DIFFERENCES IN THE WAY PARKINSON’S AND CONTROL PARTICIPANTS INITIATE WALKING

¹The University of Strathclyde, Biomedical Engineering Department, Glasgow, United Kingdom

Background: Gait initiation (GI) is defined as the of task transferring from standing to walking (Cue et al. (2014). Parkinson’s disease people (PwP) may face difficulty in GI and changes in walking speed that may increase incidences of gait freezing and higher risk of falling (Rosin et al., 2004).
Self-paced treadmill walking, synchronised with virtual reality, may help individuals recover community walking ability by offering training specificity (Plotnik et al., 2015), We don’t know, however, if the sequence of GI on a treadmill is differ with PWP compared to control group.

Purpose: The purpose of this study is to determine the biomechanics and muscle activation differences in GI in people with Parkinson's while walking compared to the control group.

Methods: Participants (n=16) included a control (n= 10, aged 31.72 +/-17.91 years) and a PwPs group (n= 6, aged 67.33 +/-11.57 years). Participants walked on a self-pacing treadmill synchronised with a virtual reality screen (MotekMedical, the Netherlands). A motion capture system (Vicon Motion Systems, UK) integrated with two embedded force plates and a wireless EMG system (Trigno, Delsys, USA) collected biomechanical and muscle excitation data.
Participants were asked to start walking at their comfortable speed after the visual signal. All gait events were identified from the changes in gyroscope signals extracted from inertial measurement unit (IMU) placed on the shank, the Trigno™ Wireless System (Delsys Inc., Boston, MA, USA) (Li et al., 2016). Data were limited to lower limb joints and three muscles (tibialis anterior, gastrocnemius and soleus).

Results: It was evident that the PwP group spent less time carrying out GI than the control group (2.06 s ± 0.39 compared with 2.25 s ±0.42). The sagittal plane (hip, knee and ankle movement) showed less movement (>5 degrees) compared with the control. Muscles work (quantified as area under the curve of the EMG envelope signal) was broadly increased in activation with PwP but slightly decreased in controls. Interestingly, The Soleus muscle showed an increase in activation in PWP (0.33±0.04) compared to the control group (0.04 ±0.01). the control group showed an increase in muscle activation on the following side at the tibialis anterior 0.19±0.42 compared with PWP0.06±0.03.

Conclusions: There are clear differences between the way PwP and unimpaired individuals initiate gait on a treadmill. PwP being faster with reduced joint movement and longer periods of muscle activity, in the dorsiflexion and plantar flexors. These differences were more evident in the more severe cases of Parkinson’s disease.

Implications: These preliminary findings should be confirmed in future studies that consider the limitations of this study, ie a small Parkinson’s sample and a control group that wasn’t matched for age.

Funding acknowledgements: I would like to thank and acknowledge the Kuwait Civil Service Commission that supported me and funded this study

Keywords:
Parkinson disease
Rehabilitation
Gait initation

Topics:
Community based rehabilitation
Neurology: Parkinson's disease
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: The university of strathclyde

Committee: the Department of Biomedical Engineering ethics committee, .

Ethics number: (DEC18/248)