Search

Gait disorders represent one of the most disabling features for people affected by neurological disease and recovery of walking function is one of the main goals of gait rehabilitation. However, to date, there is a lack of agreement on which is the most beneficial type of gait training in neurological subjects. International guidelines offer conflicting recommendations on instrumental gait rehabilitation: some recommend the use of instrumental methods [1,2], some advice against them [3,4], while others recommend instrumentation only for research purposes or for non-ambulatory persons [5,6]. Our aim was to compare the outcomes of instrumental-assisted vs overground gait training in patients with neurological disorders. The research was performed through several databases (PubMed, Scopus, Embase, Central). Eligibility criteria were studies of adults with neurologic disorders performing instrumental vs overground gait training. Outcomes were measures of gait, balance and independence in daily activities. We included randomized controlled trials in which intervention protocols included gait training performed with treadmill or Lokomat, while control group was trained by overground walking for the same experimental group's amount of time. Quality of the included trials was evaluated with the Cochrane Collaboration's tool for assessing risk of bias. Of the 1059 records identified, only 25 studies were included in this systematic review. Studies included 1075 patients in total, of whom 530 were trained by instrumental-assisted walking training and 545 by overground walking. 747 subjects (69.4%) had sequaele of stroke; 174 (16.2%) multiple sclerosis; 104 (9.7%) Parkinson's disease; 30 (2.8%) with spinal cord injury; 20 (1.9%) with traumatic brain injury. The overall weighted mean age was 60 (range, 31-74) yrs in the instrumental group and 61 (range, 32-73) yrs in the overground one. Results showed that instrumental and overground gait training similarly improved comfortable gait speed, walking distance, balance and independence in daily activities (Table 1). However, biases assessment showed high or unclear risk of bias in more than 50% of the studies. Due to the current quality of the literature, it was not possible to achieve firm conclusions about the most effective type of gait training. Indeed, the instrumental rehabilitation did not reveal more benefits compared to overground walking training in any of the analysed outcomes. Therefore, higher-quality RCTs with larger sample sizes in different populations are needed for stronger conclusions. [ABSTRACT FROM AUTHOR]

Diagnostic accuracy to differentiate Parkinson's Disease (PD) from other neurological disorders by movement disorder specialists is >85% for longer duration (>5years) and medication-responsive people with PD [1]. However, this accuracy remains suboptimal (<55%) in the early stages of disease, i.e. when symptoms may be very subtle [1]. Therefore, it's of paramount importance to identify diagnostic markers which could help in timely and accurate diagnosis and in clinical management [2]. Gait may be a potential marker since its impairments appear in the very early disease, may precede the onset of overt motor signs and evolve more rapidly than other motor features [2,3]. The purpose of this work is to assess whether gait variables, known to correctly classify PD from healthy subjects [4], are capable to differentiate PD from other Parkinsonism in subjects with an onset of symptoms from less than 3 years. 17 drug-naïve individuals with PD (mean age 70.0±7.4 yrs), 9 with vascular parkinsonism (VP, mean age 76.6±5.5 yrs) and 9 with essential tremor plus (ET, mean age 65.9±8.1 yrs) were enrolled. Eight spatiotemporal variables of gait [4] were acquired using a GAITRite® electronic walkway under comfortable walking. To assess the diagnostic performance of each variable in discriminating PD from VP and ET, the area under the receiver operating characteristic curve (AUC) and its 95% Confidence Interval (95% CI) were assessed. Participants with PD were not different from VP and ET regarding sex (p=0.86 and p=0.13, respectively) and age (0.07 and 0.06, respectively). Of the gait variables considered, gait speed, step time and step time asymmetry showed a moderate ability in differentiating PD from the other movement disorders (Table 1). In addition, double support time and swing time CV were able to differentiate individuals with PD from those with ET. The gait model, obtained combining the 8 gait variables, showed the highest ability in discriminating PD from VP (AUC=0.90) and ET (AUC=0.86), with a diagnostic accuracy of 88.5% and 80.8%, respectively. This study found that spatiotemporal gait variables, assessed with a sensorized mat, can be used to differentiate PD from VAS and ET. In particular, the model of gait obtained combining several variables had a good diagnostic accuracy in the first ages of disease. This provides a foundation for future research to investigate the use of gait assessment as a clinical tool to aid diagnostic accuracy of PD subtypes, allowing the correct treatment and care to be applied [5]. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by loss of nigrostriatal dopaminergic neurons [1]. In addition to cardinal motor symptoms, individuals with PD suffer of gait impairment [2]. Although functional imaging is useful for the diagnosis and pathophysiological evaluation of PD, little is known about the relationship between neuroimaging findings and PD clinical features. A study found a correlation between dopamine denervation and impaired gait automaticity [3]; others reported no association between dopaminergic denervation and some gait parameters, such as stride length and velocity [4,5], assuming that deficits in nondopaminergic neurotransmitter systems played the main role in gait impairments [3]. We aimed to examine the relationship between striatal dopaminergic depletion with disease severity in motor symptoms and gait variables in drug-naïve individuals with PD, in order to find where nigrostriatal pathway mainly acts. A total of 18 drug-naïve individuals with PD (mean age 70.4 ± 7.4 yrs) were enrolled. Motor symptoms were evaluated using the modified Hoehn and Yahr (H&Y) stage. Seven spatiotemporal variables of gait were acquired using a GAITRite® electronic walkway under comfortable walking, of which the coefficient of variation and the asymmetry were then calculated. The extent of striatal dopaminergic depletion was evaluated by dopamine transporter imaging with single-photon emission computed tomography using 123I-FP-CIT. Correlations between H&Y stage and gait variables with the specific binding ratios (SBRs) of the striatum (separated into putamen and caudate nucleus) were assessed with the Spearman's correlation coefficients (r). The mean SBRs of both the putamen and the caudate nucleus were significantly associated with the modified H&Y stage, with correlation coefficient of at least 0.60. A moderate correlation was found also between the asymmetry in the SBR of the putamen and the H&Y stage. Moreover, among the spatiotemporal gait variables, a moderate correlation was found between the mean double support duration and its asymmetry with the mean SBRs of both the putamen and the caudate nucleus (Table 1). On the contrary, stride length and velocity showed a weak correlation (below 0.30). Our findings suggest that both disease severity and gait impairments in early PD are associated with decreased dopamine binding in the striatum. Since the double support time showed a moderate correlation with dopaminergic depletion in particular in caudate nucleus, we propose this variable as a marker of the effect of nigrostriatal denervation on gait in individuals with early PD. On the other hand, the poor correlations found between the reduction of stride length and velocity with the nigrostriatal depletion confirmed the hypothesis of a major involvement of other systems (such as the cholinergic) in the control of these variables. Our findings supported the notion that a large part of gait impairments in PD resulted from multisystem degeneration [6,7]. [ABSTRACT FROM AUTHOR]