Table 2. Summary of the population, protocols, gait measures and results of these investigations.
| Studies | Population | Protocol | Gait measures | Results |
|---|---|---|---|---|
| Frazzitta et al.(23) | 30 patients with gait disturbance, but without FOG in “on” stage and 30 patients with FOG in “on” stage | Patients underwent a 4-week rehabilitation treatment using a treadmill with auditory and visual cues | Gait speed, stride length, asymmetry of gait, 6MWT, UPDRS II-III, Berg Balance Scale, TUG, comfortable-fast gait speeds, FOG-Q | Data support a direct involvement of the asymmetry of gait in the development of FOG in PD TT is effective in improving gait and balance in PD FOG patients, and this might be related to a reduction of asymmetric gait |
| Yang et al.(24) | 20 patients with PD with ability to walk independently | -2 groups: 1. Participants received rTMS (Experimental Group) 2. Participants received sham rTMS (Control Group) Followed by TT (30 minutes) for 12 sessions over 4 weeks (3 sessions a week) |
Corticomotor inhibition and walking performance | The findings suggested that combination of rTMS and TT enhances the effect of TT on modulation of corticomotor inhibition and improvement of walking performance in those with PD |
| Galli et al.(25) | 50 idiopathic PD Ability to walk, unassisted or with little assistance, for a distance of 25 feet |
-2 groups 1. Robot-assisted therapy group (n=25) 2. Intensive treadmill therapy group (n=25) |
Hoehn and Yahr scaleUPDRS Optoelectronic system (ELITE2002, BTS, Milan, Italy) |
In the robot group, differences were found in kinematic variables (pelvic obliquity and hip abduction and adduction). The intensive group showed no statistically significant changes. The end-effector robotic rehabilitation locomotor training improved gait kinematics and seems to be effective for rehabilitation in patients with mild PD |
| Canning et al.(26) | 20 people with idiopathic PD with <2 hours per week of leisure time physical activity in prior 3 months, and had a stable response to levodopa medications | -2 groups: 1. The Experimental Group undertook a semi-supervised home-based program of 30-40 minutes of treadmill walking, 4 times a week for 6 weeks 2. The Control Group received usual care (i.e. advice to maintain current levels of physical activity) |
The primary outcome measure of efficacy was walking capacity (6MWT) | Semi-supervised home-based TT is a feasible and safe form of exercise for cognitively intact people, with mild PD |
| Frazzita et al.(27) | 40 Parkinsonian patients with freezing were randomly assigned to two groups | 2 group: 1. Underwent a rehabilitation program based on treadmill training associated with auditory and visual cues 2. Followed a rehabilitation protocol using cues and not associated with treadmill |
Functional evaluation was based on the Unified Parkinson's Disease Rating Scale Motor Section (UPDRS III); Freezing of Gait Questionnaire (FOGQ), 6-minute walking test (6MWT), gait speed, and stride cycle | The results suggest that treadmill training associated with auditory and visual cues might give better results than more conventional treatments. Treadmill training probably acts as a supplementary external cue |
| Picelli et al.(28) | 60 patients with mild to moderate PD | 3 groups: 1. Robotic gait training group (n=20);TT group (n=20) performed equal intensity 2. TT without body-weight support 3. The physical therapy group (n=20) underwent conventional gait therapy45 minutes per session 3 days/week, during four consecutive weeks |
10-minute walking test6MWT | No statistically significant difference was found between the robotic gait training group and the TT group in the evaluation after training. Statistically significant improvement was found after treatment in favor of the robotic gait training group and TT group compared to the physical therapy group. Findings were confirmed at the 3-month follow-up evaluation |
| Fisher et al.(29) | 30 PD patients, within 3 years of diagnosis, with Hoehn and Yahr stages 1 or 2 | 3 groups: 1. High-intensity (body weight-supported TT) 2. Low-intensity exercise (exercises to range of motion, balance and gait) 3. Zero-intensity (education group) |
UPDRS Biomechanical analysis of self-selected and fast walking Sit-to-stand tasks Corticomotor excitability |
A small improvement in total and motor UPDRS was observed in all groups. High-intensity group subjects showed post-exercise increases in gait speed, step and stride length, and hip and ankle joint excursion during self-selected and fast gait, besides improved weight distribution during sit-to-stand tasks. Improvements in gait and sit-to-stand measures were not consistently observed in the low- and zero-intensity groups. The high-intensity group showed lengthening in cortical silent period |
| Schlick et al.(30) | 23 outpatients with PD | Patients received 12 training sessions within 5 weeks of either visual cues combined with TT (n=12) or pure TT (n=11) | Gait speed, stride length and cadence Functional tests included the TUG test, the UPDPRS and the freezing of gait-questionnaire |
This pilot study suggests that visual cues combined with TT have more beneficial effects on gait than pure TT, in patients with a moderate stage of PD. A large-scale study with longer follow-up is required |
| Arcolin et al.(31) | 29 patients with the diagnosis of idiopathic PDAbility to walk, unassisted | 2 groups (randomized): 1. Treadmill (n=13) 2. Cycle ergometer (n=16) Training for 3 weeks, 1 hour/day |
6MWT Spatiotemporal variables of gait assessed by baropodometry TUG test MINIBESTest UPDRS |
This pilot study shows that cycle ergometer training improves walking parameters and reduces clinical signs of PD, as much as TT does. Gait velocity is accompanied by step lengthening, making the gait pattern close to that of healthy subjects. Cycle ergometer is a valid alternative to treadmill for improving gait in short-term in patients with PD |
| Herman et al.(32) | 9 patients with PD who were able to ambulate independently and were not demented | Patients walked on a treadmill for 30 minutes during each training session, 4 training sessions a week, for 6 weeks | PDQ-39 UPDRS Gait speed, stride time variability, swing time variability SPPB |
These results show the potential to enhance gait rhythmicity in patients with PD and suggest that a progressive and intensive TT program can be used to minimize impairments in gait, reduce fall risk, and increase quality of life of these patients |
| Fernández-Lago et al.(33) | 18 idiopathic PD patientsAbility to walk, unassisted | 18 participants with PD were evaluated under the following three conditions (groups): 1. Treadmill walking alone (treadmill) 2. Treadmill walking combined with anodal tDCS (AtDCS + treadmill) delivered over the motor cortex 3. Treadmill walking combined with sham stimulation (StDCS+treadmill) |
Overground walking performance, soleus H-reflex, reciprocal Ia inhibition from the tibialis anterior to the soleus muscle, intracortical facilitation, and short intracortical inhibition of the tibialis anterior muscle | All treadmill conditions improved walking performance and modulated spinal and corticospinal parameters compare with other kind of treatments. However, AtDCS + treadmill lead to a different modulation of reciprocal Ia inhibition in comparison with the other treadmill conditions |
FOG: freezing of gait; 6MWT: 6-Minute Walk Test; UPDPRS: Unified Parkinson Disease Rating Scale; TUG: Timed Up and Go; FOG-Q: Freezing of Gait Questionnaire; TT: treadmill training; PD: Parkinson disease; rTMS: repetitive transcranial magnetic stimulation; MINIBESTest: Balance Evaluation Systems Test; PDQ-39: Parkinson Disease Questionnaire-39; SPPB: Short Physical Performance Battery; tDCS: transcranial direct current stimulation.