Taking the First Step: A Pilot Study on Gait Initiation Training in People With Parkinson Disease.

Abstract

Background and purpose: People with Parkinson disease (PwP) demonstrate decreased first step length and speed during gait initiation, mirroring impairments observed during continuous walking. Despite similar impairments, interventions targeting continuous walking may not address gait initiation's unique postural control demands, and there is a lack of evidence supporting gait initiation-specific training. This study compared continuous walking versus gait initiation-specific training on changes to first step length, first step speed, and anticipatory postural adjustment (APA) sizes during gait initiation in PwP. We hypothesized that task-specific training would yield greater improvements across all metrics.

Methods: Using a randomized crossover design, 10 PwP (Hoehn and Yahr stages 2-3) completed gait initiation-specific and continuous walking training 3 times per week for 2 weeks with a 1-week washout between training types. Gait initiation-specific training included repeated practice of gait initiation using visual biofeedback for weight shift amplitude and verbal cues for increased first step length and speed. Continuous walking training used targeted rhythmic auditory cueing to increase step length and gait speed. Each phase included pre-test, post-test, and 1-week follow-up assessments.

Results: Gait initiation-specific training yielded longer and faster first steps that persisted at follow-up (P ≤ 0.028), whereas continuous walking training did not (P ≥ 0.129). Anteroposterior APA size increased regardless of training type (P = 0.008), but mediolateral APAs remained unchanged (P ≥ 0.084).

Discussion and conclusions: In this pilot study, task-specific training improved first-step performance, while continuous walking training did not. This highlights the potential importance of task-specific practice for gait initiation in PwP. Further work is required to confirm these results.