Personalized approach may aid gait rehabilitation in PD
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Tailored Parkinson’s disease gait impairment compensation strategies may help patients, according to results of a survey study published in Neurology.
“While our clinical experience is that many persons with PD use creative strategies to overcome their walking difficulties, it has never been investigated what the actual extent of knowledge and use of these strategies was among patients,” Jorik Nonnekes, MD, PhD, and Anouk Tosserams, MD, of Radboud University Medical Center, Nijmegen, the Netherlands, told Healio Neurology. “It was also previously unknown whether the effect of the strategies depended on the context in which they were applied.”
To address these research gaps, Nonnekes, Tosserams and colleagues analyzed online survey data of 4,324 adults with PD and self-reported disabling gait impairments.
Results showed 16.7% of participants were not previously familiar with any of the compensation strategies, with only 3.5% aware of all seven compensation strategy categories. A total of 35% had read about the strategies, 29.6% had heard about it via their physical therapist, 12.5% had begun using the strategies of their own accord and 32.2% had received related targeted advice from a professional. Most (75.2%) participants expressed interest in learning more about the available compensation strategies.
Regarding use of the strategies, 22.8% of participants had never tried any form of compensation strategy, despite having significant gait impairments. A total of 78.4% and 76.8% of participants who were aware of it had ever tried adapting a new walking pattern and internal cueing, respectively, with alternatives to walking the least used category (28.3%). Overall, 64.7% of participants still used at least one compensation strategy in daily life.
Changing the balance requirements most successfully improved gait (76%), whereas external cueing had the relatively lowest success rate (62%), after strategies’ efficacies were averaged across contexts. The researchers noted compensation strategy efficacy differed significantly based on the context in which they were applied. For instance, internal cueing appeared highly effective during gait initiation but was less useful when attempting to stop walking.
Sex, freezing status, age, time since diagnosis and the ability to perform a dual task did not appear to affect awareness and use of compensation strategies. The researchers observed no differences in the reported efficacy of different strategies among these subgroups, except for a somewhat higher success rate among younger patients for external cueing and adopting a new walking pattern. This rate was also slightly higher among individuals who had little to no difficulty dual tasking for motor imagery and action observation.
“Now that we know that these strategies generally work very well, but the effects vary depending on the person using it and the situation/context in which it is used, we can work toward a more personalized approach to gait rehabilitation for persons with PD,” Nonnekes and Tosserams said. “Our findings also highlight the need for patient education on this subject. Knowing a wider variety of strategies may enable more persons to find strategies suitable for their unique circumstances and needs.”