Arm swing magnitude and asymmetry during gait in the early stages of Parkinson's disease

Lewek, Michael D.; Poole, Roxanne; Johnson, Julia; Halawa, Omar; Huang, Xuemei

doi:10.1016/j.gaitpost.2009.10.013

« Previous Next »Gait & Posture
Volume 31, Issue 2 , Pages 256-260, February 2010

Arm swing magnitude and asymmetry during gait in the early stages of Parkinson's disease

Michael D. Lewek
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina, Chapel Hill, NC 27599-7135, United States
Roxanne Poole
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599-7125, United States
Julia Johnson
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599-7125, United States
Omar Halawa
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599-7125, United States
Xuemei Huang
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599-7125, United States
- Department of Neurology, Penn State University-Milton S. Hershey Medical Center, Hershey, PA 17033-0850, United States
- Corresponding author at: Penn State University-Milton S. Hershey Medical Center, H037 Department of Neurology, 500 University Drive Hershey, PA 17033-0850, United States. Tel.: +1 717 531 1803; fax: +1 717 531 0465.

Received 20 March 2009; received in revised form 22 October 2009; accepted 26 October 2009. published online 30 November 2009.

Abstract

The later stages of Parkinson's disease (PD) are characterized by altered gait patterns. Although decreased arm swing during gait is the most frequently reported motor dysfunction in individuals with PD, quantitative descriptions of gait in early PD have largely ignored upper extremity movements. This study was designed to perform a quantitative analysis of arm swing magnitude and asymmetry that might be useful in the assessment of early PD. Twelve individuals with early PD (in “off” state) and eight controls underwent gait analysis using an optically-based motion capture system. Participants were instructed to walk at normal and fast velocities, and then on heels (to minimize push-off). Arm swing was measured as the excursion of the wrist with respect to the pelvis. Arm swing magnitude for each arm, and inter-arm asymmetry, were compared between groups. Both groups had comparable gait velocities (p=0.61), and there was no significant difference between the groups in the magnitude of arm swing in all walking conditions for the arm that swung more (p=0.907) or less (p=0.080). Strikingly, the PD group showed significantly greater arm swing asymmetry (asymmetry angle: 13.9±7.9%) compared to the control group (asymmetry angle: 5.1±4.0%; p=0.003). Unlike arm swing magnitude, arm swing asymmetry unequivocally differs between people with early PD and controls. Such quantitative evaluation of arm swing, especially its asymmetry, may have utility for early and differential diagnosis, and for tracking disease progression in patients with later PD.