Citation

Rabin E, Demin A, Pirrotta S, Chen J, Patel H, Bhambri A, Noyola E, Lackner JR, DiZio P, DiFrancisco-Donoghue J, Werner W. Arch. Phys. Med. Rehabil. 2014; 96(4): 735-741.

Affiliation

Department of Osteopathic Manual Manipulation, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, (e) Department of Physical Therapy, New York Institute of Technology, Old Westbury, NY.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.apmr.2014.07.427

PMID

25286436

Abstract

OBJECTIVE: To determine whether haptic (touch and proprioception) cues from touching a moving handrail while walking can ameliorate Parkinson's disease gait symptoms such as slowness and small stride-length.

DESIGN: Nonrandomized controlled before-after trial. SETTING: Physical therapy clinic. PARTICIPANTS: Sixteen people with Parkinson's disease (PD) and 16 healthy age-matched control subjects with no neurological disorders volunteered. No participants withdrew. INTERVENTIONS: We compared gait using a moving handrail as a novel assistive aid (speed self-selected) versus a banister and unassisted walking. Participants with PD were tested on- and off-dopaminergic medication. MAIN OUTCOME MEASURES: Mean gait speed, stride-length, stride duration, double-support duration, and medial-lateral excursion.

RESULTS: With the moving handrail participants with PD increased gait speed relative to unassisted gait 16%(.166m/s,p=0.009,d=0.76,95%CI.054-.278m/s) and stride-length 10%(.053m,p=0.022,d=0.37,95%CI.009-.097m) without significantly changing stride or double-support duration. The banister reduced speed versus unassisted gait 11%(-.097m/s,p=0.040,d=0.40,95%CI.002-.193m/s) and stride-length 8%(.32m,p=0.004,d=0.26,95%CI.010-.054m), and increased stride 3%(.023s,p=0.022,d=0.21,95%CI.004-.041s) and double-support 35%(.044s,p=0.031,d=0.58,95%CI.005-.083s) durations. All medication×condition interactions were p>0.05.

CONCLUSIONS: Using haptic speed cues from the moving handrail, people with PD walked faster by spontaneously (i.e., without specific instruction) increasing stride-length without altering cadence; banisters slowed gait. People with PD can use haptic cues from the moving handrail to engage biomechanical and neural mechanisms for interpreting tactile and proprioception changes related to gait speed to control gait better than static cues afforded by banisters.

Language: en