Case Study Report
Population: Adult
Gina M Brunetti, PT, DPT, Resident in training, Brooks/UNF Neurologic Residency Program, Brooks Rehabilitation brunettigm22@gmail.com
Pamela Spigel, PT, MHA, NCS, Neurologic Residency Coordinator, Brooks Rehabilitation pamela.spigel@brooksrehab.org
Emily Fox, PT, DPT, PhD, NCS, Neurologic Residency Research Mentor, Brooks Rehabilitation, University of Florida emily.fox@brooksrehab.org
Kathryn Doughty, PT, DPT, Resident in training, Brooks/UNF Neurologic Residency Program, Brooks Rehabilitation kathryn.doughty@brooksrehab.org
Keywords: Prevention
ABSTRACT BODY:
Background and Purpose:
Individuals with late stage Parkinson’s disease commonly demonstrate frequent freezing episodes and a festinating gait pattern, which severely impairs their ability to perform functional mobility. Use of a treadmill is beneficial for individuals with Parkinson’s disease, but it has not been established for individuals with severe breakdown of gait kinematics due to late stage Parkinson’s disease. The purpose of this case report is to describe the use of a treadmill for gait rehabilitation in a person with late stage Parkinson’s disease.
Case Description:
The participant is an 87-year-old male with Stage 4 Hoehn and Yahr Parkinson’s disease who was demonstrating almost constant freezing episodes and severe festinating gait pattern. This greatly reduced his gait speed (
Intervention:
The participant performed 2 sessions of gait training on a treadmill. He was in a passive harness for safety and was permitted to self-select gait speed as well as length of treadmill training. Additionally, a 10-meter walk test was assessed before and after treadmill training.
Outcomes:
Prior to the treadmill intervention sessions, the participant was able to perform overground ambulation with a rollator and maximal assist of one to three people. However, during treadmill training, he was able to increase distance trained from 3-135 feet overground to 218-242 feet on the treadmill with passive harness and supervision assistance. He demonstrated an absence of freezing episodes while on the treadmill compared to frequent freezing episodes while overground training (average of 1 freezing episode every 10 feet). The participant self-selected a faster gait speed on the treadmill (0.24 m/s) compared to his overground gait speed (0.027 m/s). He also demonstrated a faster self-selected overground gait speed (0.47 m/s to 0.55 m/s, 0.06m/s to 0.20 m/s) and increased stride length (60 steps to 130 steps) post treadmill stepping assessed via a 10-meter walk test.
Discussion:
Gait training distance, gait speed, and stride length during physical therapy sessions showed great improvement with the use of treadmill and also showed immediate carryover to overground stepping. The treadmill may be a valuable gait training tool to improve gait performance within physical therapy sessions in patients with late stage Parkinson’s Disease. External sensory cueing may have been provided by the treadmill including auditory stimulus of footfalls and visual stimulus on the moving belt. These stimuli may bypasses the dysfunctional neurodegenerative areas of the cortex associated with Parkinson’s disease, thus, improving motor output. This may allow patients to achieve a higher intensity of gait training within physical therapy sessions who would otherwise be limited due to the pathology of Parkinson’s disease.
Citation:
Brunetti, Gina M, PT, DPT; Spigel, Pamela M, PT, MHA, NCS; Fox, Emily J, PT, DPT, PhD, NCS; Doughty, Kathryn L, PT, DPT. Utilization of Treadmill to Improve Gait Performance in a Patient with Late Stage Parkinson’s Disease.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/030_brunetti-et-al/