Reduction of freezing of gait in Parkinson's disease by repetitive robot-assisted treadmill training: a pilot study

Albert C Lo, Victoria C Chang, Milena A Gianfrancesco, Joseph H Friedman, Tara S Patterson, Douglas F Benedicto, Albert C Lo, Victoria C Chang, Milena A Gianfrancesco, Joseph H Friedman, Tara S Patterson, Douglas F Benedicto

Abstract

Background: Parkinson's disease is a chronic, neurodegenerative disease characterized by gait abnormalities. Freezing of gait (FOG), an episodic inability to generate effective stepping, is reported as one of the most disabling and distressing parkinsonian symptoms. While there are no specific therapies to treat FOG, some external physical cues may alleviate these types of motor disruptions. The purpose of this study was to examine the potential effect of continuous physical cueing using robot-assisted sensorimotor gait training on reducing FOG episodes and improving gait.

Methods: Four individuals with Parkinson's disease and FOG symptoms received ten 30-minute sessions of robot-assisted gait training (Lokomat) to facilitate repetitive, rhythmic, and alternating bilateral lower extremity movements. Outcomes included the FOG-Questionnaire, a clinician-rated video FOG score, spatiotemporal measures of gait, and the Parkinson's Disease Questionnaire-39 quality of life measure.

Results: All participants showed a reduction in FOG both by self-report and clinician-rated scoring upon completion of training. Improvements were also observed in gait velocity, stride length, rhythmicity, and coordination.

Conclusions: This pilot study suggests that robot-assisted gait training may be a feasible and effective method of reducing FOG and improving gait. Videotaped scoring of FOG has the potential advantage of providing additional data to complement FOG self-report.

Figures

Figure 1
Figure 1
(A). The Lokomat, an automated gait orthosis on a treadmill with a body weight-support system; (B). Lokomat leg orthosis.
Figure 2
Figure 2
Frequency vFOG scores (median of all scores, recorded before and after each training session).
Figure 3
Figure 3
Severity vFOG scores for all contexts (n = 4).

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