Gait Training to Improve Balance in Parkinson’s

Parkinson’s Disease (PD), an age-related neurodegenerative movement disorder, is associated with the following cardinal manifestations- 

• Bradykinesia(slowness of movement)
• Tremors
• Gait Disturbances
• Rigidity in mobility

Difficulties with walking and balance are common in patients with Parkinson’s disease. These problems result in reduced mobility, more trips and falls, social isolation issues, reduced quality of life and increased mortality rates. The balancing issues and postural instabilities are also likely to cause more physical injuries and fractures dominantly in PD patients. Therefore effective management of walking and balance impairments is crucial.

Characteristic Gait Patterns and Kinematics in PD 

With disease progression, the symptoms of gait impairments worsen. Typical gait impairments include

• Decrease in co-ordination

• Hypokinesia wherein therein there is reduction of both step-length and speed.

• Festination which is characterized by decreased step length accompanied by increased cadence

• Freezing of Gait(FOG) which is the inability to produce effective steps or complete pause in stepping due to gait initiation

• Difficulty in performing dual tasks during gait

Gait kinematic changes include modifications in the excursion of hip and ankle joints. This leads to flat foot or toe-heel sequence in walking as PD progresses. So PD patients are likely to have primitive gait patterns rather than adult gait patterns. Specifically flat-footed gait reduces the ability to step over hurdles or even walk properly in carpeted areas which is dangerous for patients. There are also alterations in hip flexion which in turn may change the way the ankle is exerted while walking. These disorders can be largely managed by appropriate exercise regimes.

Gait Training Therapy

Gait training includes various techniques for improving balance and achieving co-ordination:

• Flexibility Exercises: Substantial numbers of PD patients have shown improvement in walking after doing flexibility exercises and following relaxation techniques. This training focuses on Parkinson’s Exercise Therapy through stretching, improving balance and range of movement activities done at least thrice a week for the duration of six months. Significant improvement in walking patterns can be achieved by the right combination of warming up exercise, technique training, endurance training and cooling down activities for de-stressing.

• Activities for enhancing Strength: Progressive resistance training can be beneficial particularly to patients with mild to moderate PD. It involves exercises for strengthening muscles and aerobic training using bicycle or treadmill for increasing physical fitness. This helps in improving aerobic capacities, muscular strength, walking, posture and balancing limitations.

• Balance Training: This can be done by using balance board systems and video demonstrations. It helps in improving selective measures of balance and gait in PD adults. Additionally, weight-bearing exercises can improve balancing difficulties and fall prevention.

• Cueing Techniques: By deploying external auditory or visual cues, the attention of patients can be used for concentrating on specific gait aspects. Cueing and attention strategies help in bypassing the defective basal ganglia in the brain which no longer control movement and it now becomes a cognitive action.

• Aquatic Program: Gait disorders in PD patients can be largely overcome by aquatic physical exercise regimes. Significant improvements in stride length and walking speed are noticed after this training program.

• Treadmill Exercises: Patients with mild to moderate PD who are physically and cognitively capable of using the treadmill with precautionary measures for balancing may utilize this program under supervision. It helps in achieving faster gait speed and improves stride length and walking distance. Treadmill also helps in enhancing dual-task performance capabilities of such individuals with PD.

• Robotics: Latest research shows that robot-assisted sensorimotor gait training reduces FOG episodes and improves gait velocity, co-ordination, stride length and rhythmicity.

Conclusion

Several Gait Training techniques may be implemented by Parkinson’s Support Program for successfully rehabilitating PD patients and improving balance.