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Complexity of the environment and asymmetry on the gait in patients with Parkinson's disease

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Diego Orcioli Silva
Total Authors: 1
Document type: Master's Dissertation
Press: Rio Claro. 2016-01-27.
Institution: Universidade Estadual Paulista (Unesp). Instituto de Biociências. Rio Claro
Defense date:
Advisor: Lilian Teresa Bucken Gobbi; Fabio Augusto Barbieri

Introduction: This dissertation consists of two studies. Study 1 investigated the influence of environmental complexity on kinematic and kinetic parameters of gait in people with Parkinson's disease (PD) and healthy older adults. Study 2 compared gait asymmetry between people with (PD) and healthy older adults while walking on an environment with multiple obstacles. Materials and method: Thirty-eight older adults (19 patients with PD and 19 healthy individuals) participated in the study. The experimental task required participants to walk at preferred speed under the following conditions: free (regular) walking, avoiding one obstacle, avoiding two obstacles placed 108cm apart (Study 1); in the Study 2, another experimental condition was added: avoiding two obstacles placed 50cm apart. In the Study 1, obstacle avoidance was performed with the right limb as the leading limb, while both limbs were used as the leading limb for the Study 2. For free walking condition, the stride cycle performed in the central area of the pathway was considered for analysis. For conditions with two obstacles, outcome measures included calculations related to the first obstacle only, considering both approach and crossing phases. In the Study 1, we calculated kinematic and kinetic parameters of walking; in the Study 2, we calculated the asymmetry index for each outcome measure. Results: Study 1: both people with PD and healthy individuals decreased the stride length while approaching obstacles (one or two) and increased stride duration while approaching two obstacles. Also, people with PD decreased the percentage of time spent in single support and increased the time spent in double support in both condition with one and two obstacles. For the crossing phase, the presence of 2 obstacles in the pathway required more evident kinematic and kinetic adjustments (decreases were observed for step length, step velocity, horizontal and vertical distances from the feet to the obstacle, and horizontal braking impulse) in comparison to the other experimental conditions. Study 2: people with PD increased asymmetry of walking in the approach phase, especially for temporal outcomes (step duration and swing phase) in the conditions with multiple obstacles. For the crossing phase, people with PD demonstrated higher asymmetry values than healthy older adults for toe clearance. Conclusion: both people with PD and healthy individuals were able to adapt walking behavior when faced with environmental constraints induced by obstacles. Due to increased attentional and sensorimotor requirements to succeed while walking in environments with multiple obstacles, both people with PD and healthy participants increased stride duration in the approach phase, suggesting that additional time is necessary to process information from the environment in this situation. However, due to deficits in sensorimotor integration and motor impairments of PD, walking in more complex environments is more harmful to patients with PD, exacerbating bradykinesia and hypometria. Lastly, people with PD demonstrated higher asymmetry of walking than healthy individuals in environment with multiple obstacles, especially in the approach phase. (AU)

FAPESP's process: 13/27032-0 - Complexity of the environment and asymmetry on the gait in elderly with Parkinson's disease
Grantee:Diego Orcioli da Silva
Support type: Scholarships in Brazil - Master