Gait assessments in patients with early Parkinson's disease

Abstract

Introduction : Gait disturbances are affected in all stages of PD. At the early stages of the disease, gait disturbances can be present but in most patients, it does not cause significant functional disability and fall-related problems. A study of gait disturbances in early PD is limited. It still fails to identify the subclinical gait abnormalities in both normal walking and dual task performed during walking in early PD patients. Objective : To identify the early or subclinical gait abnormality in patient with early Parkinson’s disease who do not as yet complain of gait difficulty. Methods : The cross – sectional analytic study in early Parkinson’s disease patients who are asymptomatic gait abnormality comparing to age and sex matched controls in the ratio of 1:1 in order to identify the gait abnormality during January 2010 – January 2011. The patients and controls were assigned to walk in both normal and narrow passage with normal walking , walking with metronome and dual tasking. The quantitative data of gait parameters are collected and examined between PD patients versus age and sex matched controls by using paired t-test. The statistical significant is set at α 0.05. Results : The total patients that met the inclusion criteria were 21. There were 12 female (57.1%) and 9 male (42.9%) patients. All were in the early PD stage. The mean Hoehn and Yahr was 1.62. The mean duration of disease was 2.77 years. The gait parameters in the PD patients were not different from controls in normal walking and walking with metronome. When dual task was performed during walking, the gait parameters were significantly changed in cadence (p=0.04), cycle time (p=0.04), swing time (p=0.02), single support time (p=0.01) and stride width (p=0.04) comparing to controls. Walking in narrow passage did not disturb the gait of PD patients except walking in narrow passage with cognitive overload. There were no freezing of gait during the walking test. Conclusions : There was a subclinical gait abnormalities in the early PD patients with dual tasking. Narrow passage does not have much as affect on gait as cognitive overload. Cognitive training and rehabilitation should be done early in early PD patients to improve gait and balance stability and reduced risk of falling.