Feasibility and efficacy of gait training in people with PD who have mild cognitive impairment.

Research Report
Population: Adult

Valerie E. Kelly, PT, PhD, Associate Professor, University of Washington vekelly@uw.edu

Ellen McGough, PT, PhD, Assistant Professor, University of Washington emcg@uw.edu

James Leverenz, MD, Director, Lee Ruvo Center for Brain Health, Cleveland Clinic leverej@ccf.org

Anne Shumway-Cook, PT, PhD, FAPTA, Professor Emeritus, University of Washington ashumway@uw.edu

Keywords: Prediction, Parkinson’s Disease, Walking, Cognition

Purpose: Gait impairments are pervasive among people with Parkinson disease (PD) and become increasingly unresponsive to pharmacological and surgical interventions with disease progression, making rehabilitation an essential part of clinical care. Previous research demonstrates that various forms of gait training are effective for people with PD. However, those with cognitive deficits are often excluded or cognition is not well documented. As a result, the efficacy of gait training is not well understood for people with cognitive dysfunction, despite the fact that up to 60% of the PD population has mild cognitive impairment (PD-MCI) and up to 20% has dementia (PD-D). The aims of this project were to determine the feasibility and efficacy of a 2-week gait rehabilitation program for persons with PD-MCI.
Subjects: Participants were Individuals who have PD with MCI diagnosed through neuropsychological assessment and consensus conference. Eligibility criteria included: (1) ability to walk 400 m without assistance; (2) no neurosurgery; and (3) no vision or hearing problems. All participants were tested when on medication.
Methods: At baseline, motor symptom severity (Unified Parkinson’s Disease Rating Scale), balance (Berg Balance Scale), falls history, and falls self-efficacy (Falls Efficacy Scale) were assessed. At baseline and post-intervention, walking was assessed using clinical tests and quantitative motion analysis of simple and complex tasks, with gait speed as the primary outcome. Participants completed a 2-week gait training program (six 1-hour sessions; six 5-minute blocks of walking/session).
Results: Preliminary results are from six participants with PD-MCI, with mean (standard deviation) age of 74.5 (8.1) years, disease duration of 10.7 (6.1 years), and MDS-UPDRS Motor Exam score of 37.2 (9.2). All participants completed the program, with no adverse events. All participants increased walking speed during gait training over the six sessions. There were no changes in balance (BBS mean [SD]: pre=50.5 [7.8]; post =49.7 [4.6]) or falls self-efficacy (FES-I: pre=27.7 [8.5]; post =27.3 [8.1]). Participants demonstrated small increases in self-selected gait speed during simple walking tasks (pre=0.87m/s; post =0.92 m/s). However, gait speed did not improve during complex walking tasks, with the exception of turning (pre: 0.64 m/s; post: 0.73 m/s).
Conclusions: Individuals with PD-MCI were able to complete the program without adverse events. Small improvements in gait speed were observed, though these were modest compared to effects previously reported. These positive effects translated to turning while walking, which is often impaired in PD, but not to other complex walking tasks.
Clinical Relevance: Determining the effects of gait training in PD-MCI is critical for predicting the response to physical therapy and guiding the development of interventions optimized for the cognitive status of persons with PD. Further research is needed to understand optimal gait training strategies to improve functional mobility for people with PD and cognitive dysfunction.

Kelly, Valerie E., PT, PhD; McGough, Ellen L., PT, PhD; Leverenz, James B., MD; Shumway-Cook, Anne , PT, PhD, FAPTA. Feasibility and efficacy of gait training in people with PD who have mild cognitive impairment.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/083_kelley-et-al/