Hulzinga Femke, Seuthe Jana, D'Cruz Nicholas, Ginis Pieter, Nieuwboer Alice, Schlenstedt Christian
Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium.
Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.
Mov Disord. 2023 Jan;38(1):92-103. doi: 10.1002/mds.29238. Epub 2022 Oct 14.
Gait deficits in people with Parkinson's disease (PD) are triggered by circumstances requiring gait adaptation. The effects of gait adaptation training on a split-belt treadmill (SBT) are unknown in PD.
We investigated the effects of repeated SBT versus tied-belt treadmill (TBT) training on retention and automaticity of gait adaptation and its transfer to over-ground walking and turning.
We recruited 52 individuals with PD, of whom 22 were freezers, in a multi-center randomized single-blind controlled study. Training consisted of 4 weeks of supervised treadmill training delivered three times per week. Tests were conducted pre- and post-training and at 4-weeks follow-up. Turning (primary outcome) and gait were assessed over-ground and during a gait adaptation protocol on the treadmill. All tasks were performed with and without a cognitive task.
We found that SBT-training improved gait adaptation with moderate to large effects sizes (P < 0.02) compared to TBT, effects that were sustained at follow-up and during dual tasking. However, better gait adaptation did not transfer to over-ground turning speed. In both SBT- and TBT-arms, over-ground walking and Movement Disorder Society-Unified Parkinson's Disease Rating Scale III (MDS-UPDRS-III scores were improved, the latter of which reached clinically meaningful effects in the SBT-group only. No impact was found on freezing of gait.
People with PD are able to learn and retain the ability to overcome asymmetric gait-speed perturbations on a treadmill remarkably well, but seem unable to generalize these skills to asymmetric gait off-treadmill. Future study is warranted into gait adaptation training to boost the transfer of complex walking skills. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
帕金森病（PD）患者的步态缺陷是由需要步态适应的情况引发的。在PD患者中，分带跑步机（SBT）上的步态适应训练效果尚不清楚。
我们研究了重复进行SBT训练与绑带跑步机（TBT）训练对步态适应的保持和自动性及其向地面行走和转弯转移的影响。
在一项多中心随机单盲对照研究中，我们招募了52名PD患者，其中22名是冻结步态患者。训练包括为期4周、每周三次的监督下跑步机训练。在训练前、训练后以及4周随访时进行测试。在地面和跑步机上的步态适应方案中评估转弯（主要结果）和步态。所有任务均在有和没有认知任务的情况下进行。
我们发现，与TBT相比，SBT训练改善了步态适应，效应量为中度至大（P < 0.02），这些效应在随访和双重任务期间持续存在。然而，更好的步态适应并没有转化为地面转弯速度。在SBT组和TBT组中，地面行走和运动障碍协会统一帕金森病评定量表III（MDS-UPDRS-III）评分均有所改善，后者仅在SBT组达到临床有意义的效果。未发现对冻结步态有影响。
PD患者能够很好地学习和保持在跑步机上克服不对称步态速度扰动的能力，但似乎无法将这些技能推广到跑步机外的不对称步态。有必要对步态适应训练进行进一步研究，以促进复杂步行技能的转移。© 2022作者。《运动障碍》由Wiley Periodicals LLC代表国际帕金森和运动障碍协会出版。
