Gait initiation in Parkinson's disease: comparison of timing and displacement during anticipatory postural adjustments as a function of motor severity and apathy in a large cohort

Ségolène De Waele; Ann Hallemans; Emke Maréchal; Patrick Cras; David Crosiers

doi:10.1016/j.heliyon.2023.e23740

Gait initiation in Parkinson's disease: comparison of timing and displacement during anticipatory postural adjustments as a function of motor severity and apathy in a large cohort

Heliyon. 2023 Dec 20;10(1):e23740. doi: 10.1016/j.heliyon.2023.e23740. eCollection 2024 Jan 15.

Authors

Ségolène De Waele^{1

2}, Ann Hallemans³, Emke Maréchal^{2

4}, Patrick Cras^{1

2}, David Crosiers^{1

2}

Affiliations

¹ Translational Neurosciences, Born-Bunge Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
² Antwerp University Hospital, Department of Neurology, Antwerp, Belgium.
³ Research group MOVANT (Movement Antwerp), Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
⁴ ZNA Middelheim Hospital, Department of Neurology, Antwerp, Belgium.

Abstract

Introduction: Gait initiation is preceded by three anticipatory postural adjustment (APA) phases. In Parkinson's disease (PD) generated force, displacement and timing during APA differ from healthy controls. APA might be influenced by disease status, weight or emotion. It is unknown how motor severity, disease duration or presence of apathy influences APA timing and displacement.

Methods: We included 99 people with PD and 50 healthy controls (HC) to perform five gait initiation trials following an auditory cue. Force plates measured timing and center of pressure (CoP) displacement during APA phases.

Results: Time to gait initiation (tGI) was higher in the PD group (p < 0.001, t = 2.74, 95%CI (0.008, 0.066)). The first two APA phases (APA1 and APA2a) lasted longer in PD (respectively p < 0.001, t = 3.87, 95%CI (0.091, 0.28) and p < 0.001, t = 4.1, 95%CI (0.031, 0.091)). Mean CoP displacement, variability in timing and displacement did not differ. A multiple regression model was used to determine if clinical variables were related to gait initiation parameters. tGI was predicted by age (p < 0.001) and weight (p = 0.005). The duration of APA1 was predicted by weight (p = 0.006) and APA2a by age (p < 0.001). Variability in duration of the locomotor phase (LOC) was predicted by age (p < 0.001).

Conclusion: tGI and initial APA phases are longer in PD than in HC. There are no significant differences in variability of timing or displacement between the two groups. Gait initiation parameters are independent of disease duration, motor severity, medication usage or apathy in PD. Our findings suggest that cueing does not speed up gait initiation but reduces variability.

Keywords: Anticipatory postural adjustments; Apathy; Cueing; Force plate; Gait analysis; Gait initiation; Parkinson's disease.