The Effects of a Secondary Task on Forward and Backward Walking in Parkinson's Disease.
ABSTRACT BACKGROUND: People with Parkinson's disease (PD) often fall while multitasking or walking backward, unavoidable activities in daily living. Dual tasks involving cognitive demand during gait and unfamiliar motor skills, such as backward walking, could identify those with fall risk, but dual tasking while walking backward has not been examined in those with PD, those who experience freezing of gait (FOG), or healthy older controls. METHODS: . A total of 78 people with PD (mean age = 65.1 +/-9.5 years; female, 28%) and 74 age-matched and sex-matched controls (mean age = 65.0 +/-10.0 years; female, 23%) participated. A computerized walkway measured gait velocity, stride length, swing percent, stance percent, cadence, heel to heel base of support, functional ambulation profile, and gait asymmetry during forward and backward walking with and without a secondary cognitive task. RESULTS: . Direction and task effects on walking performance were similar between healthy controls and those with PD. However, those with PD were more affected than controls, and freezers were more affected than nonfreezers, by backward walking and dual tasking. Walking backward seemed to affect gait more than dual tasking in those with PD,although the subset of freezers appeared particularly affected by both challenges. CONCLUSION: . People with PD are impaired while performing complex motor and mental tasks simultaneously,which may put them at risk for falling. Those with FOG are more adversely affected by both motor and mental challenges than those without. Evaluation of backward walking while performing a secondary task might be an effective clinical tool to identify locomotor difficulties.
Article: Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.[show abstract] [hide abstract]
ABSTRACT: Few detailed clinico-pathological correlations of Parkinson's disease have been published. The pathological findings in 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic Parkinson's disease are reported. Seventy six had nigral Lewy bodies, and in all of these Lewy bodies were also found in the cerebral cortex. In 24 cases without Lewy bodies, diagnoses included progressive supranuclear palsy, multiple system atrophy, Alzheimer's disease, Alzheimer-type pathology, and basal ganglia vascular disease. The retrospective application of recommended diagnostic criteria improved the diagnostic accuracy to 82%. These observations call into question current concepts of Parkinson's disease as a single distinct morbid entity.Journal of Neurology Neurosurgery & Psychiatry 04/1992; 55(3):181-4. · 4.76 Impact Factor
Article: Effect of age on characteristics of forward and backward gait at preferred and accelerated walking speed.[show abstract] [hide abstract]
ABSTRACT: Backward walking is used increasingly in rehabilitation programs to promote balance, strength, and aerobic conditioning. This study examines the effect of movement direction on the temporal-spatial gait characteristics of old versus young adults when progressing at a comfortable pace and as fast as possible. Participants included 40 old (mean age 77.7, standard deviation +/- 6.2) and 30 young volunteers (mean age 24.0, standard deviation +/- 2.3), who were independent walkers. Using a computer-based walkway system, participants were requested to walk forward and backward at a normal pace and as fast as possible. Analyses of variance and Tukey-Kramer tests were conducted to determine effects of age, movement direction, and acceleration of gait speed on various gait parameters. Forward and backward walking of elderly persons is generally characterized by a lower velocity, cadence, stride length, and swing phase, accompanied by an increase in the double-support phase. Reversing from forward to backward walking presents a similar pattern in both age groups, with a decrease in gait velocity, stride length, and swing phase, an increase in the double-support phase, and no change in cadence. However, the decrease in stride length is significantly greater among elderly persons. In young persons, higher gait velocities are achieved by concurrent increases in stride length and cadence, regardless of movement direction. Ability of older persons to increase backward ambulation is limited and relies solely on increasing cadence. Elderly persons demonstrate difficulties in walking backward, with stride length particularly affected. These difficulties must be considered when using backward ambulation for rehabilitation of elderly persons.The Journals of Gerontology Series A Biological Sciences and Medical Sciences 06/2005; 60(5):627-32. · 4.60 Impact Factor