【論文摘要】The Effect of Gait Training Emphasizing Heel-Strike on Gait Performance in People With Parkinson's Disease: A Preliminary Study

【論文摘要】強調腳跟先著地之行走訓練對於巴金森氏症患者步態之療效：初步研究

李旻昊(Min-Hao Li) ； 陳雪婷(Suet-Ting Chan) ； 李亞芸(Ya-Yun Lee)

《物理治療》 44卷2期 (2019/06) Pp. 102-103

https://doi.org/10.6215/FJPT.201906.O23

摘要

Background and Purpose: Gait disturbance is a debilitating motor symptom in people with Parkinson's disease (PD). The primary gait disorders in PD include lack of heel-strike (HS), short step length and slow walking speed. To ameliorate those gait disorders, clinicians often use verbal cues, such as ＂lift your foot up high＂ or ＂take big steps,＂ to train patients with PD. However, it is uneasy to maintain the required gait patterns because patients often feel tired and embarrassed when walking outdoors with the exaggerated walking pattern. Thus, to identify an effective verbal instruction to train the patients is important. It has often been observed that patients with PD do not have HS at the initial contact. The presence of HS at initial contact is crucial for generating longer step length, faster walking speed and increased foot clearance. Thus, this study aimed to determine whether gait training emphasizing ＂HS at initial contact＂ could improve walking ability in people with PD. Methods: Ten individuals with idiopathic PD have joined the preliminary study. The participants were randomly allocated to the HS group (n = 5) or big-steps (BIG) group (n = 5). All the participants received 12 sessions of 1-h gait training. The verbal instructions of ＂strike your foot with heel＂ and ＂lift your foot high＂ were given to the participants in the HS group and the BIG group, respectively. The participants were assessed before (pre-test), after (post-test), and 1-month after (follow-up test) the interventions. The Physilog®5 system (Gait Up, Renens, Switzerland) was used to evaluate gait parameters including the foot-strike (FS) angle, step length, gait velocity and cadence. Secondary outcomes included the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and the Timed Up and Go test (TUG). Results: Both groups showed an increase in FS angle from pre-test (HS: 15.93 ± 3.87°, BIG: 15.39 ± 3.71°) to post-test (HS: 21.17 ± 4.06°, BIG: 19.79 ± 4.06°), and maintained till follow-up test (HS: 22.02 ± 5.02°, BIG: 19.23 ± 4.47°). As for the step length, both groups showed an increase from pre-test (HS: 0.50 ± 0.05 m, BIG: 0.49 ± 0.05 m) to post-test (HS: 0.56 ± 0.05 m, BIG: 0.53 ± 0.03 m), and maintained till follow-up (HS: 0.56 ± 0.06 m, BIG: 0.51 ± 0.04 m). The HS group seemed to have greater increment in FS angle and step length than the BIG group after the interventions. The HS group showed a decrease in cadence at follow-up test compared with pre-test and post-test, while the BIG group showed an increase in cadence after training. Both groups showed similar amount of improvement on gait velocity. Scores of the UPDRS-III decreased at post-test compared with pre-test for both groups. Only the HS group, but not the BIG group, maintained the improvement of the UPDRS-III at follow-up. Subjects in both groups showed equivalent improvement in TUG at post-test and follow-up. Conclusion: Our preliminary data indicated that gait training emphasizing HS at initial contact could improve walking ability for people with PD. Clinical Relevance: Clinicians may use the verbal instructions of emphasizing HS at initial contact to improve gait performance for people with PD.