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Why we should study gait initiation in Parkinson's disease
A Delval1, C Tard2, L Defebvre2
1Université Lille Nord de France, UDSL, Lille, France; Laboratoire de Neurosciences Fonctionnelles et Pathologies, EA 4559, Lille 2, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, Lille, France.
Neurophysiologie Clinique = Clinical Neurophysiology
|February 8, 2014
Summary
Gait initiation in Parkinson's disease involves motor and cognitive processes, often disrupted by freezing of gait. Research highlights abnormal timing and scaling of anticipatory postural adjustments in these patients.
Area of Science:
- Neuroscience
- Movement Science
- Rehabilitation Medicine
Background:
- Gait initiation is a complex process involving motor and cognitive elements, crucial for daily mobility.
- Parkinson's disease (PD) significantly impacts gait initiation, manifesting as freezing of gait (FOG) and disruptions in anticipatory postural adjustments (APAs).
- Understanding these gait disturbances is vital for developing effective therapeutic strategies for PD patients.
Purpose of the Study:
- To investigate the specific disturbances in gait initiation, particularly anticipatory postural adjustments (APAs), in individuals with Parkinson's disease.
- To explore the underlying pathophysiological mechanisms, including the role of cortical and basal ganglia systems.
- To assess the potential of external cueing and rehabilitation methods in managing gait initiation deficits in PD.
Main Methods:
- Analysis of gait initiation parameters, focusing on anticipatory postural adjustments (APAs) and step execution.
- Examination of the influence of cognitive and emotional factors, as well as dopaminergic medication, on gait initiation.
- Review of existing literature on rehabilitation strategies, including external cueing, for gait disturbances in PD.
Main Results:
- Gait initiation in PD is characterized by delayed, hypokinetic, or bradykinetic APAs, with FOG representing an extreme form.
- Abnormal coupling between postural adjustments and step execution is a key pathophysiological feature.
- Emotional and cognitive factors, attention, and dopaminergic medication modulate gait initiation, suggesting complex neural involvement.
Conclusions:
- Gait initiation deficits in Parkinson's disease are multifaceted, involving disruptions in motor preparation and execution.
- The basal ganglia and cortical networks play a significant role in the pathophysiology of these disturbances.
- While external cueing shows promise, robust evidence for routine rehabilitation efficacy is still limited, necessitating further research.
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