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3.310 Obstacle avoidance while walking on a motorized treadmill provokes freezing of gait
S178 Movement
Speed over 3 m (m/min) Step lenght over 3 m (m) Cadence over 3 m (steps/min) Timed up & go (s) Standing start 180º turn step count (n) time (s) Turn on spot step count (n) 180º 360º
Wednesday, 12 December 2007 No. of assessments
Reliability coefficient
Total
Gait lab
Home
Overall
Gait lab
Home
71 71 71
35 35 35
36 36 36
71% 62% 66%
81% 67% 67%
60% 56% 65%
71
35
36
83%
86%
80%
69 69
35 35
34 34
76% 82%
74% 74%
81% 90%
71 70
35 34
36 36
86% 90%
87% 97%
86% 80%
Results: No trends of increasing/decreasing values were seen between the assessments in either setting, nor any relationship between the time interval between assessments (mean 5.4 days, range 2−14) and the difference in the values obtained. Conclusion: In this study the turns and timed up and go demonstrated better overall repeatability than step length and cadence. Neither setting had consistently higher repeatability but there was a trend for gait to be more reliable in the gait lab and turns to be more reliable at home.
3.310 Obstacle avoidance while walking on a motorized treadmill provokes freezing of gait A. Snijders1° , V. Weerdesteyn, Y. Hagen, N. Giladi, J. Duysens, B.R. Bloem Netherlands
1 Nijmegen,
Objective: Freezing of gait (FOG) is a common and disabling feature of Parkinson’s disease (PD), where the feet become suddenly and unpredictably “glued” to the floor. Detailed pathophysiological studies are hampered by the fact that FOG episodes are notoriously difficult to elicit in a gait laboratory. Stimulated by serendipitous pilot observations, we used obstacle avoidance to provoke freezing in subjects walking on a motorized treadmill. Method: We included 11 patients with PD and off-period FOG who were able to walk on a treadmill during an off-state [mean age 64 years (SD 7.3), Hoehn and Yahr stage 2 to 3, mean off-state UPDRS 36 (SD 10.1)]. Freezing severity was assessed subjectively (using the freezing of gait Questionnaire, FOGQ) and clinically by an observer (using a standardised gait trajectory and axial 360 degree turns in both directions). Patients walked on a motorized treadmill and avoided suddenly appearing obstacles. Performance was videotaped and presence of FOG was visually scored, independently by three blinded raters. This was done for the occurrence of FOG during obstacle avoidance and during baseline treadmill walking. Manifestation of FOG during baseline treadmill walking was compared to FOG during obstacle avoidance using a one-sided sign test with a significance level of p = 0.05. Results: All 11 patients were self-rated freezers (mean FOGQ score 11.3, SD 3.4). In 8 patients (73%) freezing could also be elicited with the gait trajectory and axial turns. Only one patient showed freezing during baseline treadmill walking, in contrast to seven patients (64%) who demonstrated at least one freezing episode during obstacle avoidance on the treadmill (sign test baseline treadmill vs obstacle avoidance, p = 0.031). Conclusion: Our results show that FOG can be elicited on a treadmill by suddenly appearing obstacles. This will permit detailed pathophysiological studies of freezing of gait using a treadmill in a gait laboratory.
3.311 Bobbing gait responsive to ropinerole: An atypical Parkisonism? M. Alvarez1° , J. Caviness, V. Evidente Antonio, USA
1 San
Objective: To report a case of a patient with bobbing gait responsive to ropinirole. Method: Case report of a patient with disabling “bobbing” gait. Results: A 61 year old man with complaints of difficult walking for 6 years. His gait was described as bobbing and disabling due to fear of falling. Previous diagnosis included neuropathy, multiple sclerosis (ruled out), and Parkinson’s disease (he experienced violent jerks with levodopa). MRI Brain was consistent with small vessel ischemic disease. Pertinent findings on examination: Prominent bobbing or titubating gait with slight decreased left arm swing, mild and intermittent left thumb resting tremor, and a mildly stooped posture, without rigidity, bradykinesia, or postural instability. This patient was placed on a titrating dose of ropinirole. At 4 and 11 months after initial consultation, he reported 90% improvement on ropinirole 3 mg/day. Clinical findings were verified and compared with initial findings (which were on video file). Conclusion: Titubating or bobbing movements are typical clinical findings in cerebellar disorders and in demyelinating diseases. In “lower body parkinsonism” the symptoms are predominantly in the legs, and there is an absence of tremor and levodopa-responsiveness. In Parkinson’s disease (PD), gait is usually described as small, shuffling, and or festinating steps, rather than bobbing or titubating. Other clinical features comprise resting tremor, rigidity, bradykinesia, and postural instability. Our patient’s clinical findings and response to ropinirole suggest that bobbing gait possibly is part of atypical parkinsonism. Interestingly, our patient also reported uncontrollable dyskinesia-like movements while on levodopa, comparable to those as induced by pulsatile stimulation of dopamine receptors in PD.
3.312 Application of a variable, upgradeable, individually adjustable training device in disorders of balance and gait associated with Parkinson’s disease A. Raabe-Oetker1° , R.D. Nass, A. Nass, G. Ebersbach Germany
1 K¨ oln,
Objective: Disturbance of balance is a major contributor to disability in Parkinson’s disease. Various wobble boards are used for balance training in healthy individuals. For PD patients their height, effective degrees of freedom and small standing area represent profound difficulties. On our novel board type, patients can gradually and individually increase the difficulty. To evaluate its effect on disequilibrium, the device was tested in two independent groups (DSHS and Beelitz). Method: The DSHS-group, consisting of 11 regular participants of a training program for PD-patients, used the board at home for 3 weeks. Their performances in Bohannon–Larkin-Balancing tasks (Timed-10 m-WalkingTest, Timed-Up-and-Go-Test, Standing-Balance) before and after training were compared to those of 10 age and gender matched, non-disabled controls who did not regularly partake in other physical exercises. The Beelitz-group, 7 hospital-patients, conducted daily 15−20 min exercises on the board for 2 weeks (10 sessions in total). Evaluation before and after training included posturography, Pull-Test (UPDRS), Timed-10 m-WalkingTest including the number of steps needed for 10 m. Results: Patients of the DSHS-group showed a significant improvement in the Timed-10 m-Walking-Test (p < 0.001; 25% faster) and Timed-Upand-Go-Test (p = 0.127; 12.5%), standing balance remained unchanged. The control group displayed no significant alterations in their test results. In the Beelitz group, Timed-10 m-Walking performance improved significantly (p < 0.05; 13%), the number of steps decreased by 10% (n.s.) and PullTest (UPDRS) scores dropped at least by one point. The posturographical findings were variable and insignificant. Both patients and physiotherapists rated the subjective training effect substantial.
Speed over 3 m (m/min) Step lenght over 3 m (m) Cadence over 3 m (steps/min) Timed up & go (s) Standing start 180º turn step count (n) time (s) Turn on spot step count (n) 180º 360º
Wednesday, 12 December 2007 No. of assessments
Reliability coefficient
Total
Gait lab
Home
Overall
Gait lab
Home
71 71 71
35 35 35
36 36 36
71% 62% 66%
81% 67% 67%
60% 56% 65%
71
35
36
83%
86%
80%
69 69
35 35
34 34
76% 82%
74% 74%
81% 90%
71 70
35 34
36 36
86% 90%
87% 97%
86% 80%
Results: No trends of increasing/decreasing values were seen between the assessments in either setting, nor any relationship between the time interval between assessments (mean 5.4 days, range 2−14) and the difference in the values obtained. Conclusion: In this study the turns and timed up and go demonstrated better overall repeatability than step length and cadence. Neither setting had consistently higher repeatability but there was a trend for gait to be more reliable in the gait lab and turns to be more reliable at home.
3.310 Obstacle avoidance while walking on a motorized treadmill provokes freezing of gait A. Snijders1° , V. Weerdesteyn, Y. Hagen, N. Giladi, J. Duysens, B.R. Bloem Netherlands
1 Nijmegen,
Objective: Freezing of gait (FOG) is a common and disabling feature of Parkinson’s disease (PD), where the feet become suddenly and unpredictably “glued” to the floor. Detailed pathophysiological studies are hampered by the fact that FOG episodes are notoriously difficult to elicit in a gait laboratory. Stimulated by serendipitous pilot observations, we used obstacle avoidance to provoke freezing in subjects walking on a motorized treadmill. Method: We included 11 patients with PD and off-period FOG who were able to walk on a treadmill during an off-state [mean age 64 years (SD 7.3), Hoehn and Yahr stage 2 to 3, mean off-state UPDRS 36 (SD 10.1)]. Freezing severity was assessed subjectively (using the freezing of gait Questionnaire, FOGQ) and clinically by an observer (using a standardised gait trajectory and axial 360 degree turns in both directions). Patients walked on a motorized treadmill and avoided suddenly appearing obstacles. Performance was videotaped and presence of FOG was visually scored, independently by three blinded raters. This was done for the occurrence of FOG during obstacle avoidance and during baseline treadmill walking. Manifestation of FOG during baseline treadmill walking was compared to FOG during obstacle avoidance using a one-sided sign test with a significance level of p = 0.05. Results: All 11 patients were self-rated freezers (mean FOGQ score 11.3, SD 3.4). In 8 patients (73%) freezing could also be elicited with the gait trajectory and axial turns. Only one patient showed freezing during baseline treadmill walking, in contrast to seven patients (64%) who demonstrated at least one freezing episode during obstacle avoidance on the treadmill (sign test baseline treadmill vs obstacle avoidance, p = 0.031). Conclusion: Our results show that FOG can be elicited on a treadmill by suddenly appearing obstacles. This will permit detailed pathophysiological studies of freezing of gait using a treadmill in a gait laboratory.
3.311 Bobbing gait responsive to ropinerole: An atypical Parkisonism? M. Alvarez1° , J. Caviness, V. Evidente Antonio, USA
1 San
Objective: To report a case of a patient with bobbing gait responsive to ropinirole. Method: Case report of a patient with disabling “bobbing” gait. Results: A 61 year old man with complaints of difficult walking for 6 years. His gait was described as bobbing and disabling due to fear of falling. Previous diagnosis included neuropathy, multiple sclerosis (ruled out), and Parkinson’s disease (he experienced violent jerks with levodopa). MRI Brain was consistent with small vessel ischemic disease. Pertinent findings on examination: Prominent bobbing or titubating gait with slight decreased left arm swing, mild and intermittent left thumb resting tremor, and a mildly stooped posture, without rigidity, bradykinesia, or postural instability. This patient was placed on a titrating dose of ropinirole. At 4 and 11 months after initial consultation, he reported 90% improvement on ropinirole 3 mg/day. Clinical findings were verified and compared with initial findings (which were on video file). Conclusion: Titubating or bobbing movements are typical clinical findings in cerebellar disorders and in demyelinating diseases. In “lower body parkinsonism” the symptoms are predominantly in the legs, and there is an absence of tremor and levodopa-responsiveness. In Parkinson’s disease (PD), gait is usually described as small, shuffling, and or festinating steps, rather than bobbing or titubating. Other clinical features comprise resting tremor, rigidity, bradykinesia, and postural instability. Our patient’s clinical findings and response to ropinirole suggest that bobbing gait possibly is part of atypical parkinsonism. Interestingly, our patient also reported uncontrollable dyskinesia-like movements while on levodopa, comparable to those as induced by pulsatile stimulation of dopamine receptors in PD.
3.312 Application of a variable, upgradeable, individually adjustable training device in disorders of balance and gait associated with Parkinson’s disease A. Raabe-Oetker1° , R.D. Nass, A. Nass, G. Ebersbach Germany
1 K¨ oln,
Objective: Disturbance of balance is a major contributor to disability in Parkinson’s disease. Various wobble boards are used for balance training in healthy individuals. For PD patients their height, effective degrees of freedom and small standing area represent profound difficulties. On our novel board type, patients can gradually and individually increase the difficulty. To evaluate its effect on disequilibrium, the device was tested in two independent groups (DSHS and Beelitz). Method: The DSHS-group, consisting of 11 regular participants of a training program for PD-patients, used the board at home for 3 weeks. Their performances in Bohannon–Larkin-Balancing tasks (Timed-10 m-WalkingTest, Timed-Up-and-Go-Test, Standing-Balance) before and after training were compared to those of 10 age and gender matched, non-disabled controls who did not regularly partake in other physical exercises. The Beelitz-group, 7 hospital-patients, conducted daily 15−20 min exercises on the board for 2 weeks (10 sessions in total). Evaluation before and after training included posturography, Pull-Test (UPDRS), Timed-10 m-WalkingTest including the number of steps needed for 10 m. Results: Patients of the DSHS-group showed a significant improvement in the Timed-10 m-Walking-Test (p < 0.001; 25% faster) and Timed-Upand-Go-Test (p = 0.127; 12.5%), standing balance remained unchanged. The control group displayed no significant alterations in their test results. In the Beelitz group, Timed-10 m-Walking performance improved significantly (p < 0.05; 13%), the number of steps decreased by 10% (n.s.) and PullTest (UPDRS) scores dropped at least by one point. The posturographical findings were variable and insignificant. Both patients and physiotherapists rated the subjective training effect substantial.