Gait coordination in Parkinson disease: Effects of step length and cadence manipulations

BackgroundGait impairments are well documented in those with PD. Prior studies suggest that gait impairments may be worse and ongoing in those with PD who demonstrate FOG compared to those with PD who do not.PurposeOur aim was to determine the effects of manipulating step length and cadence individually, and together, on gait coordination in those with PD who experience FOG, those with PD who do not experience FOG, healthy older adults, and healthy young adults.MethodsEleven participants with PD and FOG, 16 with PD and no FOG, 18 healthy older, and 19 healthy young adults walked across a GAITRite walkway under four conditions: Natural, Fast (+50% of preferred cadence), Small (−50% of preferred step length), and SmallFast (+50% cadence and −50% step length). Coordination (i.e. phase coordination index) was measured for each participant during each condition and analyzed using mixed model repeated measure ANOVAs.ResultsFOG was not elicited. Decreasing step length alone or decreasing step length and increasing cadence together affected coordination. Small steps combined with fast cadence resulted in poorer coordination in both groups with PD compared to healthy young adults and in those with PD and FOG compared to healthy older adults.ConclusionsCoordination deficits can be identified in those with PD by having them walk with small steps combined with fast cadence. Short steps produced at high rate elicit worse coordination than short steps or fast steps alone.

► Small, fast steps are known to precede freezing of gait in Parkinson disease (PD). ► We asked how step length and/or cadence manipulation impacts gait coordination. ► We compared four groups: PD with and without freezing, and old and young controls. ► Taking small or small, fast steps worsened coordination in PD, particularly those with freezing. ► Taking small, fast or small and fast steps did not elicit any freezing episodes.