Gait correction in Parkinson’s disease

Abstract

Parkinson’s disease (PD) is the second most common neurodegenerative disorder, and the fastest-growing neurological disease in terms of prevalence, related disability, and mortality. PD affects 1-2% of individuals above 65 and its prevalence is rapidly increasing as the population ages. Since there are currently no neuroprotective therapies able to prevent or delay disease progression, PD is a major healthcare and societal challenge. Gait impairments are common in PD and involve — but are not limited to — reduced stride length, slower gait velocity, and increased gait variability. Goal. Tо analyze the state of locomotor functions during walking in patients with PD and to investigate the effectiveness of physical therapy of the feet based on the data of static and dynamic indicators of pedobarography. Materials and methods. 29 PD patients Hoehn and Yahr stage 1.5-2 aged 54.43±2.54 years were randomly assigned to a first group (n=17) in which the patients received a set of exercises for physical therapy only. Patients of the 2nd group (n=12) were offered special exercises for the feet in addition to physical therapy. The effectiveness of therapy was assessed by certain spatial and temporal parameters of gate on the Sigma HL (France) podiatric track. Results and discussion. 6 months after the initial examination, in the first group (physical therapy only), a negative change in the integral indicator of the quality of gate according to the FAP score (p<0.05) was revealed. On the contrary, in the second group (physical therapy + special exercises for the feet), this indicator did not show the progression of gait disorder (p>0.05). The odds ratio was OR=0.27 [0.06; 1.30]. The upper limit of the confidence interval was 1.30. This does not give grounds to categorically assert the positive effectiveness of the proposed treatment. However, after 6 months, the deterioration in the overall quality of gate in the 1st group was in 66.7±11.59% versus 33.3±13.69% in the 2nd group (p<0.05). This indicates a slowdown in the progression of the disease when patients perform a complex of physical therapy simultaneously with exercises for the feet. Conclusion. The conducted pedobarographic analysis of the spatial and temporal parameters of gate made it possible to prove the effectiveness of the use of a set of special exercises for
the feet prescribed in addition to the generally accepted physical and occupational therapy in patients with PD in order to slow down the progression of gate dysfunction. Therefore, instrumentalized gait analysis will play a major role in prospective diagnosis, prevention, therapy, and monitoring of PD.