Orcioli-Silva Diego, Barbieri Fabio Augusto, Simieli Lucas, Vitorio Rodrigo, Santos Paulo Cezar Rocha Dos, Beretta Victor Spiandor, Gobbi Lilian Teresa Bucken
Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
Universidade Estadual Paulista (Unesp), Faculdade de Ciências, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil.
Gait Posture. 2017 Oct;58:510-515. doi: 10.1016/j.gaitpost.2017.09.021. Epub 2017 Sep 21.
The presence of a second obstacle changed the planning and adjustments for obstacle avoidance performance, but this context is poorly understood in Parkinson's disease (PD). The aim of this study was to investigate the walking behavior over multiple obstacles in people with PD. Nineteen people with PD and 19 healthy individuals walked across an 8m pathway, performing three trials for following conditions: unobstructed walking, walking with one obstacle avoidance (Single), and walking with two obstacles avoidance (Double). In the Double condition, the analysis was performed only for the first obstacle (First Double). The dependent variables were calculated separately for the approach and crossing phases in the obstacle conditions. The main results show that people with PD decreased single support and increased double support phase in both Single and Double conditions compared to the unobstructed walking. Both groups increased stride duration during approach phase in the Double condition compared to the unobstructed walking and Single conditions. The presence of the second obstacle led to a decrease in trailing toe clearance during obstacle avoidance of the First Double. In conclusion, people with PD use a conservative strategy while approaching obstacles. Both groups need more time to obtain and process environmental information and plan the action in environments with multiple obstacles. The smaller leading toe clearance might be an indicative that the presence of a second obstacle increase the likelihood of tripping during obstacle avoidance in both people with PD and healthy individuals.
第二个障碍物的存在改变了避障表现的规划和调整，但在帕金森病（PD）中，这种情况还知之甚少。本研究的目的是调查帕金森病患者在多个障碍物上的行走行为。19名帕金森病患者和19名健康个体走过一条8米长的通道，针对以下条件进行三次试验：无障碍行走、避开一个障碍物行走（单障碍物）和避开两个障碍物行走（双障碍物）。在双障碍物条件下，仅对第一个障碍物（首个双障碍物）进行分析。在障碍物条件下，分别针对接近阶段和通过阶段计算因变量。主要结果表明，与无障碍行走相比，帕金森病患者在单障碍物和双障碍物条件下均减少了单支撑期并增加了双支撑期。与无障碍行走和单障碍物条件相比，两组在双障碍物条件下接近阶段的步幅持续时间均增加。第二个障碍物的存在导致在首个双障碍物避障过程中后足趾离地间隙减小。总之，帕金森病患者在接近障碍物时采用保守策略。两组在有多个障碍物的环境中都需要更多时间来获取和处理环境信息并规划行动。较小的前足趾离地间隙可能表明，第二个障碍物的存在增加了帕金森病患者和健康个体在避障过程中绊倒的可能性。
