Serrao Mariano, Chini Giorgia, Caramanico Guido, Bartolo Michelangelo, Castiglia Stefano Filippo, Ranavolo Alberto, Conte Carmela, Venditto Teresa, Coppola Gianluca, di Lorenzo Cherubino, Cardinali Patrizio, Pierelli Francesco
Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
Movement Analysis LAB, Policlinico Italia, Rome, Italy.
Front Neurol. 2019 Aug 2;10:826. doi: 10.3389/fneur.2019.00826. eCollection 2019.
Gait disorders represent one of the most disabling features of Parkinson's disease, which may benefit from rehabilitation. No consistent evidence exists about which gait biomechanical factors can be modified by rehabilitation and which clinical characteristic can predict rehabilitation-induced improvements. The aims of the study were as follows: (i) to recognize the gait parameters modifiable by a short-term rehabilitation program; (ii) to evaluate the gait parameters that can normalize after rehabilitation; and (iii) to identify clinical variables predicting improvements in gait function after rehabilitation. Thirty-six patients affected by idiopathic Parkinson's disease in Hoehn-Yahr stage 1-3 and 22 healthy controls were included in the study. Both clinical and instrumental (gait analysis) evaluations were performed before and after a 10-weeks rehabilitation treatment. Time-distance parameters, lower limb joint, and trunk kinematics were measured. At baseline evaluation with matched speed, almost all gait parameters were significantly different between patients and healthy controls. After the 10-weeks rehabilitation, most gait parameters improved, and spatial asymmetry and trunk rotation normalized. Multiple linear regression of gender combined with Unified Parkinson's Disease Rating Scale-III predicted both ΔSpeed and ΔStep length of both sides; gender combined with Unified Parkinson's Disease Rating Scale-II predicted ΔCadence; age combined with Hoehn-Yahr score and disease duration predicted Δtrunk rotation range of motion. Impaired gait parameters are susceptible to improvement by rehabilitation, and younger men with Parkinson's disease who are less severely affected and at early disease stage are more susceptible to improvements in gait function after a 10-weeks rehabilitation program.
步态障碍是帕金森病最致残的特征之一，康复治疗可能会对此有所帮助。关于哪些步态生物力学因素可通过康复治疗得到改善，以及哪些临床特征能够预测康复治疗所带来的改善，目前尚无一致的证据。本研究的目的如下：（i）识别可通过短期康复计划改善的步态参数；（ii）评估康复后可恢复正常的步态参数；（iii）确定能够预测康复后步态功能改善的临床变量。本研究纳入了36例处于Hoehn-Yahr 1-3期的特发性帕金森病患者和22名健康对照者。在为期10周的康复治疗前后，分别进行了临床和仪器（步态分析）评估。测量了时间-距离参数、下肢关节和躯干的运动学指标。在基线评估中，当速度匹配时，患者与健康对照者之间几乎所有的步态参数均存在显著差异。经过10周的康复治疗后，大多数步态参数得到改善，空间不对称性和躯干旋转恢复正常。性别与统一帕金森病评定量表III的多元线性回归预测了双侧的速度变化量（ΔSpeed）和步长变化量（ΔStep length）；性别与统一帕金森病评定量表II预测了步频变化量（ΔCadence）；年龄与Hoehn-Yahr评分及病程预测了躯干旋转运动范围变化量（Δtrunk rotation range of motion）。受损的步态参数易于通过康复治疗得到改善，且在为期10周的康复计划后，病情较轻、处于疾病早期的年轻男性帕金森病患者的步态功能更易于得到改善。
