Cubo Esther, Moore Charity G, Leurgans Sue, Goetz Christopher G
Neurology Department, Clínica del Rosario, Príncipe de Vergara 53, 28006, Madrid, Spain.
Parkinsonism Relat Disord. 2003 Oct;10(1):9-14. doi: 10.1016/s1353-8020(03)00060-9.
Compare the efficacy of two walking assistance devices (wheeled walker and standard walker) to unassisted walking for patients with PD and gait freezing.
Although numerous walking devices are used clinically, their relative effects on freezing and walking speed have never been systematically tested.
Nineteen PD patients (14 non-demented) walked under three conditions in randomized order: unassisted walking, standard walker, and wheeled walker. Patients walked up to three times in each condition through a standard course that included rising from a chair, walking through a doorway, straightway walking, pivoting, and return. Total walking time, freezing time and number of freezes were compared for the three conditions using mixed models (walking time) and Friedman's test (freezing). The wheeled walker was further studied by comparing the effect of an attached laser that projected a bar of light on the floor as a visual walking cue.
Use of either type of device significantly slowed walking compared to unassisted walking. Neither walker reduced any index of freezing, nor the laser attachment offered any advantage to the wheeled walker. The standard walker increased freezing, and the wheeled walker had no effect on freezing. Among the non-demented subjects (n=14), the same patterns occurred, although the walking speed was less impaired by the wheeled walker than the standard walker in this group.
Though walkers may stabilize patients and increase confidence, PD patients walk more slowly when using them, without reducing freezing. Because the wheeled walker was intermediate for walking time and does not aggravate freezing, if walkers are used for these subjects, this type of walker should be favored.
比较两种助行装置（轮式助行器和标准助行器）与无辅助步行对帕金森病（PD）及步态冻结患者的疗效。
尽管临床上使用了多种助行装置，但它们对冻结和步行速度的相对影响从未得到系统测试。
19名PD患者（14名非痴呆患者）按随机顺序在三种条件下行走：无辅助步行、标准助行器和轮式助行器。患者在每种条件下通过标准路线行走多达三次，该路线包括从椅子上起身、穿过门道、直线行走、转身和返回。使用混合模型（步行时间）和弗里德曼检验（冻结情况）比较三种条件下的总步行时间、冻结时间和冻结次数。通过比较附加激光（在地面投射一条光带作为视觉步行提示）对轮式助行器的影响，对轮式助行器进行了进一步研究。
与无辅助步行相比，使用任何一种助行装置都会显著减慢步行速度。两种助行器均未降低任何冻结指标，附加激光对轮式助行器也没有任何优势。标准助行器增加了冻结次数，而轮式助行器对冻结没有影响。在非痴呆受试者（n = 14）中，出现了相同的模式，尽管该组中轮式助行器对步行速度的损害小于标准助行器。
尽管助行器可能使患者保持稳定并增强信心，但PD患者使用时步行速度会更慢，且不能减少冻结。由于轮式助行器在步行时间方面处于中间水平且不会加重冻结，如果为这些患者使用助行器，应优先选择这种类型的助行器。
