Frequency-Velocity Mismatch: A Fundamental Abnormality in Parkinsonian Gait

Author:

Cho Catherine1,Kunin Mikhail2,Kudo Koji13,Osaki Yasuhiro4,Olanow C. Warren1,Cohen Bernard1,Raphan Theodore12

Affiliation:

1. Department of Neurology, Mount Sinai School of Medicine, New York;

2. Department of Computer and Information Science, Brooklyn College and Graduate Center of the City University of New York, Brooklyn, New York;

3. Department of Otolaryngology, Akita University School of Medicine, Akita, Japan

4. Department of Otorhinolaryngology, Osaka University School of Medicine, Osaka; and

Abstract

Gait dysfunction and falling are major sources of disability for patients with advanced Parkinson's disease (PD). It is presently thought that the fundamental defect is an inability to generate normal stride length. Our data suggest, however, that the basic problem in PD gait is an impaired ability to match step frequency to walking velocity. In this study, foot movements of PD and normal subjects were monitored with an OPTOTRAK motion-detection system while they walked on a treadmill at different velocities. PD subjects were also paced with auditory stimuli at different frequencies. PD gait was characterized by step frequencies that were faster and stride lengths that were shorter than those of normal controls. At low walking velocities, PD stepping had a reduced or absent terminal toe lift, which truncated swing phases, producing shortened steps. Auditory pacing was not able to normalize step frequency at these lower velocities. Peak forward toe velocities increased with walking velocity and PD subjects could initiate appropriate foot dynamics during initial phases of the swing. They could not control the foot appropriately in terminal phases, however. Increased treadmill velocity, which matched the natural PD step frequency, generated a second toe lift, normalizing step size. Levodopa increased the bandwidth of step frequencies, but was not as effective as increases in walking velocity in normalizing gait. We postulate that the inability to control step frequency and adjust swing phase dynamics to slower walking velocities are major causes for the gait impairment in PD.

Publisher

American Physiological Society

Subject

Physiology,General Neuroscience

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