Can Quantitative Gait Analysis Be Used to Guide Treatment of Patients with Different Subtypes of Parkinson’s Disease?
Received 10 June 2020
Accepted for publication 12 September 2020
Published 9 October 2020 Volume 2020:16 Pages 2335—2341
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Jun Chen
Zhuang Wu,1 Min Zhong,1 Xu Jiang,1 Bo Shen,1 Jun Zhu,1 Yang Pan,1 Jingde Dong,1 Jun Yan,1 Pingyi Xu,2 Wenbin Zhang,3 Yang Gao,4 Li Zhang1
1Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Neurology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 3Department of Neurosurgery, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 4Department of Computer Science and Technology, Nanjing University, Nanjing, People’s Republic of China
Correspondence: Li Zhang Email [email protected]
Purpose: Gait impairment is a common clinical symptom of patients with Parkinson’s disease (PD). Detecting specific gait parameters’ changes in order to guide clinical intervention is at present lacking. The present study aimed to (1) quantify gait impairments in different PD subtypes and (2) explore whether the results of quantitative gait analysis are beneficial to clinical treatment.
Patients and Methods: We enrolled 86 patients with PD (48 men, and 38 women) from the Department of Geriatrics of the Affiliated Brain Hospital of Nanjing Medical University. Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr Scale were used to evaluate the motor symptoms of PD. All patients stopped anti-Parkinsonian medication for 24 hours (72 hours for controlled release medicine). The patients were divided into two subtypes, namely, postural instability gait difficulty (PIGD; n=56) and tremor dominant (TD; n=30) subtypes according to UPDRS. All patients completed the instrumented stand and walk test, and a set of JiBuEn gait analysis system was used in gait data collection.
Results: We observed a shorter stride length (p=0.021), a longer stride time (p=0.036), a faster cadence (p=0.036), and a more variable stride length (p=0.012) in the PIGD group compared with the TD group. In addition, compared with the TD group, we found that the toe-off angle (p=0.005) and the range of motion of ankle joint (p=0.009) decreased in the PIGD group.
Conclusion: Our study demonstrated that the gait performance of patients with PIGD is worse than those with TD from the perspective of quantitative gait analysis. We extended previous research and found the PIGD group exhibited severe gait impairments in some specific spatiotemporal and kinematic gait parameters. The different manifestations of these gait impairments may guide in choosing appropriate treatment of patients with different PD subtypes.
Keywords: Parkinson’s disease, postural instability gait difficulty, tremor, wearable sensors, gait
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