PATHOMICHANICS OF PARKINSON DISEASE GAITBY: JWANIKA VANSIYA

What is Parkinson’s disease?

• Parkinson’s disease is a progressive neurological condition, resulting from the degeneration of dopamine producing neurones in the substantia nigra, which is located within the basal ganglia, deep in the lower region of the brain, on either side of the brain stem.

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• Bradykinesia • Rigidity • Tremor • Postural instability

Clinical features

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• Also called Parkinsonian gait or Festinating gait.

• Parkinsonian gait is characterized by small shuffling steps and a general slowness of movement (hypokinesia), or even the total loss of movement (akinesia) in the extreme cases.

Parkinson disease gait

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• Tottering gait• Characteristically shows difficulty in initiating gait, rapid short

shuffling steps with loss of arm swing, stooped stance propulsion.

• Turning or changing direction is particularly difficult and typically accompanied by taking multiple small steps.

• Parkinsonian Gait.mp4

Festinating gait

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• Freezing of Gait (FOG) is typically a transient episode – lasting less than a minute, in which gait is halted and the patient complains that his/her feet are glued to the ground.

• ‘ignition disturbances’FallsFalls result mainly due to sudden changes in posture, in particular turning movements of the trunk, or attempts to perform more than one activity simultaneously with walking or balancing

Freezing of gait (FOG)

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Gait characteristics

Spatiotemporal parameters Kinematics data Kinetic data

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• Velocity (m/s)• Stride length (m)• Cadence (stride/min)• Double support time• Cycle time (s)

Spatiotemporal parameters

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Normal

Early stance – Dorsiflexion to planterflexionMid stance-DorsiflexionLate stance-Planter flexion

Parkinsonian gait

Reduction in dorsiflexion ROM at early stance.Reduction in planter flexion ROM during toe off.

Kinematics data

Ankle

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Normal • Early to mid stance-

Extension to 15 degree of flexion• Late stance- knee flexion

with planter flexion

Parkinsonian gait• Reduced knee extension

during single support stance.

Kinematics data

knee

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Normal • Early to mid stance

phase – flexion • Late stance phase –

extension

Parkinsonian gait• Lower flexion range

during initial contact • Decrease hip flexion

ROM in pre swing phase.

Kinematics dataHip

Ankle :• Reduced ankle moment at loading response.• Power generation in parkinson disease group deteriorate in

late stance.Knee:• Lower power generation during single stance phase of the

gait. This occurs due to limited knee extension during the stance phase.

• Decreased power absorption at the knee joint during the late stance and preswing phase.

Kinetics data

Hip • Reduction of max hip extensor moment and decrease hip

power generation in the first double support.• Also max hip flexion moment and power generation in the

second double support and pre swing reduced.• Parkinsonian Gait Demonstration.mp4

References • Sofuwa O, Nieuwboer A, Desloovere K, Willems AM, Chavret F,

Jonkers I. Quantitative gait analysis in Parkinson's disease: comparison with a healthy control group. Archives of physical medicine and rehabilitation. 2005;86(5):1007-13.

• Svehlik M, Zwick EB, Steinwender G, Linhart WE, Schwingenschuh P, Katschnig P, et al. Gait analysis in patients with Parkinson's disease off dopaminergic therapy. Archives of physical medicine and rehabilitation. 2009;90(11):1880-6.

• Svehlik M, Zwick EB, Steinwender G, Linhart WE, Schwingenschuh P, Katschnig P, et al. Gait analysis in patients with Parkinson's disease off dopaminergic therapy. Archives of physical medicine and rehabilitation. 2009;90(11):1880-6.

• Gait disorders evaluation and management Jeffrey M. Hausdorff , Neil B. Alexander• The Professional’s Guide to Parkinson’s Disease