Different protocols for analyzing behavior and adaptability in obstacle crossing in Parkinson's disease

Abstract

Imbalance and tripping over obstacles as a result of altered gait in older adults, especially in patients with Parkinson's disease (PD), are one of the most common causes of falls. During obstacle crossing, patients with PD modify their behavior in order to decrease the mechanical demands and enhance dynamic stability. Various descriptions of dynamic traits of gait that have been collected over longer periods, probably better synthesize the underlying structure and pattern of fluctuations in gait and can be more sensitive markers of aging or early neurological dysfunction and increased risk of falls. This confirmation challenges the clinimetric of different protocols and paradigms used for gait analysis up till now, in particular when analyzing obstacle crossing. The authors here present a critical review of current knowledge concerning the interplay between the cognition and gait in aging and PD, emphasizing the differences in gait behavior and adaptability while walking over different and challenging obstacle paradigms, and the implications of obstacle negotiation as a predictor of falls. Some evidence concerning the effectiveness of future rehabilitation protocols on reviving obstacle crossing behavior by trial and error relearning, taking advantage of dual-task paradigms, physical exercise, and virtual reality have been put forward in this article.

Keywords: Parkinson’s disease; aging; behavior; cognition; falls; gait; obstacle crossing.

Figure 1

The model describing the elements that affect dynamic postural control during locomotion. Note: Copyright © 2013. John Wiley and Sons. Reproduced from Earhart GM. Dynamic control of posture across locomotor tasks. Mov Disord. 2013;28(11): 1501–1508.

Figure 2

Cognitive impairment predicted dementia, although gait abnormalities increased the risk for falling (shaded arrows). Notes: A complete understanding suggests that cognitive impairment and gait abnormalities, coupled with dementia and falls, are related to each other (white arrows). In the light of recent evidence, gait abnormalities predict dementia and cognitive impairment raises fall risk (gray arrows); based on the close relationship between cognition and gait on the one hand, integrated tools for risk estimation are needed (bracket). Furthermore, the possible lines of intervention (black arrows) could rely on increasing cognition for fall prevention and on walking training for lessening dementia risk. Copyright © 2013. John Wiley and Sons. Reproduced from Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord. 2013;28(11):1520–1533.

Figure 3

This figure depicts the laboratory setup for testing continuous and intermittent walks. Notes: The authors highlight that continuous walking protocols may be more reliable. Reprinted from Gait Posture, 37(4), Galna B, Lord S, Rochester L, Is gait variability reliable in older adults and Parkinson’s disease? Towards an optimal testing protocol, 580–585, Copyright (2013), with permission from Elsevier.

Figure 4

(A) Examples of apparatus and gait parameters used to calculate the approach, crossing, and recovery steps during obstacle crossing. (B) An example of horizontal and vertical obstacle clearance parameters. Note: Reprinted from Arch Phys Med Rehabil, 93(4), Stegemöller EL, Buckley TA, Pitsikoulis C, Barthelemy E, Roemmich R, Hass CJ, Postural instability and gait impairment during obstacle crossing in Parkinson’s disease, 703–709, Copyright (2012), with permission from Elsevier. Abbreviations: LF, leading foot; TF, trailing foot.

Figure 5

Schematic illustration of the experimental set-up analyzing anticipatory postural adjustments upon gait initiation crossing an obstacle. Note: Reproduced from Yiou E, Artico R, Teyssedre CA, Labaune O, Fourcade P. Anticipatory postural control of stability during gait initiation over obstacles of different height and distance made under reaction-time and self-initiated instructions. Front Hum Neurosci. 2016;10:449.

Figure 6

Top view of the laboratory setting of the effect of Tai Chi Chuan training in obstacle crossing behavior, analyzed by kinematics (Vicon motion analysis system) and kinetic ground reaction forces (Kistler force plates). Note: The effect of Tai Chi Chuan on obstacle crossing strategy in older adults. Chang YT, Huang CF, Chang JH. Research in Sports Medicine. 26 Jun 2015. Reprinted by permission of the publisher (Taylor & Francis Ltd, http://www.tandfonline.com).