Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinson's disease

Recent reports suggest that external cueing improves stride length and gait speed in Parkinson's disease (PD). The purpose of the present study was to examine the influence of treadmill walking on gait variability. The 36 PD patients (Hoehn and Yahr stage 2--2.5) were compared to 30 controls. Subjects walked three times for 2 minutes each: (1) walking on level ground (unassisted), (2) walking on level ground while using a walker, and (3) walking on a treadmill. Stride time variability and swing time variability were significantly increased in the patients compared to the control subjects when walking on level ground with a walker. In both groups, the use of a walking aid did not significantly affect stride time variability or swing time variability, but the treadmill reduced stride time variability and swing time variability in the patients and in the controls. These results indicate that, during treadmill walking, PD subjects are able to walk with a less variable and more stable gait. Because the treadmill walking speed was set to the gait speed on level ground and because this effect was not seen with a walking aid, we suggest that the treadmill may be acting as an external cue to enhance gait rhythmicity and reduce gait variability.