Real-Time Feedback to Improve Gait and Posture in People with Parkinsons Disease

Real-Time Feedback to Improve Gait and Posture in People with Parkinsons Disease Real-Time Feedback to Improve Gait and Posture in People with Parkinson's Disease Progressive gait dysfunction, a primary motor symptom in persons with Parkinsons disease (PD), is expressed as reduced step length, gait speed, and increased ariability in step time/length. People with PD also exhibit stooped posture, which may result in reflex abnormalities and decreased stability margin. Walking with reduced step length and stooped posture are independent risk factors for falls in PD and therefore interventions that have the potential to improve them are of great clinical interest. Recently, we developed and implemented a novel treadmill-based paradigm that provides feedback of step length and uprightness in real-time. In a single session study, we demonstrated that people with PD could follow the feedback and improve their gait and posture performance. Very recently, we implemented a long-term 6-week real-time feedback training (RTFT) intervention in 2 persons with PD and found significant improvements in step/stride length, upright posture, and gait regularity at post and follow-up RTFT even in the absence of any feedback during treadmill and overground walking. This indicates that regular explicit feedback of gait and posture performance can lead to optimization of motor learning by compensating for the impaired proprioception observed in PD. Thus, the RTFT has great potential to reduce risk of falls leading to improved mobility in PD. Therefore, we would like to move forward with a pilot study applying RTFT to a larger number of participants and include a control group to investigate the effects of RTFT on gait and balance in people with PD. Obtaining pilot data will greatly enable us to design larger clinical trials to investigate the effects of RTFT and the mechanisms underlying the improvements. In the proposed pilot study, we will strive to administer and evaluate a 6-week RTFT in 8 people with mild to moderate PD. A control group of 8 persons with PD will undergo treadmill training (TT) without real-time feedback. Various quantitative and clinical measures of gait and balance and disease severity will be obtained at pre (0th week), post (6th week), and follow-up (12th week) time points. If the anticipated benefits are obtained, the feedback paradigm could be integrated into a cost-effective system for daily use in the clinic or at home. Furthermore, systems based on wearable sensors and haptic/vibratory feedback could also be developed to provide feedback during overground walking to improve gait and posture.