|Research Article (Open access)|
ABSTRACT: Introduction: Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of
the central nervous system that often impairs the sufferer's motor skills, speech, and other functions. It is characterized by
muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical
movement (akinesia). The patients with PD are typically marked by reduced speed, shortened stride length and longer
double support phase. The use of electromechanical devices such as treadmill training has been used in rehabilitation of
patients with impaired gait .This study was done to assess the effect of treadmill training over the Gait and functional
mobility in Parkinsonís patients.
Materials and Methods: This study was conducted at S.M.S Hospital Jaipur, Anisha Multispecialty Hospital Guntur, AP, Physiotherapy center, Punjabi Bagh, New Delhi and some other local referral clinics in Lucknow (2008-2010). The total study period was 2 years .The treatment for each subject was for a period of 8 weeks, 3 sessions a week with 20 minutes as a single session.
A total of 20 (n=20) patients who are diagnosed with PD by the Physician were randomly selected after taking consent for their participation in the study. The outcomes were measured by subjective assessment of PDQ-39, and objectively assessed by Gait speed and Stride length.
Results: In this study to evaluate the effectiveness of intensive treadmill training over the gait and functional mobility in Patients with Parkinsonís disease, all data was expressed as Mean+/- SD and was statistically analyzed by using Paired Ďtí test .It is used to examine the changes in the dependent variables from baseline to after completion of intervention. The pretest mean value of PDQ-39 is 31.27(SD=4.69) and the post test mean is 21.25(SD=2.95). The pretest mean value of Gait speed is 1.03(SD=0.09) and the post test mean is 1.24(SD=0.09). The pretest mean value of stride length is 0.99(SD=0.09) and the post test mean is 1.19(SD=0.06) with p value <0.05 in all the parameters. Thus from the above statistical data of PDQ-39,Gait speed and Stride length ,the post test values are significantly different from pretest values with p<0.05,i.e 95% level of significance, hence the null hypothesis was rejected.
Conclusion: Intensive treadmill training is effective on Gait and Functional mobility in patients with Parkinsonís disease.
Key-words- Parkinsonís disease, Gait, PDQ-39, Stride length, Gait speed.
Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills, speech, and other functions.
It is a slowly progressing disease involving primarily a degeneration of cells in basal ganglia and substantia nigra leading to deficit of dopamineĖa neurotransmitter which produces gradual weakness of the voluntary movement with muscular rigidity, tremors impairment in the balance and automatic reactions.
It is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia).
The term Parkinsonism is used for symptoms of tremor, stiffness, and slowing of movement caused by loss of dopamine Parkinson's disease was first described in England in 1817 by James Parkinson. The condition was popularly known as shaking palsy derived from Latin word paralysis agitans. Prevalence and incidence of PD is the second most common neurodegenerative disorder. The incidence increases dramatically with increasing age. About 1% affected over the age of 65 and more than 4% of the population is affected by the age of 85 years1. Approximately 13-33% of the patients present with postural instability and Gait disturbances as their initial motor symptoms and comprise a postural instability Gait disturbed (PIGD) group. Gait disturbances are also a common feature of late onset or advanced PD2. The Patient with PD Demonstrates a number of significant Gait changes resulting from impoverished movement. The various gait disturbances found in PD are:
Shuffling gait: Gait is characterized by short steps, with feet barely leaving the ground. Small obstacles tend to cause the patient to trip. There is decreased arm-swing.
Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
Festination: Because of a combination of stooped posture, imbalance, and short steps it results to a gait that gets progressively faster and faster, often ending in a fall.
The patients with PD are typically marked by reduced speed, shortened stride length and longer double support phase3.The mobility problems have a greater negative impact on patientís quality of life and their mental well being4. Although modern methods of Medical and surgical care is available, patients develop progressive disability5. The use of electromechanical devices such as treadmill training has been used in rehabilitation of patients with impaired gait6.This study was done to assess the effect of treadmill training over the Gait and functional mobility in Parkinsonís patients.
MATERIALS AND METHODS
This study was conducted at S.M.S Hospital Jaipur, Anisha Multispeciality Hospital Guntur, A.P, Physiotherapy center, Punjabi Bagh, New Delhi and some other local referral clinics in Lucknow (2008-2010). The total study period was 2 years .The treatment for each subject was for a period of 8 weeks, 3 sessions a week with 20 minutes as a single session.
A total of 20 patients who are diagnosed with PD by the Physician were randomly selected after taking consent for their participation in the study. The inclusion criteria include the patients who are not demented, patients who were able to ambulate, Patients with a Grade I-III on Hoeh & Yahr scale. The patients with poor general condition, patients with compromised cardiovascular responses, age more than 75 years were not included in the study.
Technique: After taking informed consent from the patients and being satisfied by inclusion criteria, were selected randomly for treatment. The patients were explained about the total treatment protocol.
Initial assessment was taken before the starting of the treatment. The patients gait was assessed subjectively by Parkinsonís disease Questionnaire (PDQ-39). The objective assessment of the gait was done by Gait speed (m/sec) and Stride length in meters.
Patient was made to walk on motorized treadmill under close supervision of the therapist. The patient was made to wear a safety helmet and harness to prevent fall. The training programme consisted of a 20 minute session for 3 times a week for a total period of 8 weeks. Once a week over ground walking speed was reevaluated and treadmill speed was adjusted accordingly, hence there was a progressive increase in the gait speed. The settings on the initiation of the programme over the treadmill were described in Table 1.1.
Outcome measures: The outcome of the treatment was assessed pretest and post test by PDQ-39. It is a 39- items questionnaire on the subjective report of the impact of PD on daily life and addresses 8 health related quality of life dimensions (Mobility, ADL, Emotional well being, Stigma, Social support, Cognition, Communication and Bodily discomfort) A summary score (The Parkinsonís disease summary index (PDSI) can also be determined with the scores that range from 0 meaning perfect health and 100 meaning worst health. The gait speed was assessed by Measure and mark technique. This included marking a standard distance 5 meters and then the patient is asked to walk with comfortable pace. The patient is made to walk 3 repetitions and the average time is calculated. Then the speed of the gait is calculated by the formula:
comfortable ambulatory speed
comfortable ambulatory speed
over the comfortable
ambulatory speed of the patient
|Measures||Pretest value||Post test value||P value|
|Stride length (meters)||0.99||0.09||1.19||0.06||0.012|
|International Journal of Life-Sciences Scientific Research (IJLSSR)
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