Research Report
Population: Adult
Deb A Kegelmeyer, PT, DPT, MS, GCS, Associate Professor Clinical Health and Rehabilitation Sciences, Ohio State University, College of Medicine, School of Health and Rehabilitation Sciences kegelmeyer.1@osu.edu
Jessica Stewart, student, student, Ohio State University, School of Health and Rehabilitation Sciences jessica.stewart@osumc.edu
Sandra Kostyk, MD, PhD, Associate Professor Neurology, Ohio State University, College of Medicine, Neurology Division sandra.kostyk@osumc.edu
Douglas Scharre, MD, Associate Professor Neurology, Ohio State University, College of Medicine, Neurology Division douglas.scharre@osumc.edu
Anne Kloos, PT, PhD, NCS, Associate Professor Clinical Health and Rehabilitation Sciences, Ohio State University, College of Medicine, School of Health and Rehabilitation Sciences anne.kloos@osumc.edu
Keywords: Plasticity, Prevention, Dementia, Mobility
Purpose/Hypothesis: Individuals with Dementia with Lewy Bodies (DLB) exhibit gait impairments that are similar to those seen in Parkinson’s disease (PD), and that increase their fall risk. While research suggests that treadmill training is an effective intervention for improving gait in people with PD, no studies to date have investigated its use in the DLB population. The purpose of this study was to investigate the feasibility, safety, and immediate effects on gait of a single 20 minute bout of treadmill walking (TW) in people with DLB. Based on studies in PD populations, we hypothesized that TW would be feasible and safe, and would result in immediate improvements in overground gait velocity.
Number of Participants: 8
Materials/Methods: Eight participants with a diagnosis of DLB walked for 20 minutes on a treadmill wearing a harness for safety but no weight support with the speed set initially based on their comfortable overground gait speeds, if unable to perform speed was decreased. After initial 5 minutes speed was increased incrementally by 10% every 5 minutes as tolerated. Spatiotemporal gait parameters during forward walking at comfortable and fast speeds, and backward walking as measured with GAITRite, and Timed-Up-and Go (TUG) measures were obtained at two time points before and once after the intervention.
Results: No abnormal physiological responses (HR, BP, RPE) or adverse events were observed during the intervention or testing. Seven of eight (87.5%) participants completed the TW and all testing; one participant with the greatest cognitive impairment stopped walking after 6 minutes due to fatigue. No participants walked on the treadmill at their comfortable overground speed initially; four participants achieved their comfortable overground walking speed by the end of the intervention. Significant improvements in measures of comfortable overground walking were found after the TW including increased stride velocity (p = 0.028), decreased stance time (p = 0.006), and decreased double support time (p = 0.012). No changes in gait measures during forward fast and backward walking were observed. Mean TUG scores improved post-intervention (25.78 ± 12.47 s and 18.87 ± 13.57 s, respectively), but the change was not significant (p = 0.282). The ability to reach comfortable walking speed on the treadmill was strongly correlated with MMSE scores (rs = 0.874; p = 0.01).
Conclusions: This study demonstrates that TW is feasible and safe in individuals with DLB. The improvements in comfortable forward overground walking but not forward fast or backward walking suggest that the immediate effects of TW may be task specific. Individuals with more advanced disease may have greater difficulty performing TW.
Clinical Relevance: TW may be feasible in individuals with dementia. Our finding of gait improvements after one treadmill session like those found in PD suggests the need for future studies to examine the long term effects of TW in people with DLB.
Citation:
Kegelmeyer, Deb A, PT, DPT, MS, GCS; Stewart, Jessica , student; Kostyk, Sandra K, MD, PhD; Scharre, Douglas W, MD; Kloos, Anne D, PT, PhD, NCS. Treadmill Walking in Individuals with Dementia with Lewy Bodies: Feasibility and Gait Effects.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/042_kegelmeyer-et-al/