Browsing by Author "Grobbelaar, Roné"
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- ItemComparison between forward and backward gait retraining for mobility in individuals with mild to moderate Parkinson’s disease(Stellenbosch : Stellenbosch University, 2017-03) Grobbelaar, Roné; Welman, Karen; Venter, Ranel; Stellenbosch University. Faculty of Education. Dept. of Sport ScienceENGLISH ABSTRACT : Background Dysfunctional gait and transitional movements are the most disabling features of Parkinson's disease (PD) and often relates to falls. Due to executive dysfunction in PD, dual tasking (DT) is detrimental to already impaired mobility parameters. Backwards walking (BW) might be a useful training alternative to improve aberrant PD gait and transitional movements to consequently improve the quality of complex, multi-directional daily activities, which most often involve DT. Over ground BW gait retraining has shown to be beneficial for neurological gait rehabilitation; however, has not yet been investigated in PD. Training in complex, novel tasks may induce enhanced cortical activity for movement preparation that is beyond training in automatic tasks. Purpose This study aimed to compare the effect of an eight-week forward and backwards gait retraining program on gait parameters, postural transitions and turning in PD individuals as well as the related percentage DT interference (%DTC). Methods This randomized controlled trial was performed as a staggered design in the Western Cape. Twenty-nine PD individuals (34.5% women) with disease severity of 38.1±12.3 (Movement Disorder Society – Unified Parkinson‟s Disease Rating Scale; UPDRS III) were randomly assigned into a forward (FWG) or backward (BWG) walking group by means of concealed, simple randomization (1:1 ratio). The FWG included 14 participants (aged: 70±11 years; Hoehn and Yahr (H&Y): 2.7±0.5; disease duration: 7±6 years) and was compared to 15 participants of similar age (72±6 years), H&Y (2.7±0.9) and disease duration (5±3 years) in the BWG. Groups performed a 24-session (3x/week for eight weeks) over ground gait retraining program of the same tasks in opposite directions. Descriptive measures at baseline included body mass index, experiences of daily living (UPDRS II), global cognition (Montreal Cognitive Assessment), depression (Patient Health Questionnaire-9) and freezing status (Freezing of Gait Questionnaire). Participants completed an instrumented (APDM®) 10m-Walk (i10mWT), a Five-times-Sit-toStand (i5xSTS) and Timed-Up-and-Go (iTUG) test under both single task (ST) and DT (cognitive, arrhythmic) conditions before and after the intervention. Participants were blinded to the primary outcome measures, which were selected gait variables (i10mWT), sit-to-stand (i5xSTS) and stand-to-sit (iTUG) transitions as well as turning variables (iTUG), together with %DTC of each variable. Secondary outcome measures included functional capacity (FC, Six Minute-Walk test), balance confidence (Activity-specific Balance Confidence scale) and disease related quality of life (Parkinson‟s Disease Questionnaire-39; PDQ-39). Results Both groups improved ST walking velocity (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57), ST turning velocity (FWG: p=0.04, d=0.28; BWG: p=0.05, d=0.28), FC (FWG: d=0.82; BWG: d=1.06; p<0.01) and MDS-UPDRS III scores (FWG: p=0.02, d=0.45; BWG: p=0.03, d=0.62). Additionally, the BWG improved individual PDQ-39 domains (p=0.01, d=0.41), i10mWTST time (p<0.01, d=0.45), gait cycle time (p=0.01, d=0.00), stride length (SL; p=0.02, d=0.39) and cadence (p<0.01, d=0.67); however worsened SL variability (p=0.04, d=0.83) under ST conditions. The BWG also improved %DTC for percentage double support (%DS) variability (p=0.05, d=0.57); however deteriorated %DTC for %DS (p=0.05, d=0.45) and swing time gait asymmetry (p=0.02, d=0.61). The FWG improved UPDRS II scores (p=0.03, d=0.44), i5xSTSST duration (p<0.01, d=0.52), iTUG duration (ST: p<0.01, d=0.71; DT: p=0.02, d=0.54), turning angle (ST: p=0.02, d=0.52; DT: p=0.01, d=0.62) and %DTC for SL (p=0.02, d=0.67). Conclusion Both FW and BW over ground gait retraining can be beneficial for PD mobility. Even though most outcomes are training direction specific, findings illustrates that the ability to learn remains intact in mild to moderate PD. Considering that both interventions yielded individual benefits, BW should not replace, but rather be added to a FW gait retraining program. Albeit FW can be a beneficial non-pharmacological method to improve mobility aspects, BW is an interesting alternative for rehabilitative purposes in mild to moderate PD.