Stability vs. performance: The role of weight shift during gait initiation for people with Parkinson disease

People with Parkinson disease (PwPD) demonstrate hypokinesia during gait initiation, marked by a decreased first step length and reduced anticipatory postural adjustment (APA) size. Effective postural control is critical for shifting from double to single limb support during gait initiation. Although PwPD are known to have impaired postural control strategies, its impact on spatial aspects of gait initiation remains unclear. This study investigated how different weight shift amplitudes onto the initial stance limb during gait initiation affect first step length, mediolateral APA size, and the ability to bring the centre of mass (COM) close to the centre of pressure (COP) for PwPD. We hypothesized that cueing for larger weight shifts would yield a larger APA, reduce the distance between COP and COM in the mediolateral direction (COM-COMx), and result in larger first steps. Eleven adults with idiopathic PD (Hoehn & Yahr Stages 1-3) were given visual biofeedback to cue weight shifts of 40, 60, and 80 % towards the initial stance limb before initiating gait. No significant difference was found between uncued and cued conditions for first step length (p = 0.210), however, cued conditions resulted in smaller mediolateral APA sizes (p < 0.001), and reduced COP-COMx compared to uncued trials (p < 0.001). A weak positive correlation was found between mediolateral APA size and first step length (ρ = 0.236, p = 0.005), suggesting a very small role of APAs in first step length amplitude in this population. In conclusion, cueing for increased weight shift amplitude improves stability but does not enhance first step length during gait initiation for PwPD.