Influence of verbal instruction on gait training in Parkinson’s disease: a randomized controlled trial

Abstract

Abstract Objective Verbal instruction is one of the most commonly used methods that therapists use to correct walking pattern for people with Parkinson’s disease (PD). This study aimed to compare the long-term training effects of two different verbal instructions that either asked the participants to ‘take big steps’ or ‘strike the ground with the heel’ on walking ability in individuals with PD. Design Forty-five participants with PD were randomized into the big-step (BIG) or heel strike (HS) group. The participants underwent 12 sessions of treadmill and overground gait training. Throughout the interventions, the BIG group received an instruction to ‘take big steps,’ while the HS group received an instruction to ‘strike the ground with your heel.’ The primary outcome was gait performance, including velocity, stride length, cadence, and heel strike angle. The participants were assessed before, immediately after, and 1-month after training. Results Both groups showed significant improvements in gait performance after training. The HS group showed continuous improvements in velocity and stride length during the follow-up period; however, the BIG group showed slightly decreased performance. Conclusion A verbal instruction emphasizing heel strike can facilitate long-term retention of walking performance in people with PD.