Elsevier

Gait & Posture

Volume 31, Issue 1, January 2010, Pages 143-146
Gait & Posture

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Effects of obstacle height on obstacle crossing in mild Parkinson's disease

https://doi.org/10.1016/j.gaitpost.2009.09.011Get rights and content

Abstract

The aim of this study was to compare the locomotor behavior of people with Parkinson's disease (PD) and healthy older adults during obstacle negotiation, both in the approaching and crossing phases. Twelve people with idiopathic PD, with mild to moderate disease, and 12 healthy individuals (CG) walked across an 8 m pathway for three obstacle conditions: no obstacle, low obstacle and high obstacle. Each performed five trials for each obstacle condition. Performance was more disturbed for the high obstacle than the low obstacle. During the approach phase, people with PD demonstrated shorter stride length (F1,22 = 8.55, P = 0.008) and greater stride duration (F1,22 = 7.371, P = 0.013) than controls. Those with PD also increased their stance phase durations (F1,22 = 7.426, P = 0.012) for both obstacle conditions, while the CG maintained comparable step durations for all conditions. For the crossing phase, people with PD demonstrated shorter step length (F1,22 = 9.699, P = 0.005) over the obstacle. Leading limbs were closer to the obstacle, before and after crossing. Thus PD hypokinesia compromises the approach and crossing phases of obstacle negotiation.

Introduction

The aim of this investigation was to compare the locomotor behavior of people with PD and healthy older adults during obstacle avoidance for objects of different heights. The gait disorders in people with PD are well documented. For straight line walking over even surfaces, there is reduced step length and longer stride duration [1]. Only a few studies have investigated obstacle avoidance tasks in people with PD comparable to unimpaired people [2], [3], [4]. Two studies introduced an obstacle while people with PD walked on a treadmill [3], [4]. Findings of Van Hedel et al. [3] indicated that mildly affected people with PD might initially experience more problems than controls when learning to perform a new obstacle crossing task. However, with repetition, they could adapt their gait pattern to the external demands. Ecological limitations arise given the differences between treadmill locomotion and over-ground walking. Studies of obstacle avoidance have been useful for understanding the mechanisms underlying dynamic motor control [5], [6], [7]. Changes in dynamics of the footstep pattern during obstacle avoidance might help to answer some of the questions related to locomotion control in people with PD, such as the effects of hypokinesia.

The primary hypothesis was that hypokinesia can compromise motor performance during the approach and crossing phases of obstacle avoidance since people with PD already show decreases in movement amplitude in other tasks like walking [1] and pointing to a remembered target [8]. We also hypothesized that crossing a high obstacle is more challenging for people with PD as it requires additional stability.

Section snippets

Methods

This study adhered to the guidelines of the Declaration of Helsinki, and it was approved by the local ethics committee (Process #2722/2005).

Twenty-four individuals, including 12 people with idiopathic PD (Table 1), and 12 neurologically healthy individuals (CG), participated in the study. The CG was pair matched with people with PD by age (respectively, 67 ± 6.44 and 67 ± 6.24 years, t22 = −0.031, P = 0.837), body height (1.62 ± 0.09 and 1.64 ± 0.09 m, t22 = 0.384, P = 0.705), body mass (66.11 ± 10.67 and 65.26 ± 

Results

During the approach phase (Table 2), ANOVA revealed a longer stride length (F1,22 = 23.309, P = 0.001) and a greater swing phase duration (F1,22 = 8.518, P = 0.008) in the NO condition. People with PD demonstrated a shorter stride length (F1,22 = 8.55, P = 0.008) than the control group in all obstacle conditions. Interaction between the factors was revealed for stride duration (F1,22 = 7.371, P = 0.013). People with PD showed greater stride duration than the control group in all conditions. The stride duration

Discussion

The results of this investigation provide evidence for differences between people with PD and controls in obstacle crossing. People with PD could adapt their gait pattern to task demands, which supports the results reported by Van Hedel et al. [3]. During the approach phase, those with PD demonstrated shorter stride length before obstacle crossing and greater stride duration than controls. They also increased their stance phase durations for both obstacle conditions, while the controls

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Acknowledgement

This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP #2005/00775-6).

References (18)

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