Journal Club CEU Approval
Contact Hours: 1
AR | FL CE26-803266 | ID
Effects of treadmill training with load on gait in Parkinson Disease
JC16Q2
On-demand
$10
On-demand
$10
Webinar Description
Tirgueiro LCL, Gama GL, Simao CR, Sousa SVC, Godeiro Junior CO, Lindquist AR. (2015). Effects of treadmill training with load on gait in Parkinson Disease. A randomized controlled clinical trial. Am J Phys Med Rehabil, 94(10):830-7.
Introduction:
The motor impacts of Parkinson's disease (PD) are well established and include changes in voluntary and automatic movements, including gait and balance, resulting in significant disability. The literature supports use of external cues, including visual and auditory cues to improve walking, specifically gait automaticity, in individuals with PD. The authors of this study argue that the treadmill serves as an external cue by imposing rhythmicity and requiring attention, similar to the lasers and music advocated in other studies. While body weight supported treadmill training has been demonstrated effective in stroke survivors, off-loading has the potential to worsen gait in people with Parkinson (PWP) by decreasing proprioceptive input from the treadmill which serves as the external cue found to be beneficial for this population. They argue that in PWP the sensitivity threshold of lower extremity (LE) muscle receptors is diminished, therefore magnifying proprioceptive input by adding external load is likely to enhance the benefit of the external cue provided by the treadmill, as increased LE muscle output, expressed via increased stance time and improved gait biomechanics, has been demonstrated with the addition of load in healthy subjects. Two previous studies have demonstrated the benefit of increased load during treadmill training in PWP, including gains in motor function, quality of life, walking speed (WS), stance time, knee extension and ankle dorsiflexion, however the ideal load is still undetermined. The results of this study indicate that load is not an important factor in gait outcomes from treadmill training in PWP. They argue that the treadmill itself, as repetitive and task-specific gait training is able to improve motor function, as all groups in this study showed motor gains after treadmill training. They suggest that the treadmill stimulates neuroplasticity of the central nervous system, acting as a neuroprotective element that causes positive changes in gait pattern, mobility and quality of life.
Study Question:
Which treadmill training condition(s) (amount of load, walking speed) produce the greatest positive impact on gait biomechanics and functional performance in PWP?
Hypothesis:
10% of body weight load would promote gains in a larger number of spatiotemporal, angular and motor function variables than 0% or 5% load. (Unsupported by study data).
STRENGTHS:
- Statistically well-matched groups
- Use of standardized criterion measures of PD severity (Hoehn & Yahr Scale, UPDRS)
- Different researchers assigned to each: random selection, training, statistical analysis.
- Inclusion of kinematic gait analysis as an outcome measure
- Withheld rehabilitation and treadmill walking during study intervention period.
- 5 minute adaptation period provided during first session (to familiarize with equipment.)
- Comparable training walking speeds used across groups (Session 1, 6, 12)
- PT monitoring of posture, body alignment, fatigue, submaximal HR (75%max) during treadmill training.
- PT provided manual and verbal corrective feedback during training.
- Data collection performed during “on-phase” of antiparkinson medication.
- Determined data normality of all study variables (Shapiro-Wilk test)
- Established group comparability (ANOVA)
- Use of Levene test to verify intergroup homogeneity of variance.
- Total training time consistent with criteria recommending 4-8 weeks of training 1-4x/week for 30-45 min.
- Progressive nature of intervention
WEAKNESSES:
- Did not investigate off-loading as a condition at varying speeds.
- Participants allowed to use UE support during treadmill training.
- No specific balance measure included in outcome measures.
- No long-term follow up.
- No stable baseline established.
- Small sample size
- Absent kinematic data on contralateral limb
| THE BOTTOM LINE: |
| What we know |
| During “off phase” of medication, people with Parkinson present with dyskinesis and worsened gait, decreasing mobility and increasing fall risk. The use of external cues associated with gait training improves walking in subjects with PD optimizing motor capacity and learning retention |
| New Information |
| Treadmill training improved activities of daily living and motor function in all participants regardless of load. |
| What this means to you |
| The treadmill acts as a neuroprotective element, enhancing motor function and activities of daily living and not merely providing a simple relief of symptoms. |
PURPOSE:
To determine the ideal external load and walking speed conditions to use during treadmill training in PWP
CEU Information
Overview
STRENGTHS:
- Statistically well-matched groups
- Use of standardized criterion measures of PD severity (Hoehn & Yahr Scale, UPDRS)
- Different researchers assigned to each: random selection, training, statistical analysis.
- Inclusion of kinematic gait analysis as an outcome measure
- Withheld rehabilitation and treadmill walking during study intervention period.
- 5 minute adaptation period provided during first session (to familiarize with equipment.)
- Comparable training walking speeds used across groups (Session 1, 6, 12)
- PT monitoring of posture, body alignment, fatigue, submaximal HR (75%max) during treadmill training.
- PT provided manual and verbal corrective feedback during training.
- Data collection performed during “on-phase” of antiparkinson medication.
- Determined data normality of all study variables (Shapiro-Wilk test)
- Established group comparability (ANOVA)
- Use of Levene test to verify intergroup homogeneity of variance.
- Total training time consistent with criteria recommending 4-8 weeks of training 1-4x/week for 30-45 min.
- Progressive nature of intervention
WEAKNESSES:
- Did not investigate off-loading as a condition at varying speeds.
- Participants allowed to use UE support during treadmill training.
- No specific balance measure included in outcome measures.
- No long-term follow up.
- No stable baseline established.
- Small sample size
- Absent kinematic data on contralateral limb
| THE BOTTOM LINE: |
| What we know |
| During “off phase” of medication, people with Parkinson present with dyskinesis and worsened gait, decreasing mobility and increasing fall risk. The use of external cues associated with gait training improves walking in subjects with PD optimizing motor capacity and learning retention |
| New Information |
| Treadmill training improved activities of daily living and motor function in all participants regardless of load. |
| What this means to you |
| The treadmill acts as a neuroprotective element, enhancing motor function and activities of daily living and not merely providing a simple relief of symptoms. |
PURPOSE:
To determine the ideal external load and walking speed conditions to use during treadmill training in PWP
Webinar Information
Contact Hours: 1
Price: $10
Instructor: Nechama Karman
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