Lack of Short-Term Effectiveness of Rotating Treadmill Training on Turning in People with Mild-to-Moderate Parkinson's Disease and Healthy Older Adults: A Randomized, Controlled Study

Abstract

Since turning is often impaired in Parkinson's disease (PD) and may lead to falls, it is important to develop targeted treatment strategies for turning. We determined the effects of rotating treadmill training on turning in individuals with PD. This randomized controlled study evaluated 180° in-place turns, functional turning (timed-up-and-go), and gait velocity before and after 15 minutes of rotating treadmill training or stepping in place in 26 people with PD and 27 age-matched controls. A subset of participants with PD (n = 3) completed five consecutive days of rotating treadmill training. Fast as possible gait velocity, timed-up-and-go time, 180° turn duration, and steps to turn 180° were impaired in PD compared to controls (P < 0.05) and did not improve following either intervention (P > 0.05). Preferred pace gait velocity and timing of yaw rotation onset of body segments (head, trunk, pelvis) during 180° turns were not different in PD (P > 0.05) and did not change following either intervention. No improvements in gait or turning occurred after five days of rotating treadmill training, compared to one day. The rotating treadmill is not recommended for short-term rehabilitation of impaired in-place turning in the general PD population.

Figure 1

Gait Velocity. Mean preferred pace gait velocity (a) and fast as possible gait velocity (b) for PD and controls in the rotating treadmill training group (Train) and the stepping-in-place group (Step). Brackets indicate a significant group effect. Error bars are SDs.

Figure 2

Functional Turning and Turn Performance. Mean timed-up-and-go time (a), 180° in-place turn duration (b), and number of steps to turn 180° in-place (c) for PD and controls in the rotating treadmill training group (Train) and the stepping in place group (Step). Brackets indicate significant group effects. Error bars are SDs.

Figure 3

Turn Kinematics Examples. Representative traces of yaw plane rotations of individual body segments during a single 180° in-place turn in one PD-Train, one PD-Step, one CN-Train, and one CN-Step participant before (PRE) and after (POST) intervention.

Figure 4

Onsets of Body Segment Rotations. Mean yaw rotation onset times of the head (HTO), trunk (TTO), and pelvis (PTO) relative to the turn onset (i.e., first foot rotation) are expressed as a percentage of the first stride of the turn for PD-Train (a), CN-Train (b), PD-Step (c), and CN-Step (d). Error bars are SDs.