How to Get Started: Identifying the Critical Ingredients to Improve Gait Initiation in Parkinson Disease

NCT05625789 | Completed DMC

• 1 other identifier: 22-2628
• Study Type: interventional
• Target: 10
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Parkinson Disease

Keywords

Freezing of Gait; Gait Initiation

Outcome Measures

Primary Outcomes (4)

• 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)

Secondary Outcomes (8)

• Change in Mediolateral Anticipatory Postural Adjustment (APA) Size from Baseline to Conclusion of the first block of training

  Baseline, at the conclusion of the first block of training (approximately 2 weeks)

• Change in Mediolateral Anticipatory Postural Adjustment (APA) Size from end of first block of training to training 2 pre-test

  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

  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

  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

  Baseline, at the conclusion of the first block of training (approximately 2 weeks)

Study Arms (2)

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.

Behavioral: Postural control (weight shift) training; Behavioral: Steady state gait training

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.

Behavioral: Postural control (weight shift) training; Behavioral: Steady state gait training

Interventions

Postural control (weight shift) training BEHAVIORAL

Visual cues to improve amplitude of weight shift prior to initiating gait.

Postural control (weight shifting) training followed by steady state gait training.; Steady state gait training followed by postural control (weight shifting) training.

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.

Postural control (weight shifting) training followed by steady state gait training.; Steady state gait training followed by postural control (weight shifting) training.

Eligibility Criteria

• Age: 35 Years - 99 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosis of idiopathic Parkinson disease characterized by asymmetrical onset of at least 2 of 3 cardinal signs (resting tremor, bradykinesia, or rigidity) with no atypical signs or exposure to dopamine-blocking drugs
• The presence of mild to moderate gait or balance impairment (a rating of 1-2 on MDS Unified Parkinson Disease Rating Scale (MDS-UPDRS) item 10 \[gait\] or rating 1-3 on item 12 \[postural stability\]
• Hoehn \& Yahr stages 1-3 ("on" for those who fluctuate)
• Self-report of difficulty with freezing of gait (i.e., a rating of 1-4 on question 3 of the Freezing of Gait Questionnaire)
• All participants must be able to walk \> 5 minutes at greater than or equal to 80% of comfortable gait speed (CGS) on the treadmill and \> 5 minutes over ground without assistance or an assistive device.

You may not qualify if:

• Uncontrolled cardiorespiratory/metabolic disease, vestibular dysfunction that may affect gait or balance
• Parkinson's related or unrelated dementia (i.e. Montreal Cognitive Assessment score \<21)
• Comfortable over ground walking speed of less than 0.5m/s
• History of traumatic brain injury
• self-reported deafness or blindness as this would impair the patient's ability to hear cues or ambulate safely within the lab environment
• other neurological disorders or orthopedic injury that may affect gait
• recent orthopedic surgery (in the last 6 months)
• Participants will also be excluded if they have severe communication impairments, which could impede understanding of the purpose or procedures of the study or an inability to comply with experimental procedures
• Participants who are currently receiving supervised physical therapy services

Sponsors & Collaborators

• University of North Carolina, Chapel Hill: lead
• LSVT Global: collaborator

Study Sites (1)

UNC Chapel Hill

Chapel Hill, North Carolina, 27599, United States

Location

MeSH Terms

Conditions

Parkinson Disease

Interventions

Postural Balance

Condition Hierarchy (Ancestors)

Parkinsonian Disorders; Basal Ganglia Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases

Intervention Hierarchy (Ancestors)

Proprioception; Vestibulocochlear Physiological Phenomena; Physiological Phenomena; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Sensation; Nervous System Physiological Phenomena

Study Officials

• Michael Lewek, PhD

  UNC Chapel Hill

  STUDY DIRECTOR

• Chelsea P Duppen, DPT

  UNC Chapel Hill

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 15, 2022
• First Posted: November 23, 2022
• Study Start: January 10, 2022
• Primary Completion: August 9, 2024
• Study Completion: August 9, 2024
• Last Updated: September 20, 2024

Record last verified: 2023-11

Data Sharing

• IPD Sharing: Will share
• Time Frame: Results will be shared following publication and up to five years following publication.
• Access Criteria: 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.

Locations

US (1)