Background: Gait impairments and postural deficits are very common in people with Parkinson Disease (PD), and also highly associated with fall risk and functional decline. Some evidence showed that in older adults, Nordic Walking (NW) could slow the progression of some gait impairments and increasing stride length and gait speed. Moreover, previous studies suggested that gait disturbances in PD are associated with less automatic gait performances and therefore gait requires more attention, as it is essential for regulation of postural balance. Further, research of this fact has very minimally been examined in PD population.
Purpose: The purpose of this study is to investigate whether Nordic walking can improve gait pattern in individual with PD after a 6-week training program, as well as determine the effect of performing a cognitive task while walking with and without the poles on gait characteristics.
Methods: Gait spatial temporal and kinetics data was collected with and without poles in 12 adults with PD (age: 61.58±11.7 years; 9 male, 3 female; Hoehn and Yahr scale 1-3 stage; UPDRS III average: 11; the year of diagnosis: 6.72 years). Participants performed six 5m walking trials; 3 with poles and 3 without after 6-week training. Participants also performed four 90 seconds walking trials on a 25m pathway in four different conditions: NP (no poles) and no cognitive task, NW (Nordic walking) and no cognitive task, NP and a cognitive task, NW and a cognitive task. For this latter part of the experiment, gait characteristics and trunk kinematics were quantified by using a 6 inertial sensor accelerometry system (APDM, Oregon, USA). As for the 5m tasks, gait spatial temporal and kinetics were collected with an eight cameras 3-dimensional motion capture system (Vicon, Oxford, UK) and 2 force platforms (Kistler, Winterthur, Switzerland). All variables were assessed using paired t-test to compare NW to conventional walking and two-way ANOVA to compare cognitive and pole conditions.
Results: When comparing NW to NP, the results showed significantly longer stride length, and larger single support time. The data also showed larger knee power generation during mid-stance as well as decreased power absorption at the knee during swing. Moreover, when assessing the effect of performing a cognitive task on gait, gait speed and cadence in both normal walking and Nordic pole walking was significant smaller when performing the cognitive task. The trunk frontal range of motion (ROM) and velocity were smaller compared NW to NP. When adding cognitive tasks, trunk frontal ROM and velocity were significantly smaller.
Conclusions: Based on the results, 16 self-directed sessions of NW can help improve certain gait spatial-temporal characteristics as well as some aspect of the gait pattern kinetics, especially at the knee. Moreover it seems that a 16 sessions (45mintues per session) or even longer practice period is necessary for NW beginner, in order to gain perfect technique and restore gait to a more normal pattern than novice.
|Université d'Ottawa / University of Ottawa
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