Beijing Rehabilitation Medical College, Capital Medical University, Beijing, 100144, China.
Neurological Rehabilitation Center, Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China.
Gait Posture. 2022 Jan;91:79-85. doi: 10.1016/j.gaitpost.2021.10.010. Epub 2021 Oct 11.
BACKGROUND: Walking adaptability is an obvious manifestation of Parkinson's disease (PD). Augmented reality technologies such as interactive walkways may improve walking adaptability in patients with Parkinson's Disease (PWP). RESEARCH QUESTION: How effective is C-Mill gait adaptability training in the early and middle stages of PD for improving walking adaptability in motor subtypes of the disease? METHODS: Fifty-two patients with early- or middle-stage PD were divided into two groups according to motor subtype (postural instability/gait disorder [PIGD] and non-PIGD) and received 7 days of training (0.5 h every day, 2 h after medication) on an augmented reality treadmill with built-in visual targets and obstacles. Functional assessments were performed before and after intervention, including posture control and walking, C-gait assessment, and participant experience. The Parkinson Disease Quality of Life questionnaire was administered at 3-month follow-up. RESULTS: Both the PIGD (n = 29) and non-PIGD (n = 23) groups showed improved tandem walking, obstacle avoidance, and overall score in C-gait assessment and Timed Up and Go test after C-Mill training. However, there were no differences between the two groups. The PIGD group showed improvement in visually guided stepping and Speed adaptations, whereas the non-PIGD group did not improve. The non-PIGD group reported they could complete the training with less exertion after the intervention and at the 3-month follow-up, these patients reported improvement in quality of life. SIGNIFICANCE: C-Mill gait adaptation training in the early and middle stages of PD improves walking adaptability in both motor subtypes. Cue strategies are the probable mechanism and may decrease fall risk after training. There was no difference between the groups in the improvements of perceived exertion and quality of life at follow-up. Although PIGD patients showed statistic improvements in visually guided stepping compared with non-PIGD patients, but the difference was not likely to be clinically meaningful. Specific effects of C-mill training for different types of PD were not observed in our study.
背景：行走适应性是帕金森病（PD）的明显表现。增强现实技术（如互动步道）可改善帕金森病患者（PWP）的行走适应性。 研究问题：在 PD 的早期和中期，C-Mill 步态适应性训练对改善疾病运动亚型的行走适应性的效果如何？ 方法：根据运动亚型（姿势不稳/步态障碍[PIGD]和非 PIGD）将 52 例早期或中期 PD 患者分为两组，在带有内置视觉目标和障碍物的增强现实跑步机上接受 7 天的训练（每天 0.5 小时，服药后 2 小时）。干预前后进行功能评估，包括姿势控制和行走、C 步态评估和参与者体验。在 3 个月随访时进行帕金森病生活质量问卷评估。 结果：C-Mill 训练后，PIGD 组（n = 29）和非 PIGD 组（n = 23）的串联行走、障碍物回避和 C 步态评估以及计时起立和行走测试的总分均有所改善。但两组间无差异。PIGD 组在视觉引导步调和速度适应方面有所改善，而非 PIGD 组则无改善。非 PIGD 组在干预后和 3 个月随访时报告说他们可以更轻松地完成训练，这些患者报告生活质量有所改善。 意义：在 PD 的早期和中期，C-Mill 步态适应性训练可改善两种运动亚型的行走适应性。线索策略可能是其潜在机制，并可降低训练后的跌倒风险。两组在随访时的感知用力和生活质量改善方面无差异。尽管 PIGD 患者在视觉引导步调和非 PIGD 患者相比有统计学上的改善，但差异可能无临床意义。在本研究中，未观察到 C-mill 训练对不同类型 PD 的特定影响。
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