People with Parkinson disease (PD) experience various motor impairments, including locomotor deficitsthat may reduce their mobility and quality of life. In particular, the majority of people with PD report difficultieswith turning in place or turning while walking. Problems with turning may lead to falls and serious injuries, suchas hip fractures. Hip fractures are about eight times more likely to occur when an individual falls during a turn,compared to during straight walking. Relatively little is known about the mechanisms of turning difficulties andthere are currently no effective treatments that specifically target turning difficulties. This study will helpelucidate the mechanisms of turning difficulty and assess a potential novel treatment option for turningdifficulties. Turning difficulties in PD may occur as a result of impairments in an individual's ability to select andexecute the appropriate motor patterns to complete a turn, which may be improved by motor training. It issuspected that turning difficulties are only minimally improved by prescribed anti-parkinson medications, whichwould indicate lack of a substantial contribution of dopaminergic systems to turning impairments. Externalcues, on the other hand, have been shown to be relatively effective for improving motor function in people withPD. Stepping on a rotating treadmill may serve as an external cue to facilitate turning, resulting in measurablechanges in how turns are completed. Completing training sessions on the rotating treadmill may reinforce theappropriate turning motor patterns or make these correct patterns more automatic, resulting in functionalimprovements in turning. This study will assess turn kinematics, muscle activity patterns during turning, and functional measuresof turning to determine whether: 1) anti-parkinson medications improve turn performance in PD, 2) rotatingtreadmill stimulation results in improved turn performance in PD, 3) greater changes in turning performance areseen following multiple rotating treadmill training sessions, and 4) changes in turning performance aremaintained following rotating treadmill stimulation, making the treadmill a viable option for rehabilitationapplications. Major goals of the research proposed include achieving a better understanding of the mechanisms ofturning difficulty, and also learning more about the locomotor adaptations that occur following rotating treadmilltraining. Insight gained from these studies will help in the development of innovative methods for therehabilitation of gait and turning impairments in people with PD, which will potentially reduce the incidence offalls and injury in these individuals.
Nearly one million people in the United States have been diagnosed with Parkinson disease (PD), and turning difficulties in many of these individuals have led to falls, serious injuries, and a reduced quality of life. The proposed research will contribute to our knowledge about turning difficulties and their potential mechanisms, particularly examining how turn kinematics, muscle activity during turning, and overall turn performance are affected by anti-parkinson medications and rotating treadmill training in PD. Further, it will evaluate an innovative potential intervention for its effectiveness in targeting and improving turning difficulties, as well as its potential for long-term improvements in turning, with the ultimate goal of reducing falls and injuries in individuals with PD.
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| McNeely, Marie E; Earhart, Gammon M (2011) The effects of medication on turning in people with Parkinson disease with and without freezing of gait. J Parkinsons Dis 1:259-70 |
