FIRST STEP, OBSTACLE NEGOTIATION AND POSTURAL ADJUSTMENTS IN HYPERKINETIC AND AKINETIC-RIGID PARKINSON’S SUBTYPES: A KINEMATIC AND ELECTROMYOGRAPHIC STUDY

M. Zimmermann Casal¹, A. Ivaniski-Mello¹, L. de Liz Alves¹, A.P. Janner Zanardi², A. Nogueira Haas¹, L.A. Peyré-Tartaruga¹, F. Gomes Martinez¹

¹Federal University of Rio Grande do Sul, Physical Education, Physiotherapy and Dance Department, Porto Alegre, Brazil, ²Univesity Center of Cascavel, Physiotherapy Department, Cascavel, Brazil

Background: People with Parkinson's disease (PD) have different combinations of motor symptoms, compatible with different clinical subtypes. Among these, the akinetic rigid (AK-R) and hyperkinetic subtypes are most observed. Rigidity and bradykinesia are motor symptoms that can directly affect postural adjustments and performance in daily tasks, including gait initiation and obstacle negotiation, increasing the risk of falls and functional dependence in this population.

Purpose: To compare postural adjustments and biomechanical parameters during the gait initiation and obstacle negotiation of people with AK-R and HYP PD and correlate with functional mobility and risk of falls.

Methods: Cross-sectional study. Thirty-three volunteers with PD (mild to moderate staging) were divided into two groups according to clinical motor manifestations: AK-R (n=16) and hyperkinetic (n=17). We assessed the anticipatory (APA) and compensatory (CPA) postural adjustments by analyzing 3D-kinematic, kinetic and electromyographic parameters during the gait initiation and obstacle negotiation tests. We applied independent T-tests and Pearson correlation tests for comparisons and correlations, respectively (α=.05).

Results: In the APA phase of the gait initiation test, compared to the functional hyperkinetic group, the AK-R group showed a shorter time for single support (p=.01), longer time for double support (p=.01) accompanied by a smaller first step (size, p=.05; height, p=.04) and reduced muscle activation of obliquus internus (p=.02). Similarly, during the first step in the obstacle negotiation test, the AK-R group showed less step height (p=.01) and hip excursion (p=.02), accompanied by a reduced mediolateral displacement of the center of pressure (p=.02) during APA, and activation of the gluteus medius (p=.02) and the anterior tibialis (p=.04) during CPA in comparison with hyperkinetic group.

Conclusions: The findings suggest that people with AK-R present impaired postural adjustments during gait initiation and obstacle negotiation compared to hyperkinetic PD.

Implications: Based on defined motor symptoms, the proposition presented here revealed consistent postural adjustments during complex tasks and, therefore, may offer new insights into PD motor evaluation and neurorehabilitation.

Funding acknowledgements: Funding agencies: Call FAPERGS/MS/CNPq/SESRS 03/2017 – PPSUS-Brazil, Call FAPERGS/PqG/2017-172551-0001, and Institutional Program of Internationalization Capes-PrInt-Brazil 2019/2020.

Keywords:
Parkinson
Anticipatory adjustments
Gait

Topics:
Neurology: Parkinson's disease
Older people
Research methodology, knowledge translation & implementation science

Did this work require ethics approval? Yes

Institution: Federal University of Rio Grande do Sul

Committee: Federal University of Rio Grande do Sul - Brazil

Ethics number: 69919017.3.0000.5347