Gait initiation and Parkinson's disease: influence of an obstacle, a cognition task and sensory information

Author(s)

Lucas Simieli

• Document type: Doctoral Thesis
• Press: Bauru. 2022-01-31.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Ciências. Bauru
• Defense date: 2021-08-17
• Advisor: Fabio Augusto Barbieri

Abstract

Difficulty in gait initiation is recurrent in people with Parkinson's disease (PD). The absence of anticipatory postural adjustments (APAs) that occur before the beginning of walking is the main cause of difficulties in this population and is related to common signs and symptoms in PD, such as akinesia and postural instability. The increase in motor complexity and cognitive and sensory demand can further impair gait initiation in PD patients. Thus, this study aims to investigate the effect of the presence of obstacles, dualtask, and sensory restriction during the beginning of walking in people with PD. For this, a sequence of four studies was developed. In the first study, a systematic review was performed to determine changes in the center of pressure, APAs, and spatiotemporal parameters during gait initiation in PD patients. Further studies aimed to verify the effect of the presence of the obstacle of different heights on gait initiation, to analyze the influence of cognitive load, and to determine the contribution of visual and proprioceptive information in gait initiation with and without the presence of the obstacle in PD patients. Between 13 and 15 patients with PD and the same number of neurologically healthy elderly people participated in each study. All participants were cognitively evaluated, and patients with PD were clinically evaluated either. The results of the systematic review illustrate the importance of studying the initiation of walking, since the PD group has difficulties in performing the first step, reducing the number of APAs to perform this initiation more safely and efficiently compared to people without PD. Furthermore, it revealed that little is known about the influence of dual tasks during this phase, with little evidence, but that already indicates the even greater difficulty of the PD group in dealing with two or more tasks during this stage of walking. Our study on the height of the obstacle showed an interesting characteristic about the APA: the DP group maintains the parameters of the APA practically unchanged, regardless of the height. The adjustments to start the task with an obstacle are, mostly, in the spatiotemporal parameters (step length, width, duration, and velocity). Data from studies 3 and 4 add to the findings from study 2, showing the robustness of data from the APAs. In other words, individuals with PD changing APAs during only gait initiation in more complex environments, modifying the spatiotemporal parameters of gait in most of cases (easier tasks). Moreover, when the vision of the lower limbs is blocked, the spatiotemporal parameters were even more affected, demanding further adjustments. These results corroborate with the literature on the need for greater visual information for individuals with Parkinson's disease. Thus, it is possible to state that people with PD have difficulties in starting to walk so that the APAs are smaller and slower when compared to elderly people without PD. However, these parameters are dependent of task difficulty, elucidating the robustness that the system loads to modify them according to the task, doing all changes on spatiotemporal parameters to perform the task. (AU)

• FAPESP's process: 16/14950-9 - GAIT INITIATION AND PARKINSON DISEASE: INFLUENCE OF OBSTACLES AVOIDANCE, COGNITIVE TASK AND SENSORY INFORMATION
• Grantee: Lucas Simieli
• Support Opportunities: Scholarships in Brazil - Doctorate