Abstract
Objective
This systematic review and meta-analysis aimed to review and quantify the changes
in gait parameters after therapeutic intervention in adults with neurologic disorders.
Data Sources
A keyword search was performed in 4 databases: PubMed, CINAHL, Scopus, and Web of
Science (01/2000-12/2021). We performed the search algorithm including all possible
combinations of keywords. Full-text articles were examined further using forward/backward
search methods.
Study Selection
Studies were thoroughly screened using the following inclusion criteria: Study design:
randomized controlled trial; adults ≥55 years old with a neurologic disorder; therapeutic
intervention; spatiotemporal gait characteristics; and language: English.
Data Extraction
A standardized data extraction form was used to collect the following methodological
outcome variables from each of the included studies: author, year, population, age,
sample size, and spatiotemporal gait parameters such as cadence, step length, step
width, or double limb support. A meta-analysis was performed among trials presenting
with similar characteristics, including study population and outcome measure. If heterogeneity
was >50%, a random plot analysis was used; otherwise, a fixed plot analysis was done.
Data Synthesis
We included 25 out of 34 studies in our meta-analysis that examined gait in adults
with neurologic disorders. All analyses used effect sizes and standard error and a
P<.05(denoted by *) threshold was considered statistically significant. Overall, we
found that sensory (SS) and electrical stimulation (ES) had the most significant effect
on step length (SS: z=5.44*, ES: z=2.42*) and gait speed (SS: z=6.19*, ES: z=7.38*)
in adults with Parkinson disease (PD). Although balance or physical activity interventions
were not found to be effective in modifying step length in adults with PD, they showed
a significant effect on gait speed. Further, physical activity had the most significant
effect on cadence in adults with PD (z=2.84*) relative to sensory stimulation effect
on cadence (z=2.59*). For stroke, conventional physical therapy had the most significant
effect on step length (z=3.12*) and cadence (z=3.57*).
Conclusion
Sensory stimulation such as auditory and somatosensory stimulation while walking had
the most significant effect on step length in adults with PD. We also found that conventional
physical therapy did improve spatial gait parameters relative to other physical activity
interventions in adults with PD and stroke.
Keywords
List of abbreviations:
AMPS (automated mechanical peripheral stimulation), ES (electrical stimulation), PD (Parkinson disease), PT (physical therapy), SS (sensory stimulation)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Whittle’s gait analysis.Elsevier Health Sciences, UK2012
- Aging and selective sensorimotor strategies in the regulation of upright balance.in: 2006 International Workshop on Virtual Rehabilitation. IEEE, New York, NY, USA2006: 187-192
- Aging of the somatosensory system: a translational perspective.Phys Ther. 2007; 87: 193-207
- A weak balance: The contribution of muscle weakness to postural instability and falls.Nat Clin Pract Neurol. 2008; 4: 504-515
- Muscle weakness and falls in older adults: a systematic review and meta-analysis.J Am Geriatr Soc. 2004; 52: 1121-1129
- Neurological gait disorders in elderly people: clinical approach and classification.Lancet Neurol. 2007; 6: 63-74
- Biofeedback for training balance and mobility tasks in older populations: a systematic review.J Neuroeng Rehabil. 2010; 7: 58
- Diagnostic criteria for Parkinson disease.Arch Neurol. 1999; 56: 33-39
- Gait disorders in Parkinsonʼs disease: a framework for physical therapy practice.Neurol Rep. 1997; 21: 125-131
- Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson's disease and Huntington's disease.Mov Disord. 1998; 13: 428-437
- Gait variability in people with neurological disorders: a systematic review and meta-analysis.Hum Mov Sci. 2016; 47: 197-208
- Pathogenesis-targeted, disease-modifying therapies in Parkinson disease.Neurotherapeutics. 2014; 11: 6-23
- Medical treatment of Spasticity.Prat Neurol-FMC. 2010; 1: 53-71
- The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson's disease.Parkinsonism Relat Disord. 2013; 19: 955-960
- Symptom and gait changes after sensory attention focused exercise vs aerobic training in Parkinson's disease.Mov Disord. 2009; 24: 1132-1138
- Balance and gait training with augmented feedback improves balance confidence in people with Parkinson's disease.Neurorehabil Neural Repair. 2014; 28: 524-535
- Progressive resistance training improves gait initiation in individuals with Parkinson's disease.Gait Posture. 2012; 35: 669-673
- Effects of acupuncture treatment on motor function in patients with subacute hemorrhagic stroke: a randomized controlled study.Complement Ther Med. 2020; 49102296
- Effects of augmented proprioceptive cues on the parameters of gait of individuals with Parkinson′s disease.Ann Indian Acad Neurol. 2012; 15: 267-272
- Focal muscle vibration improves gait in Parkinson's disease: a pilot randomized, controlled trial.Mov Disord Clin Pract. 2016; 3: 559-566
- Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement.Clin Rehabil. 2003; 17: 713-722
- Automated mechanical peripheral stimulation effects on gait variability in individuals with Parkinson disease and freezing of gait: a double-blind, randomized controlled trial.Arch Phys Med Rehabil. 2018; 99: 2420-2429
- Automated mechanical peripheral stimulation improves gait parameters in subjects with Parkinson disease and freezing of gait.Am J Phys Med Rehabil. 2018; 97: 383-389
- Peripheral neurostimulation breaks the shuffling steps patterns in Parkinsonian gait: a double blind randomized longitudinal study with automated mechanical peripheral stimulation.Eur J Phys Rehabil Med. 2019; 54: 860-865
- Plantar stimulation in parkinsonians: From biomarkers to mobility—randomized-controlled trial.Restor Neurol Neurosci. 2018; 36: 195-205
- Effects of mechanical stimulation of the feet on gait and cardiovascular autonomic control in Parkinson's disease.J Appl Physiol. 2014; 116: 495-503
- Evidence for motor learning in Parkinson's disease: acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues.Brain Res. 2010; 1319: 103-111
- The use of footstep sounds as rhythmic auditory stimulation for gait rehabilitation in Parkinson's disease: a randomized controlled trial.Front Neurol. 2018; 9: 348
- Acute and chronic effect of acoustic and visual cues on gait training in Parkinson's disease: a randomized, controlled study.Parkinsons Dis. 2015; 2015: 1-9
- Walking with music is a safe and viable tool for gait training in Parkinson's disease: the effect of a 13-week feasibility study on single and dual task walking.Parkinsons Dis. 2010; 2010: 1-9
- Randomized controlled trial of a home-based action observation intervention to improve walking in Parkinson disease.Arch Phys Med Rehabil. 2016; 97: 665-673
- Comparison between treadmill training with rhythmic auditory stimulation and ground walking with rhythmic auditory stimulation on gait ability in chronic stroke patients: a pilot study.NeuroRehabilitation. 2015; 37: 193-202
- Effect of rhythmic auditory cueing on parkinsonian gait: a systematic review and meta-analysis.Sci Rep. 2018; 8: 506
- Effectiveness of music-based interventions on motricity or cognitive functioning in neurological populations: a systematic review.Eur J Phys Rehabil Med. 2017; 53: 466-482
- Music therapy and dance as gait rehabilitation in patients with Parkinson disease: a review of evidence.J Geriatr Psychiatry Neurol. 2019; 32: 49-56
- A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke.Clin Rehabil. 2013; 27: 879-891
- What is the evidence for physical therapy poststroke? A systematic review and meta-analysis.PLoS One. 2014; 9: e87987
- Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis.BMJ. 2012; 345: 1-14
- Effectiveness of physical therapy interventions in reducing fear of falling among individuals with neurologic diseases: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2021; 102: 132-154
- Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.Syst Rev. 2015; 4: 1-9
NIH_quality assessment tool. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed November 3, 2022.
- Plantar cutaneous sensory stimulation improves single-limb support time, and EMG activation patterns among individuals with Parkinson's disease.Parkinsonism Relat Disord. 2009; 15: 697-702
- Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia.Dement Geriatr Cogn Disord. 2010; 29: 109-114
- Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial.Arch Phys Med Rehabil. 2007; 88: 1236-1240
- Task-oriented biofeedback to improve gait in individuals with chronic stroke: motor learning approach.Neurorehabil Neural Repair. 2010; 24: 478-485
- Effects of stair task training on walking ability in stroke patients.J Phys Ther Sci. 2017; 29: 235-237
- Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial.J Neuroeng Rehabil. 2015; 12: 1-14
- Aquatic exercise therapy for people with Parkinson disease: a randomized controlled trial.Arch Phys Med Rehabil. 2017; 98: 631-638
- Proprioceptive focal stimulation (Equistasi®) may improve the quality of gait in middle-moderate Parkinson's disease patients. Double-blind, double-dummy, randomized, crossover, Italian multicentric study.Front Neurol. 2019; 10: 998
- Does dual-task training improve spatiotemporal gait parameters in Parkinson's disease?.Parkinsonism Relat Disord. 2018; 55: 86-91
- Core stabilization exercise with real-time feedback for chronic hemiparetic stroke: a pilot randomized controlled trials.Restor Neurol Neurosci. 2014; 32: 313-321
- Instrumental or physical-exercise rehabilitation of balance improves both balance and gait in Parkinson's disease.Neural Plast. 2018; 2018: 1-17
- Walking with rhythmic auditory stimulation in chronic patients after stroke: a pilot randomized controlled trial.Physiother Res Int. 2020; 25: 1-7
- Beneficial effect of foot plantar stimulation in gait parameters in individuals with Parkinson's disease.Brain Sci. 2020; 10: 1-12
- Comparison of dual task specific training and conventional physical therapy in ambulation of hemiplegic stroke patients: a randomized controlled trial.J Pak Med Assoc. 2020; 70: 7-10
- Home-based gait training using rhythmic auditory cues in Alzheimer's disease: feasibility and outcomes.Front Med. 2019; 6: 335
- Balance and gait in the elderly: a contemporary review.Laryngoscope Investig Otolaryngol. 2019; 4: 143-153
Article info
Publication history
Published online: July 01, 2022
Accepted:
June 5,
2022
Received in revised form:
May 31,
2022
Received:
July 20,
2021
Footnotes
Disclosures: The authors have nothing to disclose
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
