Gait and gait variability in individuals with Parkinson’s disease: validity, reliability and long-term effects of intensive balance and gait training
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AbstractMany individuals with Parkinson’s disease (PD), a degenerative neurological disorder affecting the basal ganglia, experience disturbances of postural control and gait. Structured exercise is an integral part of PD-management, and evidence based training programs that promote long-term effects are needed. The High Intensity Balance program (HiBalance-program) was developed to target Parkinson-specific balance and gait impairments. Focused progression was ensured through intensive physiotherapist-led training performed in smaller groups. The aims of the thesis were firstly to explore valid and reliable methods for estimating level of variability in PD-gait. Secondly, the knowledge gained from this part of the thesis was implemented when evaluating immediate and long term-effects of the HiBalance-program on variables associated with pace, rhythm, variability, asymmetry and postural control aspects of PD-gait during normal and fast walking. Overall, when estimating level of gait variability in PD-gait it is recommended that at least 40 steps are used, both for normal and fast walking speed. However, reliability could not be confirmed for slow gait, and caution is warranted when investigating gait variability at lower gait speeds. Immediate training effects were seen in pace, rhythm and variability aspects of PD-gait, suggesting improved stability and motor control during normal and fast walking. However, improvements were lost within six months, and could reflect the susceptibility to evolutionary deterioration in pace and rhythm aspects of PD-gait, as well as decreased ability for long-term skill retention seen with PD. Upholding gait function in the mild to moderate stages of the disease may require regular booster sessions of intensive balance and gait training.
List of papers
|Paper I: Rennie L, Dietrichs E, Moe-Nilssen R, Opheim A, Franzen E. The validity of the Gait Variability Index for individuals with mild to moderate Parkinson’s disease. Gait and Posture, 2017. 54: p. 311-317. DOI: 10.1016/j.gaitpost.2017.03.023. The article is included in the thesis. Also available at: https://doi.org/10.1016/j.gaitpost.2017.03.023|
|Paper II: Rennie L, Löfgren N, Moe-Nilssen R, Opheim A, Dietrichs E, Franzén E. The reliability of gait variability measures for individuals with Parkinson's disease and healthy older adults - The effect of gait speed. Gait Posture, 2018. 62: p. 505-509. DOI: 10.1016/j.gaitpost.2018.04.011. The article is included in the thesis. Also available at: https://doi.org/10.1016/j.gaitpost.2018.04.011|
|Paper III: Rennie L, Opheim A, Dietrichs E, Löfgren N, Franzén E. Highly challenging balance and gait training for individuals with Parkinson’s disease improves pace, rhythm and variability domains of gait. Clinical rehabilitation, 2020. DOI: 10.1177/0269215520956503. The paper is included in the thesis. Also available at: https://doi.org/10.1177/0269215520956503|