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    Top gait training exercises for Parkinson’s Disease

Parkinson’s disease (PD) is a debilitating neurodegenerative disease. It is known for its characteristic gait, especially in the later stages of the disease, that can lead to an increased risk of falls and fractures. In this article, we will discuss top gait training exercises for parkinson’s disease that physical therapists can adopt to improve PD management. 

 

Parkinson’s gait problems 

PD gait typically involves small, shuffling steps and difficulty picking up the feet. Gait changes in PD may be episodic or continuous. Episodic changes, may be freezing of gait, which may come on suddenly and randomly. Continuous changes are constant while walking, for example walking more slowly.

In PD, there is a lack of dopamine production in the substantia nigra, resulting in a progressive neurodegenerative movement disorder. This disorder is characterized by bradykinesia, gait disturbance, rigidity, and tremor. Balance and postural stability impairments are likely to contribute to the increased risk of falls and fractures. 

Compared with healthy age-matched controls, patients with Parkinson’s Disease show altered weight shifting, use a modified ankle joint motion before lift-off, and land with weight shifted posteriorly in response to perturbations of balance with a backward waist pull.

Typical parkinson’s gait pattern 

With PD, a person’s gait often becomes impaired as the disease progresses. 

These impairments may include:

  • Hypokinesia (decreased step length with decreased speed)
  • Decreased coordination
  • Festination (decreased step length with increased cadence)
  • Freezing of gait  (a brief, episodic absence or reduced ability to make a forward step despite the intention to walk)
  • Difficulty with dual tasking during gait 

In addition to these gait impairments, there is an increased risk and rate of falling. A gait impairment is accompanied by an increased risk and rate of falling. This increases the risk of injuries such as hip fractures and also affects the patients social life. Fear of falling has an impact on the patients psychological well-being and may lead to self-isolation and depression.

Parkinson’s gait is characterized by reduced arm swing for balance. A stooped posture and flexed legs are common manifestations. Bradykinesia results in shuffling steps. There are occurrences of freezing and rapid movements.

Gait Training Exercises for Parkinson’s Disease – Physiotherapy Management 

There is no doubt that physical therapy and complementary exercises can improve motor performance and functional mobility. The following exercises are standard approaches used in physiotherapy management to improve gait training for PD patients. 

  • Flexibility Exercises – These are low impact exercises that focus on stretching to help keep muscles elastic and joints moving. Examples include yoga, mat exercises and tai chi.
  • Strength Training – Physical exercises, often used with weights, that are designed to improve strength and endurance.
  • Balance Training – Exercises that strengthen core muscles and leg muscles. These exercises help improve stability, helping prevent falls. Examples include yoga and pilates.
  • Cueing Strategies – Visual cueing techniques can be used to help increase spatial parameters including step/stride length, while reducing step/stride length variability and asymmetry. 
  • Aquatic Therapy – This low impact form of exercise supports weak muscles, allowing limbs to be moved in a less painful manner thanks to the buoyancy matter of water while the resistance of the water helps strengthen muscles and limbs.
  • Treadmill Training  – Treadmill training offers walking practice in an effort to improve walking skills.
  • Dual-Task Gait Training – Training while doing two tasks simultaneously, for example, cognitive and motor tasks.
  • Robotics – A method of rehabilitation that repeats a normal gait pattern with high intensity.

 

A recent review in 2019 presents evidence on the efficacy of a variety of physical therapy and complementary exercises. 

In this article, we will specifically discuss the benefits of integrating cognitive rehabilitation approaches alongside targeted motor gait training exercises to further improve PD management.  

Cognitive challenges in exercise 

As one of the most common non-motor symptoms of Parkinson’s disease, cognitive dysfunction primarily affects executive function, visuospatial function, and memory.  Currently, there is no effective pharmacological treatment for cognitive dysfunction in Parkinson’s disease, thus the need to identify potential non-pharmacological therapies to improve cognitive function is of significant interest. 

There is evidence that adding a VR cognitive component to exercise can be beneficial to people with Parkinson’s. For example, “the largest and most comprehensive trial to date (the V-TIME trial commercialised as GaitBetter) reported some important extra benefits of VR.”

“Notably, the aforementioned V-TIME trial is an example of a VR intervention that closely replicated the target activity, that is, walking under specifically tailored and progressively challenging motor–cognitive conditions.”

“The aforementioned V-TIME trial was the only trial to explicitly report acceptability”

With modern forms of technology such as virtual reality, cognitive elements are easily and effectively implemented. As seen above with the V-TIME prototype of the GaitBetter system, a semi-immersive form of virtual reality that can be easily added to an existing treadmill. The system projects a virtual reality with obstacles that the trainee must overcome. 

In this study using the GaitBetter system, it was the first-time treadmill training plus VR was used in PD. The study with GaitBetter involving 20 PD patients showed gait speed increasing while walking, performing dual tasks and negotiating over-ground obstacles.  Addition of VR may significantly improve physical performance, gait during complex challenging conditions, and even certain aspects of cognitive function in PD.

The potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, provides new rehabilitation approaches to optimize the delivery of PD gait training. 

To learn more about GaitBetter’s evidence-based motor-cognitive technology, please schedule a demo or download our literature review here.

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