Short-term effects of posture-assisted step training on rapid step initiation in Parkinson's disease.
OBJECTIVE
Anticipatory postural adjustments (APAs) for lateral weight transfer and stability precede and accompany gait initiation. Individuals with Parkinson's disease (PD) show altered APA characteristics with delays in initiating stepping that may reflect impaired interactions between posture and locomotion. The purpose of this study was to determine the short-term effects of a single session of repetitive robotic assistance training with the APA on rapid step initiation in individuals with PD in the medications "on" state and healthy control individuals. Ground reaction forces and step kinematics were recorded.


METHODS
Subjects first performed baseline trials of unassisted self-paced rapid forward stepping. Next, a training acquisition series involved 50 trials with a lateral pull applied to the pelvis by a robotic system to assist with the early phase of the APA during stepping. To assess potential retention effects of training, unassisted stepping trials were evaluated immediately after acquisition trials (immediate retention) and one week later (one-week retention).


RESULTS
Overall, the subjects with PD had a longer APA duration (P < 0.03), and longer first step duration (P < 0.04) than the healthy control individuals. Compared with baseline, APA duration was shorter (P < 0.001) and step onset time became earlier (P < 0.001) for acquisition trials but these effects were not retained. Step duration, which became shorter (P < 0.001) during the late acquisition trials (P = 0.002), demonstrated immediate retention (P < 0.001) and one-week retention (P < 0.001).


CONCLUSIONS
Posture-assisted training, affecting the interaction between posture and locomotion, may have therapeutic potential for improving movement performance in individuals with PD.
Mille
Marie-Laure
ML
Department of Physical Therapy, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Hilliard
Marjorie Johnson
MJ
Martinez
Katherine M
KM
Simuni
Tanya
T
Zhang
Yunhui
Y
Rogers
Mark W
MW
D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology* / Q000534:rehabilitation*; D012371:Robotics; D016896:Treatment Outcome