Moving forward with prisms: sensory-motor adaptation improves gait initiation in Parkinson's disease

It is postulated that the decreased walking speed; small, shuffling steps; and "freezing" shown by patients with Parkinson's disease could stem from an inability to tilt the body forward enough to provide sufficient forward propulsion. In two repeated-measures studies we examined whether adaptation to upward-shifting prisms, resulting in a downward after-effect, could improve gait initiation in healthy participants and patients with Parkinson's disease. Faster forward stepping followed a brief (5 min) exposure period for patients, and a longer (20 min) exposure period for age-matched controls. Backward stepping was unchanged, and adaptation to downward-shifting prisms with control participants showed no effect on forward or backward stepping. These results suggest that adaptation of arm proprioception in the vertical plane may generalize to anterior-posterior postural control, presenting new possibilities for the treatment of gait disturbance in basal ganglia disorders.