Sensory Stimulation, Physical Therapy Effective at Improving Gait Performance in PD

Sensory stimulation and conventional physical therapy are effective interventions for improving step length and spatial gait parameters, respectively, in adults with Parkinson disease (PD), according to a study recently published in the Archives of Physical Medicine and Rehabilitation.

The study also found that electrical stimulation, physical activity, and balance interventions had positive effects on common gait outcomes for adults with PD.

To quantify the effect of different therapeutic interventions on spatiotemporal gait parameters in different neurological populations, researchers conducted a meta-analysis that reviewed and synthesized gait parameter differences assessed by therapeutic intervention effects on adults with neurological disorders.

To source the included studies, researchers performed a keyword search in the following databases: PubMed, CINAHL, Scopus, and Web of Science. An algorithm was used to search all possible combinations of key words from January 2001 to December 2021. Each study was evaluated based on a quality assessment criterion.

Researchers then screened the studies based on inclusion criteria, such as randomized control trial study design, adults aged 55 or older with a neurological disorder, therapeutic intervention, and spatiotemporal gait characteristics.

Data was extracted from selected studies through a standard data extraction form and then analyzed.

Across all studies, after applying inclusion criteria, the 3 main neurological disorders included PD, stroke, and dementia.

The researchers analyzed evidence on therapeutic interventions for 1473 adults with neurological disorders across 34 studies.

Of these 34 studies, 25 were included in the meta-analysis examining gait in adults with neurological disorders.

Common gait outcome measures were used to provide a comparison of the efficacy of therapeutic interventions on gait function. Such outcome measures include cadence, step length, stride length, double limb support time, and gait speed.

The researchers found that sensory stimulation and electrical stimulation had the most significant effect on step length in adults with PD (z = 6.19*, z = 7.38*, respectively).

The findings suggested that patients experienced a greater reduction in PD symptoms after sensory stimulation given while walking, particularly forms of auditory stimulation.

Balance and physical activity interventions were found not to be effective in modifying step length in adults with PD. However, they showed a significant effect on gait speed.

Physical activity was found to have the most significant effect on cadence in adults with PD (z = 2.84*) compared with sensory stimulation effect on cadence (z = 2.59*).

Of studied physical activity interventions, strength, resistance, and balance training classes had the most significant effect on motor symptoms in adults with PD. Aerobic training had the strongest effect on increasing the step length of adults with PD.

In adults with PD, regular physical therapy and peripheral stimulations showed great effects on gait speed as well.

Conventional physical therapy was found to have the most significant effect on step length (z = 3.12*) and cadence (z = 3.57*) for adults who experienced stroke.

Electrical stimulation and physical activity interventions had the overall largest effect size on step length and stride length among all interventions.

Additionally, all intervention groups showed a positive effect on gait performance in adults with PD overall, though the researchers were not able to justify the effect of interventions due to a lack of studies in other populations.

The study had a few limitations. Few studies reporting on healthy adults were available for appropriate comparison with adults with neurological disorders. In addition, the small number of studies available on adults with PD also limited the power to detect bias.

However, the authors suggest that results of this study may still help inform clinicians in choosing specific interventions bases on the needs of patients with neurological disorders such as PD, stroke, or dementia.

They encourage future additional research to examine the effect of these therapeutic interventions on spatiotemporal gait parameters with larger sample size in adults with neurological disorders and a comparison group of healthy older adults.

Reference

Bishnoi A, Shankar M, Lee R, Hu Y, Hernandez ME. Effects of therapeutic intervention on spatiotemporal gait parameters in adults with neurological disorder: systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. Published online July 01, 2022. doi:10.1016/j.apmr.2022.06.003