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PubMed2005

Gait dynamics in mouse models of Parkinson's disease and Huntington's disease.

BACKGROUND: Gait is impaired in patients with Parkinson's disease (PD) and Huntington's disease (HD), but gait dynamics in mouse models of PD and HD have not been described. Here we quantified temporal and spatial indices of gait dynamics in a mouse model of PD and a mouse model of HD. METHODS: Gait indices were obtained in C57BL/6J mice treated with the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 30 mg/kg/day for 3 days) for PD, the mitochondrial toxin 3-nitropropionic acid (3NP, 75 mg/kg cumulative dose) for HD, or saline. We applied ventral plane videography to generate digital paw prints from which indices of gait and gait variability were determined. Mice walked on a transparent treadmill belt at a speed of 34 cm/s after treatments. RESULTS: Stride length was significantly shorter in MPTP-treated mice (6.6 +/- 0.1 cm vs. 7.1 +/- 0.1 cm, P < 0.05) and stride frequency was significantly increased (5.4 +/- 0.1 Hz vs. 5.0 +/- 0.1 Hz, P < 0.05) after 3 administrations of MPTP, compared to saline-treated mice. The inability of some mice treated with 3NP to exhibit coordinated gait was due to hind limb failure while forelimb gait dynamics remained intact. Stride-to-stride variability was significantly increased in MPTP-treated and 3NP-treated mice compared to saline-treated mice. To determine if gait disturbances due to MPTP and 3NP, drugs affecting the basal ganglia, were comparable to gait disturbances associated with motor neuron diseases, we also studied gait dynamics in a mouse model of amyotrophic lateral sclerosis (ALS). Gait variability was not increased in the SOD1 G93A transgenic model of ALS compared to wild-type control mice. CONCLUSION: The distinct characteristics of gait and gait variability in the MPTP model of Parkinson's disease and the 3NP model of Huntington's disease may reflect impairment of specific neural pathways involved.

Journal Article↗
PubMed1999

Gait analysis before and after unilateral total knee arthroplasty. Study using a linear regression model of normal controls -- women without arthropathy.

Stepwise multiple regression analysis (forward method) was performed with 22 gait variables obtained from the free and slow gait of 35 normal controls (women without knee arthropathy). These 22 variables were target variables, and velocity, age, body height, and body weight were explanatory variables. Velocity showed the greatest effect on the gait variables, followed by weight, age, and height. Of the 22 target variables, 16 could be explained by a significant level of difference of P < 0.01. A linear regression model of normal gait was then established, based on the judgment that these 16 gait variables were greatly affected by four variables -- velocity, age, height, and weight. Since this model does not perfectly represent the observed values, we compared the observed value/predicted value ratios in different groups to compensate for their differences. The free gait velocity in 20 osteoarthritic patients, 1 year or more after unilateral total knee arthroplasty (TKA), and who had no pain in the contralateral knee was lower than in the normal controls. In comparisons using linear regression models, step length was shorter, step width was longer, and gait cycle was shorter than in controls. Single support time was shorter and double support time was longer. Of the ground reaction forces, the first peak of the vertical component and the peak of the driving force of the fore-aft component were smaller than in controls. The total range of motion (TRM) in the stance phase was less than in controls. These results show quantitatively not only that the velocity of gait after TKA is lower than in normal controls, but also that gait patterns are different. In eight osteoarthritic patients assessed before and after TKA, and who had no pain in the contralateral knee, free gait velocity increased 6 months post-operation, but showed no further changes at 1 year. A linear regression study comparing the gait before TKA and 6 months post-TKA revealed that step time, single support time, double support time, and step width, and -- with regard to ground reaction forces -- the peaks of the driving force and the braking force of the fore-aft component, and TRM in the stance phase all approached the levels in the normal controls. No further changes were observed 1 year postoperatively. Although our models were not perfect, we were able to clarify the differences in gait variables between a TKA group and normal controls and the improvements from pre- to post TKA by normalizing the influence of the four independent variables, (velocity, age, weight, and height) with particular emphasis on gait velocity.

Aged↗
PubMed1993

A study of the stability of generalized wave gaits.

The wave gait has been observed in animal and insect walking and has been widely implemented in the control of walking machines. It has been proved that the wave gait possesses the optimum stability among all periodic gaits under the geometrical condition that R/P < or = 1, where R and P are respectively the stroke and pitch of a walking machine. Recently, based on numerical results, a generalized hexapodal wave gait was reported to be more stable than the wave gait for R/P > 1. In this paper, in order to understand more about the generalized wave gait, an analytical method is applied to study its stability in three categories of multilegged systems: quadrupeds, hexapods, and 2n-legged systems (n > or = 4). Two optimal generalized wave gaits are found for quadrupeds, and three optimal gaits are found for each of the other two categories. For all three categories, one of the optimal generalized wave gaits is the wave gait. The stability and geometrical conditions of these optimal gaits are derived and verified numerically. Furthermore, it is shown that the quadrupedal generalized wave gaits have the optimum stability among all periodic gaits with the stepping sequence 1-4-2-3.

Animals↗
PubMed1999

Prediction of gait velocity in ambulatory stroke patients during rehabilitation.

OBJECTIVE: To quantify prediction of gait velocity in ambulatory stroke patients during rehabilitation. DESIGN: Single group (n = 42) at the beginning of rehabilitation (Test 1) and 8 weeks later (Test 2). SETTING: Inpatient rehabilitation. PATIENTS: Unilateral first stroke; informed consent; able to walk 10 meters. MEASURES INDEPENDENT VARIABLES: Gait velocity at Test 1, age, time from stroke to Test 1, side of lesion, neglect. DEPENDENT VARIABLES: Gait velocity at Test 2, gait velocity change. RESULTS: The correlation between initial gait velocity and gait velocity outcome at Test 2 was of moderate strength (r2 = .62, p<.05). However, even at its lowest, the standard error of prediction for an individual patient was 9.4 m/min, with 95% confidence intervals extending over a range of 36.8 m/min. Age was a weak predictor of gait velocity at Test 2 (r2 = -.10, p<.05). Gait velocity change was poorly predicted. The only significant correlations were initial gait velocity (r2 = .10, p<.05) and age (r2 = .10, p<.05). CONCLUSION: While the prediction of gait velocity at Test 2 was of moderate strength on a group basis, the error surrounding predicted values of gait velocity for a single patient was relatively high, indicating that this simple approach was imprecise on an individual basis. The prediction of gait velocity change was poor. A wide range of change scores was possible for patients, irrespective of their gait velocity score on admission to rehabilitation.

Aged↗
PubMed2003

Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer's disease.

OBJECTIVES: To evaluate how cognitive function and divided attention affect gait in Alzheimer's disease (AD). DESIGN: Cross-sectional intervention study with subjects serving as their own controls. SETTING: Inpatient unit and outpatient clinic for patients with dementia located at a Veterans Affairs Medical Center. PARTICIPANTS: Twenty-eight patients diagnosed with probable AD. INTERVENTION: Performance of a cognitive task (repeating random digits) while walking. MEASUREMENTS: Neuropsychological measures including clock drawing, verbal fluency, and digit span were obtained along with the Clinical Dementia Rating and Mini-Mental State Examination, the measures of dementia severity. Gait speed and stride-to-stride variability of gait rhythm were measured, once during normal walking and once during dual-task walking. RESULTS: During usual walking, subjects walked slowly and with greater gait variability than older adults without AD. Gait speed was significantly reduced (P<.012) and gait variability increased with dual-task walking (P<.007). The effect on gait variability was larger than the effect on gait speed (P<.015). Executive and neuropsychological function were significantly (P<.02) associated with the increased gait variability that occurred when walking with divided attention but not with gait speed or usual, single-task walking measures of gait. CONCLUSION: Divided attention markedly impairs the ability of patients with AD to regulate the stride-to-stride variations in gait timing. This susceptibility to distraction and its effect on stride time variability, a measure of gait unsteadiness, could partially explain the predilection to falling observed in patients with dementia. The results also support the concept that persons with AD have significant impairments in the cognitive domain of attention and that locomotor function relies upon cognitive, especially executive, function.

Aged↗
PubMed2004

What is a waddling gait?

PURPOSE: A patient's gait can provide important diagnostic and functional information. Though 'waddling gait' is a long-established concept, we question whether this description is precise or clinically useful. METHODS: We searched 'waddling gait' in all main medical specialties core textbooks, in animal locomotion books and in Medline, Healthstar and Embase. Further we obtained expert advice on the gait of ducks. RESULTS: Many names are used for 'waddling gait', and its description is imprecise and inconsistent. Trendelenburg described it as a pelvic drop on the side of the swinging leg and compensatory lateral trunk bending towards the side of the standing leg. Many conditions have been described as producing a waddling gait. We accepted the gait pattern of ducks as being true waddling. This often-used comparison does not accurately reflect the gait pattern seen in humans with a range of medical disorders; nor is it the same as a Trendelenburg gait. CONCLUSIONS: As we have found no condition in which patients have a truly duck-like gait, we propose that the phrase 'waddling gait' should be abandoned. We suggest that for clarity and good communication, clinicians should describe the observed elements of the gait rather than using imprecise and unhelpful terms such as 'waddling gait'.

Animals↗
PubMed2000

The effect of preoperative gait analysis on orthopaedic decision making.

The impact of preoperative gait analysis on the orthopaedic care of 97 patients (101 gait analyses) at the authors' institution was evaluated. For the 70 patients for whom a specific treatment plan had been outlined before the preoperative gait study, the treatment plan was altered in 62 (89%) after the gait analysis study. In 10 of the 70 patients with specific treatment plans before the gait study, the referring physician also served as the physician in the gait laboratory; ultimate treatment was changed in nine of these 10 patients. Of the 273 surgical procedures recommended before the gait study in the 70 patients, 106 (39%) of these procedures were not done when the gait laboratory data were considered. An average of 1.5 procedures per patient that were planned before the gait study ultimately were not deemed necessary by the treating physician after the addition of the gait data. An additional 110 procedures (1.6 per patient) that had not been recommended before the gait study ultimately were performed after addition of the gait laboratory data. This study shows that ultimate surgical intervention frequently is altered by the addition of gait laboratory data.

Adolescent↗
PubMed2001

Prospective dynamic functional evaluation of gait and spinal balance following spinal fusion in adolescent idiopathic scoliosis.

STUDY DESIGN: Prospective evaluation of gait and spinal-pelvic balance parameters in patients with adolescent idiopathic scoliosis undergoing a spinal fusion. OBJECTIVE: To evaluate changes in gait and three-dimensional alignment and balance of the spine relative to the pelvis as a consequence of spinal fusion. SUMMARY OF BACKGROUND DATA: Preoperative and postoperative spinal radiographs have been the major forms of outcome analysis of adolescent idiopathic scoliosis fusions. The use of optoelectronic analysis for posture and gait has gained acceptance recently. However, there is a paucity of data quantifying, comparing, and correlating structural and functional changes in patients undergoing scoliosis fusion surgery including upright posture and gait. METHODS: Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion were prospectively evaluated. Coronal and sagittal vertical alignment was evaluated on radiographs (CVA-R, SVA-R), during upright posture (CVA-P and SVA-P), and during gait (CVA-G, SVA-G). Transverse plane alignment was evaluated by the acromion-pelvis angle during gait. RESULTS: Gait speed was significantly decreased (P < 0.05) between preoperative (129 +/- 16 cm/sec) and 2-year postoperative (119 +/- 16 cm/sec) testing sessions. Decreasing gait speed was the result of significantly reduced cadence and decreased stride length. There were no significant differences for lower extremity kinematics over the entire gait cycle. Spinal-pelvic balance parameters showed significant improvement in mean CVA-R, CVA-G (P < 0.05), then unchanged CVA-P at 2 years postoperation. CVA-P was relatively unchanged while the mean CVA-G also showed significant improvement from preoperation (2.2 +/- 2.4 cm) to 2 years postoperation (1.3 +/- 1.3 cm)(P < 0.05). The mean SVA-R, SVA-P, and SVA-G were unchanged at 2 years postoperation (P > 0.05). The acromion-pelvis angle during gait at maximum shoulder rotation was statistically improved at 1 year (P = 0.002) and 2 years (P = 0.001) after surgery. Importantly, CVA-P correlated with CVA-G, and SVA-P correlated with SVA-G to the P < 0.05 level. CONCLUSIONS: Patients with adolescent idiopathic scoliosis undergoing spinal fusion show slightly decreased gait speed at 2 years postoperation without any change in lower extremity kinematics. Spinal-pelvic balance parameters are improved in the coronal plane and unchanged in the sagittal plane radiographically and during standing posture and gait. Transverse plane parameters also are improved at maximum shoulder rotation during gait.

Adolescent↗
PubMed2003

The effect of leg length discrepancy on spinal motion during gait: three-dimensional analysis in healthy volunteers.

STUDY DESIGN: This study focused on the effects of leg length discrepancy on the motion of the normal spine during gait in healthy male volunteers who wore a heel-raising orthotic device on the right foot. OBJECTIVE: To evaluate the effect of leg length discrepancy on the changes in curvature of the normal spine during gait. SUMMARY OF BACKGROUND DATA: There are few published data on the effects of leg length discrepancy on the motion of the normal spine during gait. METHODS: An orthotic device that raised the heel by 3 cm was used to simulate leg length discrepancy. Twenty-two healthy male volunteers participated (age: 28.2 +/- 6.1 years, average +/- SD). The dynamic curvatures of the spine under two conditions (without and with a heel-raising orthotic device; normal gait and heel-raising gait) were evaluated during gait. The leg length discrepancy values without and with the device were measured and analyzed using a VICON system (Oxford Metrics, United Kingdom). RESULTS: The spine showed an asymmetrical lateral-bending motion during heel-raising gait as compensation for the leg length discrepancy. Maximum lateral bending angle of the thoracic spine was 4.2 +/- 1.4 degrees in heel-raising gait, whereas it was 3.0 +/- 1.0 degrees in normal gait. Maximum lateral bending angle of the lumbar spine was 8.1 +/- 2.8 degrees in heel-raising gait, whereas it was 6.1 +/- 2.1 degrees in normal gait. The maximum bending angle and bending velocity were significantly larger in the heel-raising gait than in normal gait. CONCLUSION: Patients who have leg length discrepancy due to disorders in the lower extremities are at greater risk of developing disabling spinal disorders due to exaggerated degenerative change. Therefore, treatment for leg length discrepancy may be helpful in preventing degenerative spinal changes.

Adult↗
PubMed2007

The role of gait analysis in the orthopaedic management of ambulatory cerebral palsy.

PURPOSE OF REVIEW: The literature was reviewed to describe the role of gait analysis in the orthopaedic management of ambulatory children with cerebral palsy and examine the current best evidence to support these roles. RECENT FINDINGS: Gait laboratory analysis is superior to visual or observational analysis of gait because it provides an objective record of gait that is able to quantify the magnitude of deviations of pathologic gait from normal and also explain these abnormalities. Recognizable gait patterns can be classified and used for making treatment decisions, the effectiveness of which can be assessed using gait analysis as a measure of gait outcomes. There are many sources of variability, however, including patients themselves, the gait laboratories and testing processes, interpretation of data and surgeons' surgical recommendations. SUMMARY: Although gait analysis has been shown to alter decision making, there is little evidence that the decisions based on gait analysis lead to better outcomes. Consequently, clinical gait analysis remains controversial, with wide variation in the rates of utilization of gait analysis in the management of children with ambulatory cerebral palsy. The time is ripe for clinical trials and cohort studies to provide the evidence to establish the appropriate utilization of this technology.

Ambulatory Surgical Procedures↗
PubMed2005

Support vector machines for automated gait classification.

Ageing influences gait patterns causing constant threats to control of locomotor balance. Automated recognition of gait changes has many advantages including, early identification of at-risk gait and monitoring the progress of treatment outcomes. In this paper, we apply an artificial intelligence technique [support vector machines (SVM)] for the automatic recognition of young-old gait types from their respective gait-patterns. Minimum foot clearance (MFC) data of 30 young and 28 elderly participants were analyzed using a PEAK-2D motion analysis system during a 20-min continuous walk on a treadmill at self-selected walking speed. Gait features extracted from individual MFC histogram-plot and Poincaré-plot images were used to train the SVM. Cross-validation test results indicate that the generalization performance of the SVM was on average 83.3% (+/-2.9) to recognize young and elderly gait patterns, compared to a neural network's accuracy of 75.0+/-5.0%. A "hill-climbing" feature selection algorithm demonstrated that a small subset (3-5) of gait features extracted from MFC plots could differentiate the gait patterns with 90% accuracy. Performance of the gait classifier was evaluated using areas under the receiver operating characteristic plots. Improved performance of the classifier was evident when trained with reduced number of selected good features and with radial basis function kernel. These results suggest that SVMs can function as an efficient gait classifier for recognition of young and elderly gait patterns, and has the potential for wider applications in gait identification for falls-risk minimization in the elderly.

Adult↗
PubMed2006

Epidemiology of gait disorders in community-residing older adults.

OBJECTIVES: To study the epidemiology of gait disorders in community-residing older adults and their association with death and institutionalization. DESIGN: Community-based cohort study. SETTING: Bronx County and the research center at Albert Einstein College of Medicine. PARTICIPANTS: The Einstein Aging study recruited 488 adults aged 70 to 99 between 1999 and 2001. At entry and during annual visits over 5 years, subjects received clinical evaluations to determine presence of neurological or nonneurological gait abnormalities. MEASUREMENTS: Prevalence and incidence of gait disorders based on clinical evaluations and time to institutionalization and death. RESULTS: Of 468 subjects (95.9%) with baseline gait evaluations, 168 had abnormal gaits: 70 neurological, 81 nonneurological, and 17 both. Prevalence of abnormal gait was 35.0% (95% confidence interval (CI) = 28.6-42.1). Incidence of abnormal gait was 168.6 per 1,000 person-years (95% CI = 117.4-242.0) and increased with age. Men had a higher incidence of neurological gait abnormalities, whereas women had a higher incidence of nonneurological gaits. Abnormal gaits were associated with greater risk of institutionalization and death (hazard ratio (HR) = 2.2, 95% CI =1.5-3.2). The risk was strongly related to severity of impairment; subjects with moderate to severe gait abnormalities (HR = 3.2, 95% CI = 1.9-5.2) were at higher risk than those with mild gait abnormalities (HR = 1.8, 95% CI = 1.0-2.8). CONCLUSION: The incidence and prevalence of gait disorders are high in community-residing older adults and are associated with greater risk of institutionalization and death.

Aged↗
PubMed2002

The use of multidisciplinary assessment and scientific measurement in advanced juvenile idiopathic arthritis can categorise gait deviations to guide treatment.

BACKGROUND: It is difficult to identify the range of gait deviations associated with juvenile idiopathic arthritis (JIA) using simple clinical observations. AIMS: To use objective gait analysis to accurately describe biomechanical gait abnormalities in JIA and to search for common patterns, which may subsequently serve as a basis for therapeutic intervention. METHODS: Children with persistent polyarticular arthritis and symmetrical joint involvement were referred to the Gait Analysis Laboratory and independently assessed by a multidisciplinary team. Gait analysis was performed using an in-house Visual Vector System and the Novel PEDAR in-shoe plantar pressure measurement system. Clinical groupings were based on the extent of joint restriction: minimal (group A), and moderate-severe (with supinatory foot deformity (group B), or with pronatory foot deformity (group C)). Gait analysis enabled classification of each subject into one of four gait patterns: either near normal (pattern I) or one of three adaptive patterns defined by the predominant abnormality--lower limb pain (pattern II), lower limb deformity (pattern III), or a combination of pain and deformity of the lower limb (pattern IV). RESULTS: Of the 15 subjects assessed as part of this study, seven were placed into clinical group A, six into group B, and two into group C. All the subjects with gait patterns I and II were found in clinical group A. Both subjects from clinical group C exhibited gait pattern III. All subjects from clinical group B and the remainder from group A exhibited a mixture of gait patterns III and IV. CONCLUSION: Despite the initial clinical observations it was not always possible to predict the resultant gait pattern. Scientific gait analysis allowed a clear distinction to be made between primary and secondary gait deviations, and accurate targeting of physiotherapy and orthotic interventions to suit each individual. Prospective quantitative analysis in a larger sample is under way to support the clinical effectiveness of these findings.

Adaptation, Physiological↗
PubMed2006

Pectoral fin coordination and gait transitions in steadily swimming juvenile reef fishes.

A common feature of animal locomotion is its organization into gaits with distinct patterns of movement and propulsor use for specific speeds. In terrestrial vertebrates, limb gaits have been extensively studied in diverse taxa and gait transitions have been shown to provide efficient locomotion across a wide range of speeds. In contrast, examination of gaits in fishes has focused on axial gaits and the transition between synchronous paired fin locomotion and axial propulsion. Because many fishes use their pectoral fins as their primary propulsors, we aimed to examine more broadly the use of pectoral fin gaits in locomotion. We used juvenile reef fishes in these experiments because their swimming could be recorded readily across a wide range of Reynolds numbers, which we thought would promote gait diversity. Based on previous work in larval fishes, we hypothesized that juveniles have alternating pectoral fin movements rather than the synchronous, or in-phase, coordination pattern of adults. In flow tank swim studies, we found that juvenile sapphire damselfish Pomacentrus pavo used two fin gaits during steady swimming. Below approximately 3 BL s(-1), P. pavo primarily swam with alternating fin strokes 180 degrees out of phase with one another. At speeds in the range of 3-4 BL s(-1), they performed a gait transition to synchronous fin coordination. Between approximately 4 and 8 BL s(-1), P. pavo primarily beat their fins synchronously. At around 8 BL s(-1) there was another gait transition to body-caudal fin swimming, in which the pectoral fins were tucked against the body. We suggest that the transition from alternating to synchronous fin coordination occurs due to mechanical limits of gait performance rather than to energy efficiency, stability or transitions in hydrodynamic regime. To determine whether this gait transition was species-specific, we surveyed pectoral fin locomotion in juveniles from 11 species in three reef fish families (Pomacentridae, Labridae and Scaridae). We found that this gait transition occurred in every species examined, suggesting that it may be a common behavior of juvenile reef fishes. Greater inclusion of early life history stages in the study of fin-based locomotion should significantly enhance and inform the growing body of work on these behaviors.

Analysis of Variance↗
PubMed2004

Gait assessment in Parkinson's disease: toward an ambulatory system for long-term monitoring.

An ambulatory gait analysis method using body-attached gyroscopes to estimate spatio-temporal parameters of gait has been proposed and validated against a reference system for normal and pathologic gait. Later, ten Parkinson's disease (PD) patients with subthalamic nucleus deep brain stimulation (STN-DBS) implantation participated in gait measurements using our device. They walked one to three times on a 20-m walkway. Patients did the test twice: once STN-DBS was ON and once 180 min after turning it OFF. A group of ten age-matched normal subjects were also measured as controls. For each gait cycle, spatio-temporal parameters such as stride length (SL), stride velocity (SV), stance (ST), double support (DS), and gait cycle time (GC) were calculated. We found that PD patients had significantly different gait parameters comparing to controls. They had 52% less SV, 60% less SL, and 40% longer GC. Also they had significantly longer ST and DS (11% and 59% more, respectively) than controls. STN-DBS significantly improved gait parameters. During the stim ON period, PD patients had 31% faster SV, 26% longer SL, 6% shorter ST, and 26% shorter DS. GC, however, was not significantly different. Some of the gait parameters had high correlation with Unified Parkinson's Disease Rating Scale (UPDRS) subscores including SL with a significant correlation (r = -0.90) with UPDRS gait subscore. We concluded that our method provides a simple yet effective way of ambulatory gait analysis in PD patients with results confirming those obtained from much more complex and expensive methods used in gait labs.

Acceleration↗
PubMed2006

Response of gait deficits to neuromuscular electrical stimulation for stroke survivors.

Persistent gait deficits after stroke can cause falls, elevated energy cost and poor endurance. Coordination impairment is an underlying cause of gait deficits. Few efficacious interventions have been described that have targeted and measured restoration of coordinated gait components. Neuromuscular electrical stimulation can provide the critical gait practice characteristic of close-to-normal movements, by electrically inducing muscle contractions and coordinated movements that are not possible under volitional effort. Two-channel, surface neuromuscular electrical stimulation can be synchronized with phases of gait and can provide faster, more symmetrical neuromuscular electrical stimulation-assisted gait than gait with no neuromuscular electrical stimulation. Difficulties encountered during the use of surface neuromuscular electrical stimulation for gait training led to the development of neuromuscular electrical stimulation with implanted technologies. Implanted electrodes and/or stimulators proved to be feasible for gait training in stroke survivors. Gait training with a multichannel neuromuscular electrical stimulation system with implanted electrodes proved more advantageous than gait training without neuromuscular electrical stimulation, according to measures of volitional coordinated gait components (neuromuscular electrical stimulation deactivated).

Electric Stimulation Therapy↗
PubMed2003

Effects of subthalamic nucleus stimulation and levodopa treatment on gait abnormalities in Parkinson disease.

BACKGROUND: Stimulation of the subthalamic nucleus is proposed for the treatment of patients presenting with severe Parkinson disease. The effect on gait is not clearly established. OBJECTIVES: To evaluate objectively the influence of bilateral subthalamic nucleus stimulation on gait in Parkinson disease and to compare it with the effects of levodopa treatment. METHODS: Ten patients underwent bilateral subthalamic nucleus stimulation. The preoperative and postoperative (3 months after surgery) clinical gait disturbances, as well as spatial and temporal gait parameters, were analyzed in off and on-drug conditions. The gait analysis was performed using a video motion analysis system (optoelectronic VICON system; Oxford Metrics, Oxford, England). RESULTS: In the off condition, there was an improvement after surgery for the total motor score and the gait subscore. In the on-drug condition, there was an improvement in levodopa-induced dyskinesias and the motor score, whereas the gait subscore was unchanged. For the gait parameters measured by the video motion analysis system system, there was also an improvement in the off condition and to a lesser extent in the on-drug condition. CONCLUSIONS: Our method allowed exact quantification of the benefit of surgery on gait parameters. Compared with the levodopa treatment, the effect of stimulation on gait kinematic parameters seems to be qualitatively similar but quantitatively different with a lower benefit on gait velocity and stride length. Concerning the pathophysiology of gait troubles in Parkinson disease, the deficit in control of stride length would be the fundamental deficit. The study underlines the possible role of the subthalamic nucleus on the stride length regulation.

Antiparkinson Agents↗
PubMed2005

Three-dimensional stereotactic surface projection study of freezing of gait and brain perfusion image in Parkinson's disease.

Gait disturbance is a cardinal symptom in patients with Parkinson's disease. Among the gait disturbances, freezing of gait is a unique and troublesome symptom, but its mechanism is unclear. We compared brain perfusion images using three-dimensional stereotactic surface projection analysis of N-isopropyl-p-123I iodoamphetamine single photon emission computed tomography between Parkinson's disease patients with freezing of gait and those without. Twenty-four cases (freezing of gait group) with Parkinson's disease with freezing of gait, and 31 Hoehn and Yahr stage-matched cases (no freezing of gait group) with Parkinson's disease without freezing of gait were studied. Bilateral Brodmann area 11 perfusion of the freezing of gait group decreased significantly compared to that of the no freezing of gait group. The Brodmann area 11 may play important roles in gait, and impairment in this region may have a close relationship with freezing of gait in Parkinson's disease.

Aged↗