Quantitative assessment of the gait improvement effect of LSVT BIG® using a wearable sensor in patients with Parkinson's disease

Abstract

Background: The main effects of Lee Silvermann Voice Treatment-BIG® therapy (LSVT-BIG) on gait function are improvements in gait speed and stride length. Considering the mechanism of this improvement, LSVT-BIG may affect joint angles of the lower extremities. Therefore, further investigation of the effect of LSVT-BIG on gait function, especially joint angles, is needed.

Methods: Patients with Parkinson's disease (PD) who were eligible for LSVT-BIG were recruited. We measured the following items pre- and post-LSVT-BIG: MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Functional Independence Measure (FIM), timed up and go test (TUG), and gait parameters using RehaGait®. Gait parameters included gait speed, stride duration and length, the standard deviation of stride duration and length, cadence, the ratio of the stance/swing phase, and the flexion and extension angles of the hip, knee, and ankle joints. Range of motion (ROM) was calculated as the difference of values between the maximum flexion and extension angles of each joint.

Results: Twenty-four participants completed the LSVT-BIG. Significant improvement was observed in the MDS-UPDRS (mean changes: Part I, -2.4 points; Part II, -3.5 points; Part III -8.9 points), TUG (-0.61 s), gait speed (+0.13 m/s), stride length (+0.12 m), flexion and extension angles and ROM of the hip joints (flexion, +2.0°; extension, +2.0; ROM, +4.0°). Enlargement in ROM of the hip joint was strongly correlated with increase in gait speed and stride length (r = 0.755, r = 0.804, respectively).

Conclusions: LSVT-BIG enlarged flexion and extension angles and ROM of the hip joint significantly. Change of ROM of the hip joint was directly related to the increase in stride length and gait speed observed in patients with PD after LSVT-BIG.

Keywords: Gait analysis; LSVT-BIG; Parkinson disease; Wearable sensor.

Fig. 1

(a) An anterior view and (b) a posterior view of the lower extremities with the RehaGait® system. We used 7 sensors (1 sensor at the waist, 2 sensors at both sides of the knee joints, and 4 sensors at both sides of the ankle joints) in this study. Circles indicate the position of the sensors.

Fig. 2

The change in the range of motion of the ankle, knee, and hip joints through LSVT-BIG. Circles represent mean value and bars represent 95% confidence intervals. An asterisk represents the statistical significance (p < 0.05). “pre” and “post” represent the time of measurements. pre, pre-LSVT-BIG; post, post-LSVT-BIG.