Highlights
- •PD+FOG presented altered preparation and execution of the gait initiation process.
- •PD patients initially positioned their COP towards stance leg prior to preparation.
- •This mediolateral COP position worsened first-step execution in PD+FOG.
- •Rehabilitation should target quiet stance prior to gait initiation in PD+FOG.
Abstract
Introduction
Freezing of gait (FOG) in Parkinson's disease (PD) is associated with an altered posture
during quiet stance as well as an impaired preparation and execution of the gait initiation
process. We aimed to investigate whether an altered initial posture impacts anticipatory
postural adjustments (APAs) and first-step execution during gait initiation in people
with PD with FOG (PD + FOG).
Methods
Twenty-seven PD+FOG, 30 PD patients without FOG and 27 age-matched healthy controls
performed self-generated gait initiation. Initial mean center of pressure (COP) position
prior to APA onset, characteristics of APAs and features of first-step execution were
investigated.
Results
Contrarily to controls, PD patients showed a COP that was initially positioned more
towards the stance leg (p = 0.007). Moreover, significantly smaller backward COP shift,
longer duration of swing-foot unloading phase, and lower first-step length and velocity
characterized PD+FOG compared to controls. While size and duration of backward COP
shift during APA and lateral COP shift during the unloading phase were main predictors
of first-step length and velocity in all groups, the medio-lateral shift of the initial
COP position in PD+FOG was a main predictor of first-step execution (β = −0.191, p = 0.001
for velocity).
Conclusion
In PD+FOG, the more the COP was initially positioned towards the stance foot, the
slower and shorter the first step. The initial medio-lateral COP position may be a
compensatory strategy to address postural instability of PD+FOG. A specific training
regarding postural control prior to gait preparation and execution could improve functional
mobility in PD+FOG.
Keywords
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Article info
Publication history
Published online: January 22, 2021
Accepted:
January 11,
2021
Received in revised form:
January 8,
2021
Received:
September 30,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
