Increased foot strike variability in Parkinson's disease patients with freezing of gait
Jesal Shah, Lakshmi Pillai, David K Williams, Shannon M Doerhoff, Linda Larson-Prior, Edgar Garcia-Rill, Tuhin Virmani, Jesal Shah, Lakshmi Pillai, David K Williams, Shannon M Doerhoff, Linda Larson-Prior, Edgar Garcia-Rill, Tuhin Virmani
Abstract
Introduction: Freezing of gait (FOG) is a debilitating, late motor complication of Parkinson's disease (PD) that occurs in 50-80% of patients. Gait freezing significantly worsens quality of life by decreasing mobility and increasing falls. Studies have shown that patients with episodic freezing episodes also have deficits in continuous gait. We evaluated whether there was an objective gait correlate to the increased stumbling reported by many patients with gait freezing.
Methods: PD subjects and healthy controls (HC) were enrolled after IRB approval. Subjects with more than 1 fall/day or a Montreal Cognitive Assessment score <10 were excluded. Subjects walked at their normal pace, 8 lengths of a 20 × 4 foot pressure-sensor mat. Data was collected and analyzed using PKMAS software (Protokinetics) and statistical analysis performed using SPSS 22 (IBM).
Results: 72 age matched subjects (22 PD FOG, 27 PD no-FOG, and 23 HC) were enrolled. Disease duration and Hoehn & Yahr scores were not significantly different between the PD groups. Mean dimensions of foot strike were not significantly different between groups, but PD FOG subjects had increased step-to-step variability in foot strike as measured by the percent coefficient of variation (%CV) in foot strike length compared to PD no-FOG and HC, independent of stride velocity. In PD no-FOG subjects, fallers also had higher variability in foot strike length compared to non-fallers.
Conclusion: PD subjects with FOG had increased variability in foot strike suggesting that in addition to stride length variability, foot strike variability could contribute to imbalance leading to falls.
Keywords: Falls; Freezing of gait; Parkinson's disease.
Conflict of interest statement
Declaration of interest:
Jesal Shah is a medical student at the University of Arkansas for Medical sciences. She has no financial disclosures.
Lakshmi Pillai is a research technician at the University of Arkansas for Medical Sciences and received salary support from the Clinician Scientist Training program grant to Tuhin Virmani.
Shannon Doerhoff is an Advanced practice nurse employed by the University of Arkansas for Medical Sciences and has no other financial disclosures.
Dr. Williams is a Professor in Biostatics employed at the University of Arkansas for Medical Sciences. He has served on the advisory board for Core Metabolics, and received grant support from the NIGMS IDeA Program Center of Excellence award P30 GM110702.
Dr. Larson-Prior is a Professor of Psychiatry, Neurobiology & Developmental Sciences, & Neurology employed by the University of Arkansas. She received grant support from NSF EPScOR and NIH SBIR.
Dr. Garcia-Rill is Director of the Center for Translational Neuroscience and a Professor of Neurobiology & Developmental Sciences employed by the University of Arkansas for Medical sciences and he also received salary support from the University of Arkansas for Medical Sciences’ Clinician Scientist Program for mentoring Dr. Virmani. He has also received salary support as the PI of NIH award P30 GM110702, and has received reviewer fees from the NIH, as well as international grant agencies and has served as a consultant on the Las Vegas COBRE and the Chilean Millennium Project. He has also received Royalties from Elsevier.
Dr. Virmani is Director of the Movement Disorders Program and an Assistant Professor of Neurology employed by the University of Arkansas for Medical Sciences. He received salary and grant support from the University of Arkansas for Medical Sciences Clinician Scientist program as well as grant support from the NIGMS IDeA Program Center of Excellence award P30 GM110702.
Copyright © 2018 Elsevier Ltd. All rights reserved.
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Source: PubMed