The Cost of Gait Slowness: Can Persons with Parkinson's Disease Save Energy by Walking Faster?
The Cost of Gait Slowness: Can Persons with Parkinson's Disease Save Energy by Walking Faster?
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DOI：
10.3233/jpd-212613
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发表时间：
2021-09
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影响因子：
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通讯作者：
Purnima Padmanabhan;Keerthana Sreekanth Rao;Anthony J. Gonzalez;A. Pantelyat;V. Chib;Ryan T. Roemmich
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作者：
Purnima Padmanabhan;Keerthana Sreekanth Rao;Anthony J. Gonzalez;A. Pantelyat;V. Chib;Ryan T. Roemmich
背景技术步态减慢是帕金森病(PD)的一个常见特征。许多疗法旨在提高帕金森病患者的步态速度，但目标往往不精确。每个病人应该走多快？帕金森病患者如何从更快的步行中受益？非常需要了解步行速度如何影响步态的基本方面（包括能量消耗和稳定性），这可以指导帕金森病患者的个体化治疗决策。目的 我们研究了步行速度的变化如何影响帕金森病患者的能量消耗和时空步态参数。我们将多巴胺能药物状态之间的这些影响与在年龄匹配的对照参与者中观察到的影响进行了比较。方法 12 名 PD 患者和 12 名对照参与者进行跑步机步行试验，跨越至少五种不同的速度（期望七种速度，但并非所有参与者都能以最快的速度行走）。帕金森病患者在不同的日子参加两次步行训练（一次在最佳药物治疗期间，一次在停药 12 小时后）。我们测量了所有试验的运动学和代谢数据。结果 帕金森病患者通过比自己喜欢的速度更快地行走，显着降低了能量消耗。这在不同的药物治疗条件下都是成立的，并且在对照组参与者中没有观察到。降低能量成本的患者特定步行速度不会显着影响步态变异性指标（用作步态稳定性的指标）。结论 PD 导致的步态减慢导致步行时能量不理想。针对患者特定的步行速度提高的康复策略可能会导致步态不那么费力。
BACKGROUND Gait slowing is a common feature of Parkinson's disease (PD). Many therapies aim to improve gait speed in persons with PD, but goals are often imprecise. How fast should each patient walk? And how do persons with PD benefit from walking faster? There is an important need to understand how walking speed affects fundamental aspects of gait-including energy cost and stability-that could guide individualized therapy decisions in persons with PD. OBJECTIVE We investigated how changes in walking speed affected energy cost and spatiotemporal gait parameters in persons with PD. We compared these effects between dopaminergic medication states and to those observed in age-matched control participants. METHODS Twelve persons with PD and twelve control participants performed treadmill walking trials spanning at least five different speeds (seven speeds were desired, but not all participants could walk at the fastest speeds). Persons with PD participated in two walking sessions on separate days (once while optimally medicated, once after 12-hour withdrawal from dopaminergic medication). We measured kinematic and metabolic data across all trials. RESULTS Persons with PD significantly reduced energy cost by walking faster than their preferred speeds. This held true across medication conditions and was not observed in control participants. The patient-specific walking speeds that reduced energy cost did not significantly affect gait variability metrics (used as proxies for gait stability). CONCLUSION The gait slowing that occurs with PD results in energetically suboptimal walking. Rehabilitation strategies that target patient-specific increases in walking speed could result in a less effortful gait.