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| Name | Class |
|---|---|
| LSVT Global | UNKNOWN |
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The purpose of this study is to understand the treatment approach (i.e., targeting gait or targeting the postural adjustment prior to gait) that is most effective at improving gait initiation dynamics in people with Parkinson disease. Ten adults with idiopathic Parkinson disease who self-report difficulty initiating gait will complete the study. The investigators will be using a randomized crossover design, where the participants will participate in two series of training (i.e., postural training and steady-state gait training) with a one-week washout between trainings. Investigators will evaluate the changes induced in gait initiation postural adjustment size, first step length, and first step speed from each intervention. Due to the anticipated limitation of steady-state walking to directly address postural adjustment amplitude, it is hypothesized that training for larger amplitude weight shift during gait initiation will yield improved gait initiation dynamics compared to training with large amplitude movements during steady-state walking.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Postural control (weight shifting) training followed by steady state gait training. | Experimental | For postural control training, participants will be provided visual biofeedback to increase weight shift prior to the first step. The feedback program cues participants to reach a target amount of weight shift. Once the target is reached, participants are cued to initiate walking. Participants will complete a total of 30 minutes of training, ensuring at least 45 repetitions. To create larger amplitude movements during steady state gait, participants will walk on a treadmill set to their comfortable gait speed while attempting to match their steps to a metronome beeping at 85% of their comfortable cadence. Participants will complete a total of 10 minutes of treadmill walking with rest breaks as needed. Next, participants will walk overground to a metronome beeping at 115% of their comfortable cadence with a goal of 10 total minutes of training. Each training will be three times per week for two weeks. There is a one week break between the two trainings. |
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| Steady state gait training followed by postural control (weight shifting) training. | Experimental | To create larger amplitude movements during steady state gait, participants will walk on a treadmill set to their comfortable gait speed while attempting to match their steps to a metronome beeping at 85% of their comfortable cadence. Participants will complete a total of 10 minutes of treadmill walking with rest breaks as needed. Next, participants will walk overground to a metronome beeping at 115% of their comfortable cadence with a goal of 10 total minutes of training. For postural control training, participants will be provided visual biofeedback to increase weight shift prior to the first step. The feedback program cues participants to reach a target amount of weight shift. Once the target is reached, participants are cued to initiate walking. Participants will complete a total of 30 minutes of training, ensuring at least 45 repetitions. Each training will be three times per week for two weeks. There is a one week break between the two trainings. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Postural control (weight shift) training | Behavioral | Visual cues to improve amplitude of weight shift prior to initiating gait. |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in First Step Length from Baseline to Conclusion of the first block of training | Length of the first step during gait initiation (i.e., distance from stepping limb heel marker at quiet stance to heel marker of stepping limb at heel strike of the first step forward). | Baseline, at the conclusion of the first block of training (approximately 2 weeks) |
| Change in First Step Length from end of first block of training to training 2 pre-test | Length of the first step during gait initiation (i.e., distance from stepping limb heel marker at quiet stance to heel marker of stepping limb at heel strike of the first step forward). | Conclusion of first training block, just prior to beginning the second training series (1 week) |
| Change in First Step Length from training block 2 pre-test to conclusion of second block of training | Length of the first step during gait initiation (i.e., distance from stepping limb heel marker at quiet stance to heel marker of stepping limb at heel strike of the first step forward). | Prior to beginning second block of training, at the conclusion of second block of training (2 weeks) |
| Change in First Step Length from conclusion of second training block to 1 week follow up from second training block | Length of the first step during gait initiation (i.e., distance from stepping limb heel marker at quiet stance to heel marker of stepping limb at heel strike of the first step forward). | Conclusion of second training block, 1 week follow up from conclusion of second training block (1 week) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Mediolateral Anticipatory Postural Adjustment (APA) Size from Baseline to Conclusion of the first block of training | Center of pressure displacement towards the stepping limb from quiet stance until toe off of the stepping limp (i.e., the initiation of gait). | Baseline, at the conclusion of the first block of training (approximately 2 weeks) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Michael Lewek, PhD | UNC Chapel Hill | Study Director |
| Chelsea P Duppen, DPT | UNC Chapel Hill | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UNC Chapel Hill | Chapel Hill | North Carolina | 27599 | United States |
Deidentified individual data that supports the results will be shared beginning after publication to five years following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with the University of North Carolina at Chapel Hill.
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Results will be shared following publication and up to five years following publication.
The investigator who proposes to use the data must have approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and must execute a data use/sharing agreement with the University of North Carolina at Chapel Hill.
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| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| ID | Term |
|---|---|
| D004856 | Postural Balance |
| ID | Term |
|---|---|
| D011434 | Proprioception |
| D000084323 | Vestibulocochlear Physiological Phenomena |
| D010829 | Physiological Phenomena |
| D009142 | Musculoskeletal Physiological Phenomena |
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|
| Steady state gait training | Behavioral | Auditory cues are provided to increase amplitude of movement (e.g., step length) during continuous walking, to determine its effects on gait initiation amplitude of movement. |
|
| Change in Mediolateral Anticipatory Postural Adjustment (APA) Size from end of first block of training to training 2 pre-test | Center of pressure displacement towards the stepping limb from quiet stance until toe off of the stepping limp (i.e., the initiation of gait). | Conclusion of first training block, just prior to beginning the second training series (1 week) |
| Change in Mediolateral Anticipatory Postural Adjustment (APA) Size from training block 2 pre-test to conclusion of second block of training | Center of pressure displacement towards the stepping limb from quiet stance until toe off of the stepping limp (i.e., the initiation of gait). | Prior to beginning second block of training, at the conclusion of second block of training (2 weeks) |
| Change in Mediolateral Anticipatory Postural Adjustment (APA) Size from conclusion of second training block to 1 week follow up from second training block | Center of pressure displacement towards the stepping limb from quiet stance until toe off of the stepping limp (i.e., the initiation of gait). | Conclusion of second training block, 1 week follow up from conclusion of second training block (1 week) |
| Change in First Step Speed from Baseline to Conclusion of the first block of training | First step speed is measured by dividing the first step length by the time it takes to take the first step - which is calculated as the time from toe off of the stepping limb to heel strike of the stepping limb. | Baseline, at the conclusion of the first block of training (approximately 2 weeks) |
| Change in First Step Speed from end of first block of training to training 2 pre-test | First step speed is measured by dividing the first step length by the time it takes to take the first step - which is calculated as the time from toe off of the stepping limb to heel strike of the stepping limb. | Conclusion of first training block, just prior to beginning the second training series (1 week) |
| Change in First Step Speed from training block 2 pre-test to conclusion of second block of training | First step speed is measured by dividing the first step length by the time it takes to take the first step - which is calculated as the time from toe off of the stepping limb to heel strike of the stepping limb. | Prior to beginning second block of training, at the conclusion of second block of training (2 weeks) |
| Change in First Step Speed from from conclusion of second training block to 1 week follow up from second training block | First step speed is measured by dividing the first step length by the time it takes to take the first step - which is calculated as the time from toe off of the stepping limb to heel strike of the stepping limb. | Conclusion of second training block, 1 week follow up from conclusion of second training block (1 week) |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
| D012677 | Sensation |
| D009424 | Nervous System Physiological Phenomena |