Changes in the coordination of stride length and leg movement put people with Parkinson’s disease at risk of falling. Measuring these changes can serve as an important tool in Parkinson’s gait therapy and fall prevention, physiotherapists say.
“Parkinson’s patients are less constant in setting their feet while walking, and the walking time as a result tends to be unstable,” explained the leader of the study and the science of movement, Dr. Fabio Augusto Barbieri from the State University of São Paulo in Bauru, Brazil. “Their speed rises and falls as they walk, and the length of the steps varies along with the placement of the feet.”
Overall, these patients tend to fall on average three times more often than their peers in the same year without the disease, Barbieri said. Measuring step length synergy, which may include combined leg work and foot placement, can reveal where changes need to be made, he added.
The customized measurement method allowed Barbieri and his colleagues to engage the mobile system (or musculoskeletal system) and help patients adjust movement by teaching them to combine factors such as speed and foot position as they cross an obstacle, he explained.
The study included 13 patients with Parkinson’s disease and 11 age-appropriate control groups. Participants were asked to cross 15 times and cross an obstacle 15 cm high. Step length was stabilized in Parkinson’s patients as well as in controls.
The researchers found that Parkinson’s patients had less variation in foot placement than controls when approaching and crossing an obstacle. And their synergy in stride length during crossover was weaker – or 53% lower – than in controls, the authors reported.
Most members of the Parkinson’s cohort were in the early stages of the disease, an ideal time to practice good stepping behaviors for future use, the authors noted.
“There are patients in our exercise group who fall three or four times a week,” Barbieri said. “It’s important to understand how the gait and movement of these patients adjust as they cross obstacles so we can improve stride length synergy.”
The measurement approach “allows us to perfect the exercise protocol, improve movement, and try to reduce the frequency of falls,” he concluded. “Improving synergies in Parkinson’s patients as they walk can significantly affect their quality of life.”
A recent related study found that older adults have a step length synergy index that is 38% lower than younger adults. “This decline may be related to functional deficits associated with aging and falls associated with stumbling,” the authors theorized.
The results of the current study were published in the journal Gait and posture.