SIAMOC Best Paper Award for 2015Underwater gait analysis in Parkinson’s disease
Introduction
Gait disturbances are a common feature in Parkinson’s disease (PD) [1], with a significant impact on quality of life in the advanced stage of the disease [2]. Gait in PD subjects (PDS) has been thoroughly studied with 3D gait analysis (3DGA) systems in last years documenting a typical hypokinetic gait [3]. The typical kinematics alterations are a reduction of the stride-length with asymmetry between the strides, an increment of the cadence, the stance and double support phases, which compensates for the reduced stride length [4]; a reduction of both the upper arms’ swing and the lower limb joints range of motion (ROM), has also been documented. In PDS the foot tends to drag on the floor, more horizontal than usual due to the important reduction of the angle width between the heel and the sole with freinage and beginning of shuffling [3].
Hydrotherapy is an evidence-based intervention used in treating motor impairments due to orthopaedic [5] and neurological diseases [6]. Aquatic exercises have been used especially when exercise under normal conditions of gravity is difficult and painful. Water buoyancy abolishes gravity thus allowing the body to float, reducing the weight that joints, bones, and muscles have to bear. Consequently, an underwater (UW) environment allows early active mobilization and dynamic strengthening [7].
Recently hydrotherapy has been proposed as an innovative rehabilitative strategy for motor symptoms’ treatments and quality of life in PD [8], in particular for balance dysfunctions documenting significant improvements [9]. Currently no published studies investigated the effects of hydrotherapy on UW gait kinematics in PD. This is mainly due to difficulties in UW video recordings analysis linked to the small target size, the low image quality and the presence of background clutters.
The aim of this pilot-study is to document the modification of gait’s parameters UW through UW GA (UWGA) in a group of PDS and controls (CS). For this purpose a first cohort of subjects was enrolled and evaluated through 2D UWGA (2DUWGA) and on land GA (2DOLGA) before and after a hydrotherapy program. Within this cohort a group of PDS underwent a land based walking (LBW) program for comparison. By considering that in people with PD it has been documented a reduced movement amplitude across all lower limb joints, in all movement planes [3], 3D UWGA (3DUWGA) and OLGA (3DOLGA) were performed on a second cohort of subjects before and after UW gait treatment. Comparisons between the two approaches were made in term of key kinematics variables in order to evaluate if hydrotherapy produces any gait-related outcomes on all movement planes in parkinsonians. Results will allow speculating on the added value of a 3DGA in assessing hydrotherapy derived gait improvements on PDS.
Section snippets
Subjects
Fifty-six subjects were enrolled in the study, divided in two different subjects cohorts (Fig. 1): Protocol 1 and Protocol 2.
The trial was approved by the Ethic Committee. Written informed consent was obtained from the participants or from their spouses if they scored less than 25/30 on the Mini Mental State Examination (MMSE) [10].
Inclusion criteria: participants were eligible for inclusion if they consented to participation, had PD diagnosed according to the current criteria [11], Hoehn and
Results
Table 1 reports the clinical and demographic characteristics of the studied subjects. No significant differences existed between CS1 and CS2, PDS1 UW and PDS1 LBW, PDS2 and CS2 (apart for gender) in relation to the various clinical and demographic parameters (Table 1). Significant differences were observed between PDS1 UW or PDS1 LBW and CS1, PDS1 and PDS2, in terms of age and BMI, but not in term of clinical scales between PDS1 and PDS2. For the clinical outcome measures, a significant (p <
Discussion
The rehabilitative program was delivered successfully with high adherence in both cohorts and underwater training significantly improved the key clinical variables after hydrotherapy.
The present pilot study has shown that enhancing gait training in a rehabilitation setting as a swimming pool leads to a clinically meaningful effect in PDS with gait impairment. Specifically, we found an overall better clinical outcome in PDS with significant improvement at the end of studied period as compared
Acknowledgements
The authors acknowledge the contribution of Giuseppe Caraccio in providing the facility for underwater and on land measurements as well as treatments, Riccardo Spezzamonte, Fulvia Fichera and Veronica Scalchi for their help in the initial stage of the project.
References (28)
- et al.
Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis
Arch. Phys. Med. Rehabil.
(2014) - et al.
Aquatic therapy versus conventional land-Based therapy for Parkinson’s disease: an open-label pilot study
Arch. Phys. Med. Rehabil.
(2011) - et al.
Mini-mental state: a practical method for grading the cognitive state of patients for the clinician
J. Psychiatr. Res.
(1975) - et al.
Is gait variability reliable in older adults and Parkinson’s disease? Towards an optimal testing protocol
Gait Posture
(2013) - et al.
A new anatomical based protocol for gait analysis in children
Gait Posture
(2007) Functional roles of lower-limb joint moments while walking in water
Clin. Biomech.
(2005)- et al.
Does the Pisa syndrome affect postural control, balance, and gait in patients with Parkinson’s disease? An observational cross-sectional study
Parkinsonism Relat. Disord.
(2015) - et al.
Biomechanical characteristics of adults walking in shallow water and on land
J. Electromyogr. Kinesiol.
(2006) - et al.
Biomechanical characteristics of elderly individuals walking on land and in water
J. Electromyogr. Kinesiol.
(2008) - et al.
Gait disorders in Parkinson’s disease: clinical description, analysis of posture, initiation of stabilized gait
Presse Med.
(2001)
Gait disturbances in advanced stages of Parkinson’s disease
Adv. Neurol.
Three-dimensional gait biomechanics in Parkinson’s disease: evidence for a centrally mediated amplitude regulation disorder
Mov. Disord.
Abnormalities of the spatiotemporal characteristics of gait at the onset of freezing in Parkinson’s disease
Mov. Disord.
The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review
Clin. Rehabil.
Cited by (28)
Quantitative assessment of training effects using EksoGT® exoskeleton in Parkinson's disease patients: A randomized single blind clinical trial
2022, Contemporary Clinical Trials CommunicationsCitation Excerpt :Being the present study, a pilot study investigating for the first time the effect of an OWET in PD individuals, and being some of the outcomes still explorative, a specific statistical power analysis to determine the adequate sample size for the study is so far not applicable. Thus, the sample size has been obtained considering a study in which the aim was to evaluate the potential benefits of a hydrokinetic treatment on an analogous PD population [16]. The contemplated study considered changes in gait speed assessed via instrumented gait analysis as parameter to evaluate the treatment effect (primary motor outcome).
Principles and Practice of Movement Disorders
2021, Principles and Practice of Movement DisordersEffect of walking speed during gait in water of healthy elderly
2020, Gait and PostureMuscular activation changes in lower limbs after underwater gait training in Parkinson's disease: A surface emg pilot study
2020, Gait and PostureCitation Excerpt :Gait analysis was performed on both groups by means of an 8 cameras stereophotogrammetric system (300 Hz) synchronized with 2 force plates (BTS, Italy) and a portable sEMG system (FREEEMG1000, 1000 Hz, BTS Padova). The protocol reported in Volpe et al. 2017 [14] was applied and a minimum of three walking trials per subject were collected. The electrical activity of the following muscles for each lower limb were collected: Rectus Femoris (RF), Tibialis Anterior (TA), Bicipes Femoris (BF) and Gastrocnemius Lateralis (GL).
Comparison of underwater gait training and overground gait training for improving the walking and balancing ability of patients with severe hemiplegic stroke: A randomized controlled pilot trial
2020, Gait and PostureCitation Excerpt :In other words, the buoyancy of water can help them in practicing to walk with reduced lower limb loading compared to overground walking [2], and the slow motions caused by viscosity and resistance of water help to reduce the speed-dependent stiffness response [1]. In addition to stroke patients, such underwater exercise has gained much attention as an important rehabilitation treatment for patients with central nervous system disorders such as Parkinson's disease [3–5]. In general, gait training methods for improving the gait functioning of stroke patients include treadmill gait training, partial weight-supported treadmill gait training, and on-ground walking training under the supervision and assistance of a therapist [6–9].
Gait and Posture Virtual Special Issue “Gait Complexity in Parkinson's Disease”
2020, Gait and Posture