title: Parkinsonian gait ameliorated with a moving handrail, not with a banister.
abstract: OBJECTIVE
  To determine whether haptic (touch and proprioception) cues from touching a moving handrail while walking can ameliorate the gait symptoms of Parkinson disease (PD), such as slowness and small stride length.
  
  
  METHODS
  Nonrandomized, controlled before-after trial.
  
  
  METHODS
  Physical therapy clinic.
  
  
  METHODS
  People with PD (n=16) and healthy age-matched control subjects (n=16) with no neurologic disorders volunteered. No participants withdrew.
  
  
  METHODS
  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.
  
  
  METHODS
  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 by 16% (.166m/s, P=.009, d=.76; 95% confidence interval [CI], .054-.278m/s) and increased stride length by 10% (.053m, P=.022, d=.37; 95% CI, .009-.097m) without significantly changing stride or double-support duration. The banister reduced speed versus unassisted gait by 11% (-.097m/s, P=.040, d=.40; 95% CI, .002-.193m/s) and reduced stride length by 8% (.32m, P=.004, d=.26; 95% CI, .010-.054m), whereas it increased stride duration by 3% (.023s, P=.022, d=.21; 95% CI, .004-.041s) and double-support duration by 35% (.044s, P=.031, d=.58; 95% CI, .005-.083s). All medication × condition interactions were P>.05.
  
  
  CONCLUSIONS
  Using haptic speed cues from the moving handrail, people with PD walked faster by spontaneously (ie, without specific instruction) increasing stride length without altering cadence; banisters slowed gait. Haptic cues from the moving handrail can be used by people with PD 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.
authors.affiliation: Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY. Electronic address: erabin@nyit.edu.
authors.forename: Ely
authors.initials: E
authors.lastname: Rabin
authors.affiliation: Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Demin
authors.affiliation: Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Stefania
authors.initials: S
authors.lastname: Pirrotta
authors.affiliation: Baylor College of Medicine, Physical Medicine and Rehabilitation, Houston, TX.
authors.forename: Jason
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Hemal
authors.initials: H
authors.lastname: Patel
authors.affiliation: Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Ankur
authors.initials: A
authors.lastname: Bhambri
authors.affiliation: Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Estella
authors.initials: E
authors.lastname: Noyola
authors.affiliation: Ashton Graybiel Spatial Orientation Laboratory, Brandeis University, Waltham, MA.
authors.forename: James R
authors.initials: JR
authors.lastname: Lackner
authors.affiliation: Ashton Graybiel Spatial Orientation Laboratory, Brandeis University, Waltham, MA.
authors.forename: Paul
authors.initials: P
authors.lastname: DiZio
authors.affiliation: Department of Osteopathic Manual Manipulation, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Joanne
authors.initials: J
authors.lastname: DiFrancisco-Donoghue
authors.affiliation: Department of Physical Therapy, New York Institute of Technology, Old Westbury, NY.
authors.forename: William
authors.initials: W
authors.lastname: Werner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D012656:Self-Help Devices; D016138:Walking
keywords: Assistive devices; Gait disorders, neurologic; Parkinson disease; Proprioception; Rehabilitation; Touch