Effects of ankle dorsiflexion training on anticipatory postural adjustments during gait initiation in patients with Parkinson's disease

Atsushi Nagai; Kohei Marumoto; Kota Ohata; Shoma Takasaki; Hideki Moriyama

doi:10.1016/j.gaitpost.2024.12.015

Effects of ankle dorsiflexion training on anticipatory postural adjustments during gait initiation in patients with Parkinson's disease

Gait Posture. 2024 Dec 12:117:109-114. doi: 10.1016/j.gaitpost.2024.12.015. Online ahead of print.

Authors

Atsushi Nagai¹, Kohei Marumoto², Kota Ohata³, Shoma Takasaki³, Hideki Moriyama⁴

Affiliations

¹ Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Shingucho 1-8-7-1, Koto, Tatsuno, Hyogo 679-5165, Japan; Department of Rehabilitation Science, Graduate School of Health Science, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, Hyogo 654-0142, Japan.
² Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Shingucho 1-8-7-1, Koto, Tatsuno, Hyogo 679-5165, Japan.
³ Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Shingucho 1-8-7-1, Koto, Tatsuno, Hyogo 679-5165, Japan.
⁴ Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, Hyogo 654-0142, Japan. Electronic address: morihide@harbor.kobe-u.ac.jp.

PMID: 39693727
DOI: 10.1016/j.gaitpost.2024.12.015

Abstract

Background: Freezing of gait (FOG) during gait initiation in patients with Parkinson's disease (PD) is associated with anticipatory postural adjustments (APAs) with diminishing amplitude, leading to a risk of falls. Assistance with ankle dorsiflexion function by external devices improve APAs during gait initiation, however, the effect of training to improve ankle dorsiflexion function on APAs during gait initiation is unclear.

Research question: Does ankle dorsiflexion training improve APAs and FOG during gait initiation in patients with PD?

Method: This 4-week prospective controlled trial included 30 patients with PD, who were divided into two groups: the control group, which received only conventional inpatient rehabilitation, and the intervention group, which received ankle dorsiflexion training in addition to inpatient rehabilitation. Ankle dorsiflexion training consisted of strengthening ankle dorsiflexion muscles and transferring weight backwards while standing. The primary outcomes were displacement of the center of pressure (COP) and electromyography of the tibialis anterior muscle during gait initiation as APAs. The secondary outcome was the New freezing of gait questionnaire (NFOGQ) to determine the severity of FOG. We analyzed differences in treatment effects between groups and within groups.

Result: In the intervention group, the anteroposterior component of COP displacement and muscle activity of the tibialis anterior muscle increased significantly and NFOGQ decreased after the intervention. After intervention, the anteroposterior component of COP displacement showed a significant intervention effect.

Significance: Ankle dorsiflexion training for patients with PD improves APAs and FOG during gait initiation and may reduce the risk of falls.

Keywords: Ankle dorsiflexion; Anticipatory postural adjustments; Freezing of gait; Gait initiation; Parkinson’s disease.