title: Curved Walking Rehabilitation with a Rotating Treadmill in Patients with Parkinson's Disease: A Proof of Concept.
abstract: Training subjects to step-in-place eyes open on a rotating platform while maintaining a fixed body orientation in space [podokinetic stimulation (PKS)] produces a posteffect consisting in inadvertent turning around while stepping-in-place eyes closed [podokinetic after-rotation (PKAR)]. Since the rationale for rehabilitation of curved walking in Parkinson's disease is not fully known, we tested the hypothesis that repeated PKS favors the production of curved walking in these patients, who are uneasy with turning, even when straight walking is little affected. Fifteen patients participated in 10 training sessions distributed in 3 weeks. Both counterclockwise and clockwise PKS were randomly administered in each session. PKS velocity and duration were gradually increased over sessions. The velocity and duration of the following PKAR were assessed. All patients showed PKAR, which increased progressively in peak velocity and duration. In addition, before and at the end of the treatment, all patients walked overground along linear and circular trajectories. Post-training, the velocity of walking bouts increased, more so for the circular than the linear trajectory. Cadence was not affected. This study has shown that parkinsonian patients learn to produce turning while stepping when faced with appropriate training and that this capacity translates into improved overground curved walking.
authors.affiliation: Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno , Veruno , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Godi
authors.affiliation: Department of Translational Medicine, University of Eastern Piedmont , Novara , Italy.
authors.forename: Marica
authors.initials: M
authors.lastname: Giardini
authors.affiliation: Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Laboratorio di Comunicazione e Domotica, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Veruno, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nardone
authors.affiliation: Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno , Veruno , Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Turcato
authors.affiliation: Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Laboratorio di Comunicazione e Domotica, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno , Veruno , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Caligari
authors.affiliation: Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Division of Neurological Rehabilitation, Scientific Institute of Veruno , Veruno , Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pisano
authors.affiliation: Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Centro Studi Attività Motorie, Pavia, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Schieppati
keywords: Parkinson’s disease; circular treadmill; curved walking; gait rehabilitation; podokinetic after-rotation