Review Article (Meta-Analysis)| Volume 104, ISSUE 3, P451-474, March 2023

Effects of Therapeutic Intervention on Spatiotemporal Gait Parameters in Adults With Neurologic Disorder: Systematic Review and Meta-analysis



      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*).


      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.


      List of abbreviations:

      AMPS (automated mechanical peripheral stimulation), ES (electrical stimulation), PD (Parkinson disease), PT (physical therapy), SS (sensory stimulation)
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        • Levine D
        • Richards J
        • Whittle MW.
        Whittle’s gait analysis.
        Elsevier Health Sciences, UK2012
        • Bugnariu N
        • Fung J.
        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
        • Shaffer SW
        • Harrison AL.
        Aging of the somatosensory system: a translational perspective.
        Phys Ther. 2007; 87: 193-207
        • Horlings CGC
        • van Engelen BGM
        • Allum JHJ
        • Bloem BR.
        A weak balance: The contribution of muscle weakness to postural instability and falls.
        Nat Clin Pract Neurol. 2008; 4: 504-515
        • Moreland JD
        • Richardson JA
        • Goldsmith CH
        • Clase CM.
        Muscle weakness and falls in older adults: a systematic review and meta-analysis.
        J Am Geriatr Soc. 2004; 52: 1121-1129
        • Snijders AH
        • Van De Warrenburg BP
        • Giladi N
        • Bloem BR.
        Neurological gait disorders in elderly people: clinical approach and classification.
        Lancet Neurol. 2007; 6: 63-74
        • Zijlstra A
        • Mancini M
        • Chiari L
        • Zijlstra W.
        Biofeedback for training balance and mobility tasks in older populations: a systematic review.
        J Neuroeng Rehabil. 2010; 7: 58
        • Gelb DJ
        • Oliver E
        • Gilman S.
        Diagnostic criteria for Parkinson disease.
        Arch Neurol. 1999; 56: 33-39
        • Morris M
        • lansek R
        Gait disorders in Parkinsonʼs disease: a framework for physical therapy practice.
        Neurol Rep. 1997; 21: 125-131
        • Hausdorff JM
        • Cudkowicz ME
        • Firtion R
        • Wei JY
        • Goldberger AL.
        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
        • Moon Y
        • Sung JH
        • An R
        • Hernandez ME
        • Sosnoff JJ.
        Gait variability in people with neurological disorders: a systematic review and meta-analysis.
        Hum Mov Sci. 2016; 47: 197-208
        • AlDakheel A
        • Kalia LV
        • Lang AE.
        Pathogenesis-targeted, disease-modifying therapies in Parkinson disease.
        Neurotherapeutics. 2014; 11: 6-23
        • Rode G
        • Maupas E
        • Luaute J
        • Courtois-Jacquin S BD
        Medical treatment of Spasticity.
        Prat Neurol-FMC. 2010; 1: 53-71
        • Amano S
        • Nocera JR
        • Vallabhajosula S
        • et al.
        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
        • Sage MD
        • Almeida QJ.
        Symptom and gait changes after sensory attention focused exercise vs aerobic training in Parkinson's disease.
        Mov Disord. 2009; 24: 1132-1138
        • Shen X
        • Mak MKY.
        Balance and gait training with augmented feedback improves balance confidence in people with Parkinson's disease.
        Neurorehabil Neural Repair. 2014; 28: 524-535
        • Hass CJ
        • Buckley TA
        • Pitsikoulis C
        • Barthelemy EJ.
        Progressive resistance training improves gait initiation in individuals with Parkinson's disease.
        Gait Posture. 2012; 35: 669-673
        • Wang H-Q
        • Hou M
        • Li H
        • et al.
        Effects of acupuncture treatment on motor function in patients with subacute hemorrhagic stroke: a randomized controlled study.
        Complement Ther Med. 2020; 49102296
        • El-Tamawy M
        • Darwish M
        • Khallaf M.
        Effects of augmented proprioceptive cues on the parameters of gait of individuals with Parkinson′s disease.
        Ann Indian Acad Neurol. 2012; 15: 267-272
        • Camerota F
        • Celletti C
        • Suppa A
        • et al.
        Focal muscle vibration improves gait in Parkinson's disease: a pilot randomized, controlled trial.
        Mov Disord Clin Pract. 2016; 3: 559-566
        • Schauer M
        • Mauritz KH.
        Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement.
        Clin Rehabil. 2003; 17: 713-722
        • Kleiner AFR
        • Souza Pagnussat A
        • Pinto C
        • Redivo Marchese R
        • Salazar AP
        • Galli M
        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
        • Pinto C
        • Pagnussat AS
        • Rozin Kleiner AF
        • et al.
        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
        • Galli M
        • Vicidomini C
        • Rozin Kleiner AF
        • et al.
        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
        • Pagnussat AS
        • Kleiner AFR
        • Rieder CRM
        • et al.
        Plantar stimulation in parkinsonians: From biomarkers to mobility—randomized-controlled trial.
        Restor Neurol Neurosci. 2018; 36: 195-205
        • Barbic F
        • Galli M
        • Dalla Vecchia L
        • et al.
        Effects of mechanical stimulation of the feet on gait and cardiovascular autonomic control in Parkinson's disease.
        J Appl Physiol. 2014; 116: 495-503
        • Rochester L
        • Baker K
        • Hetherington V
        • et al.
        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
        • Murgia M
        • Pili R
        • Corona F
        • et al.
        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
        • De Icco R
        • Tassorelli C
        • Berra E
        • Bolla M
        • Pacchetti C
        • Sandrini G.
        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
        • de Bruin N
        • Doan JB
        • Turnbull G
        • et al.
        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
        • Jaywant A
        • Ellis TD
        • Roy S
        • Lin C-C
        • Neargarder S
        • Cronin-Golomb A.
        Randomized controlled trial of a home-based action observation intervention to improve walking in Parkinson disease.
        Arch Phys Med Rehabil. 2016; 97: 665-673
        • Park J
        • Park S
        • Kim Y
        • Woo Y.
        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
        • Ghai S
        • Ghai I
        • Schmitz G
        • Effenberg AO.
        Effect of rhythmic auditory cueing on parkinsonian gait: a systematic review and meta-analysis.
        Sci Rep. 2018; 8: 506
        • Moumdjian L
        • Sarkamo T
        • Leone C
        • Leman M
        • Feys P.
        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
        • Pereira APS
        • Marinho V
        • Gupta D
        • Magalhães F
        • Ayres C
        • Teixeira S.
        Music therapy and dance as gait rehabilitation in patients with Parkinson disease: a review of evidence.
        J Geriatr Psychiatry Neurol. 2019; 32: 49-56
        • Tyson S
        • Sadeghi-Demneh E
        • Nester C.
        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
        • Veerbeek JM
        • Van Wegen E
        • Van Peppen R
        • et al.
        What is the evidence for physical therapy poststroke? A systematic review and meta-analysis.
        PLoS One. 2014; 9: e87987
        • Tomlinson CL
        • Patel S
        • Meek C
        • et al.
        Physiotherapy intervention in Parkinson's disease: systematic review and meta-analysis.
        BMJ. 2012; 345: 1-14
        • Abou L
        • Alluri A
        • Fliflet A
        • Du Y
        • Rice LA.
        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
        • Moher D
        • Shamseer L
        • Clarke M
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1-9
      1. NIH_quality assessment tool. Available at: Accessed November 3, 2022.

        • Jenkins ME
        • Almeida QJ
        • Spaulding SJ
        • et al.
        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
        • Kemoun G
        • Thibaud M
        • Roumagne N
        • et al.
        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
        • Yang Y-R
        • Wang R-Y
        • Chen Y-C
        • Kao M-J.
        Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial.
        Arch Phys Med Rehabil. 2007; 88: 1236-1240
        • Jonsdottir J
        • Cattaneo D
        • Recalcati M
        • et al.
        Task-oriented biofeedback to improve gait in individuals with chronic stroke: motor learning approach.
        Neurorehabil Neural Repair. 2010; 24: 478-485
        • Choi Y-K
        • Kim K
        • Choi J-U.
        Effects of stair task training on walking ability in stroke patients.
        J Phys Ther Sci. 2017; 29: 235-237
        • Buesing C
        • Fisch G
        • O'Donnell M
        • et al.
        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
        • Carroll LM
        • Volpe D
        • Morris ME
        • Saunders J
        • Clifford AM.
        Aquatic exercise therapy for people with Parkinson disease: a randomized controlled trial.
        Arch Phys Med Rehabil. 2017; 98: 631-638
        • Peppe A
        • Paravati S
        • Baldassarre MG
        • et al.
        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
        • Geroin C
        • Nonnekes J
        • de Vries NM
        • et al.
        Does dual-task training improve spatiotemporal gait parameters in Parkinson's disease?.
        Parkinsonism Relat Disord. 2018; 55: 86-91
        • Chung E
        • Lee B-H
        • Hwang S.
        Core stabilization exercise with real-time feedback for chronic hemiparetic stroke: a pilot randomized controlled trials.
        Restor Neurol Neurosci. 2014; 32: 313-321
        • Giardini M
        • Nardone A
        • Godi M
        • et al.
        Instrumental or physical-exercise rehabilitation of balance improves both balance and gait in Parkinson's disease.
        Neural Plast. 2018; 2018: 1-17
        • Elsner B
        • Schöler A
        • Kon T
        • Mehrholz J.
        Walking with rhythmic auditory stimulation in chronic patients after stroke: a pilot randomized controlled trial.
        Physiother Res Int. 2020; 25: 1-7
        • Brognara L
        • Navarro-flores E
        • Iachemet L
        • Serra-catalá N
        • Cauli O.
        Beneficial effect of foot plantar stimulation in gait parameters in individuals with Parkinson's disease.
        Brain Sci. 2020; 10: 1-12
        • Iqbal M
        • Arsh A
        • Hammad SM
        • Haq IU
        • Darain H.
        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
        • Wittwer JE
        • Winbolt M
        • Morris ME.
        Home-based gait training using rhythmic auditory cues in Alzheimer's disease: feasibility and outcomes.
        Front Med. 2019; 6: 335
        • Osoba MY
        • Rao AK
        • Agrawal SK
        • Lalwani AK.
        Balance and gait in the elderly: a contemporary review.
        Laryngoscope Investig Otolaryngol. 2019; 4: 143-153