward, backward and sideways walks; time and number of steps to turn 360°; and the timed 5-step test and Timed Up-and-Go (TUG) test were performed after the first session of MDTT and every 2 weeks. Effect size of MDTT on each gait and balance variable was measured every 2 weeks for 8 weeks to determine the optimal training duration. Gait and balance variables after the first session of MDTT were compared to the baseline values (pre-MDTT) to study the acute effect of MDTT. RESULTS: Stride length of forward, backward, and sideways walks improved immediately after 1 session of MDTT (P = .031, .012, and .001, respectively). The number of steps to turn and the timed 5-step test score decreased after the first session (P = .016, and .010, respectively). Six weeks of training was found to yield the largest mean effect size of all gait and balance variables. At 6 weeks of MDTT, gait speed of all walking directions (P = .001-.031), stride length of backward (P \u3c .005) and sideways (P = .001) walks, cadence of sideways walk (P = .036), number of steps to turn (P = .014), and timed 5-step test (P = .033) improved from pre-MDTT measures. CONCLUSIONS: MDTT immediately improved gait and balance in persons with PD. Six weeks of MDTT might be the optimal training duration to improve gait and balance in the long term

Gait Variability in Parkinson\u27s disease: Levodopa and Walking Direction

BACKGROUND: Levodopa treatment has been shown to improve gait spatio-temporal characteristics in both forward and backward walking. However, effect of levodopa on gait variability during backward walking compared with forward walking has not been reported. AIMS OF STUDY: To study the effects of levodopa on gait variability of forward and backward walking in individuals with Parkinson\u27s disease (PD). METHODS: Forty individuals with PD were studied. Their mean age was 68.70 ± 7.46 year. The average time since diagnosis was 9.41 ± 5.72 year. Gait variability was studied while \u27OFF\u27 and \u27ON\u27 levodopa when the participants walked forward and backward at their usual speed. Variability in step time, swing time, stride length, double support time, and stride velocity were compared between medication condition and walking direction. RESULTS: Variability of step time, swing time, stride length, and stride velocity decreased significantly during forward and backward walks (P \u3c 0.001; P \u3c 0.001; P = 0.003, P = 0.001, respectively) after levodopa administration. Variability of double support time was not changed after levodopa administration (P = 0.054). CONCLUSIONS: Levodopa had positive effects on gait variability of forward and backward walking in individuals with PD. However, variability in double support time was not affected by the levodopa

Determinants of Use of a Walking Device in Persons With Parkinson\u27s Disease

Objective To identify determinants for the use of a walking device in persons with Parkinson\u27s disease (PD). Design Cross-sectional study of participants with PD. Setting Laboratory. Participants Persons with PD (N=85; 60 men) were studied. Their mean age was 69.4±8.9 years. The average time since diagnosis was 7.9±5.3 years. Interventions Not applicable. Main Outcome Measures Age, sex, disease duration, disease severity, and motor impairment were recorded. Participants were asked whether they usually used any walking device (eg, cane or walker) and were categorized as either an “independent walker” or a “device walker.” Clinical balance measures including functional reach, turn duration, 5-meter timed Up and Go (5m-TUG) test, and Activities-specific Balance Confidence (ABC) scale were investigated for their contribution to the prediction of walking with a device. Results Thirty-one participants (36.5%) reported that they usually used a walking device. Classification and regression tree analysis determined that the 5m-TUG test and the ABC scale were important factors in differentiating participants who used a walking device from those who did not. Critical thresholds included 13 seconds for the 5m-TUG test and a score of 75 for the ABC scale in determining device walking. Using only these 2 determinants, the classification and regression tree model correctly classified 81% of the patients as either independent or needing a walking device. Conclusion The 5m-TUG test and the ABC scale may be useful in clinical assessments of the need for a walking device in persons with PD