Contribution of Step Length to Increase Walking and Turning Speed as a Marker of Parkinson's Disease Progression

Abstract

When increasing ambulation speed in Parkinson's disease, step cadence increases more than stride length, indicating movement scaling difficulties that affect step generation in particular. We investigated whether step length variation when increasing ambulation speed was related to disease progression. Patients with Parkinson's disease (N = 39) and controls (N = 152) performed two timed ambulation tasks: at a 'free' (self-selected) pace and then at 'maximal' speed. The total number of steps (including during turns) and time to complete the task were clinically measured. The relative contribution of step length and cadence to increased ambulation speed was determined using two methods: the ratios of change in step length or in cadence to the change in ambulation speed, and the step length index. While the relative contribution of step length and cadence to increased ambulation speed was independent of age in both control and patient groups, in Parkinson's disease there was a negative correlation between time from diagnosis and the ratio of change in step length to change in ambulation speed (R = 0.54; p = 0.0004) and the step length index (R = 0.56, p = 0.0002). In parallel, there was a positive correlation between time since diagnosis and the ratio of change in cadence to change in ambulation speed (R = 0.57; p = 0.0002). The relative contribution of step length and cadence to increased ambulation speed is age invariant but a marker of Parkinson's disease advancement, and can be easily determined in the clinical setting.

Fig 1. Ambulation task.

each trial started with subjects in the sitting position in a first chair, from which they stood up, walked 5 m to a second chair, turned 180° before sitting in the second chair, stood up again, walked 5 m back to the starting point, turned 180° and then sat down in the first chair.

Fig 2. Age and contributions of step length and cadence change to increased ambulation speed.

Contributions of step length (CSL, ΔSL/ΔSP) and cadence (CCAD, ΔCAD/ΔSP) to speed (SP) increase, as a function of age in all controls (A) and age-matched controls (B).

Fig 3. Mean ambulation characteristics in all subjects groups.

Results expressed in mean±SEM, as absolute values of speed, step length and cadence (A), and percent change in parameters from free to fast speed (B). ***, p < 0.001, **, p < 0.01 (pairwise comparisons, ANOVA).

Fig 4. Contributions of step length and cadence change to increased ambulation speed vs age or time since diagnosis in patients with PD.

Contributions of step length (CSL) and cadence (CCAD) to speed increase as a function of age (A) and time since diagnosis (B). Step length Index (SLI) as a function of age (C), and time since diagnosis (D).