Parkinsonian gait ameliorated with a moving handrail, not with a banister

Abstract

Objective: To determine whether haptic (touch and proprioception) cues from touching a moving handrail while walking can ameliorate the gait symptoms of Parkinson disease (PD), such as slowness and small stride length.

Design: Nonrandomized, controlled before-after trial.

Setting: Physical therapy clinic.

Participants: People with PD (n=16) and healthy age-matched control subjects (n=16) with no neurologic disorders volunteered. No participants withdrew.

Interventions: We compared gait using a moving handrail as a novel assistive aid (speed self-selected) versus a banister and unassisted walking. Participants with PD were tested on and off dopaminergic medication.

Main outcome measures: Mean gait speed, stride length, stride duration, double-support duration, and medial-lateral excursion.

Results: With the moving handrail, participants with PD increased gait speed relative to unassisted gait by 16% (.166m/s, P=.009, d=.76; 95% confidence interval [CI], .054-.278m/s) and increased stride length by 10% (.053m, P=.022, d=.37; 95% CI, .009-.097m) without significantly changing stride or double-support duration. The banister reduced speed versus unassisted gait by 11% (-.097m/s, P=.040, d=.40; 95% CI, .002-.193m/s) and reduced stride length by 8% (.32m, P=.004, d=.26; 95% CI, .010-.054m), whereas it increased stride duration by 3% (.023s, P=.022, d=.21; 95% CI, .004-.041s) and double-support duration by 35% (.044s, P=.031, d=.58; 95% CI, .005-.083s). All medication × condition interactions were P>.05.

Conclusions: Using haptic speed cues from the moving handrail, people with PD walked faster by spontaneously (ie, without specific instruction) increasing stride length without altering cadence; banisters slowed gait. Haptic cues from the moving handrail can be used by people with PD to engage biomechanical and neural mechanisms for interpreting tactile and proprioception changes related to gait speed to control gait better than static cues afforded by banisters.

Keywords: Assistive devices; Gait disorders, neurologic; Parkinson disease; Proprioception; Rehabilitation; Touch.