The Influence of an Overground Locomotor Training Program on Walking Gait Propulsive Force in Ambulatory Patients with Parkinson’s Disease

Abstract

OBJECTIVE: To determine the effect of a 12-week overground locomotor training (OLT) program on the anterior-posterior (A-P) ground reaction force in ambulatory subjects with mild to moderate Parkinson’s disease (PD).DESIGN: This is a pre- and post-test design interventional study. SETTING: The study was conducted at the university gait analysis laboratory. METHODS: Participants performed a propulsive force testing procedure before and after the OLT program. PARTICIPANTS: Eleven adults with mild to moderate PD (Hoehn & Yahr stage 1-3, ambulatory). INTERVENTIONS: The intervention was a 12-week OLT program. MAIN OUTCOME MEASURES: Gait parameters: peak anterior ground reaction force (AGRF), rate of rise (ROR) of AGRF, push-off impulse, push-off duration, peak posterior ground reaction force (PGRF), single stance duration, center of mass (COM) to center of pressure (COP) distance at push-off, and walking speed. RESULTS: Paired t-tests indicated significant differences in the ROR between pre and post OLT, the push-off impulse pre OLT and post OLT, and the preferred walking speed pre and post OLT. In addition, a Wilcoxon signed-rank test indicated significant differences in the push-off duration between pre and post OLT, and the single stance duration pre and post OLT. No significant differences were observed in peak AGRF and PGRF between pre and post OLT, and in the COM-COP distance between pre and post OLT. DISCUSSION: Taken together, our results suggest the OLT program was able to improve walking postural and dynamic stability in patients with PD. PD patients were able to spend less time in stance phase, less time in push-off duration, and decrease the rise time of the AGRF (push-off rate increased). This appears to have led to a quicker, more powerful AGRF without changes in peak PGRF, peak AGRF, or push-off posture, and an increase in walking speed in our patients with PD.