Using Gait Modulation Patterns to Characterize Gait Precision Deficits in Parkinson's Disease Open Access
Hamby, Lydia (Spring 2025)
Abstract
Abstract
Using Gait Modulation Patterns to Characterize and Treat Gait Precision Deficits in Parkinson’s Disease
By Lydia Hamby
Importance:
Parkinson’s Disease (PD) severely impacts gait adaptability, increasing fall risk when navigating everyday environments. While rehabilitation often focuses on movement accuracy, it frequently overlooks precision, or an individual’s self-consistency of repeated movements, which better captures PD-related motor deficits caused by rigidity, tremors, and postural instability. Research on gait variability and adaptability in PD provides critical assessment of motor pathologies, yet studies quantifying these deficits relative to normal aging, and evaluating interventions aimed to address them, are scarce. Dance-based therapies, specifically the Spatial Gait Modulation (SGM) battery, provide a promising strategy for identifying gait precision deficits in PD.
Objective:
To characterize the effects of PD on the precision of lower-extremity joint motion during complex gait modulation patterns, relative to both younger and older adults without PD.
Study Design:
A cross-sectional study involving 36 participants, 12 younger adults (YA), 12 older adults (OA), and 12 people with PD (PWP), recruited from Emory University and the metro-Atlanta area. Participants completed standard motor-cognitive assessments and a SGM battery assessment.
Main Outcome and Measure:
Sagittal-plane joint angles of the hip, knee, and ankle were measured using OPALS sensors during all gait cycles. Precision was quantified as variability (standard deviation) of joint angles and adaptability from cycle-to-cycle (cycle-to-cycle error correction).
Results:
Participants with PD demonstrated significantly greater variability in joint angles (mean normalized SD is 0.076) compared to OA (0.057) and YA (0.053). Precision deficits were most evident during swing-phase modifications, particularly in the passe battement (p = 0.0018). Additionally, individuals with PD showed reduced cycle-to-cycle error correction, indicating impaired movement adaptability during swing-phase tasks (p = 0.017).
Conclusion and Relevance:
These findings highlight that movement precision serves as a distinct marker of PD-specific gait dysfunction beyond age-related motor changes. There is a need for dance-based therapies to explicitly address movement precision in PD.
Table of Contents
Table of Contents
Introduction & Background……………………………………………………………………….1
Introduction to Parkinson’s Disease & Research on Motor Pathology…………………...1
The Role of Precision in PD Movement Deficits……………………………………........4
Spatiotemporal Gait Modulation in Movement Therapy………………………………….5
Study Objective and Hypothesis…………………………………………………………..6
Materials & Methods……………………………………………………………………………...7
Study Design………………………………………………………………………………7
Participants………………………………………………………………………...8
Table 1: Participant Demographic Characteristics by Group…………..…8
Clinical Motor Cognitive Assessment………………………………………….....9
Table 2: Participant Clinical Characteristics……………………………..10
SGM Protocol……………………………………………………………………11
Figure 1: Kinematic Gait Modulation Dictionary - Library of Movement Patterns Inducing Non-Stereotypical Joint Coordination of the Lower-Extremity During Forward Gait………………………………………….13
Figure 2: Innovative SGM Developed and Tested………………………14
SGM Assessment Protocol………………………………………………………15
SGM Assessment Data Processing………………………………………………16
Gait Modulation Variability Metric…………………………………………...…16
Equation 1: Variability Metric………………………………………...…17
Gait Modulation Adaptability Metric……………………………………………18
Equation 2: Adaptability Metric…………………………………………19
Statistical Analysis……………………………………………………………………………….19
Results……………………………………………………………………………………………20
Subjects…………………………………………………………………………………..20
Variability Results……………………………………………………………………….20
Figure 3: Average Lower-Limb Kinematics Across Spatial
Modification Patterns…………………………………………………………….21
Figure 4: Variability in Joint-Angle Kinematics During Attitude Movement in PWP and YA participants………………………………………………………..22
Table 3: Variability Descriptive Statistics……………………………………….24
Figure 5: Variability Box Plot: Spatial Class…………………………………….28
Figure 6: Variability Box Plot: Spatial Sub-Classes……………………………..28
Figure 7: Variability Box Plot: SGM Patterns…………………………...………29
Adaptability Results……………………………………………………………………...30
Figure 8: Cycle-to-Cycle Correction for SW Passe Battement in PWP and
YA….....................................................................................................................31
Table 4: Adaptability Metric Descriptive Statistics……………………………..32
Figure 9: Cycle-to-Cycle Correction Slope Box Plot: Spatial Class…………….36
Figure 10: Cycle-to-Cycle Correction Slope Box Plot: Spatial Sub-Classes……36
Figure 11: Cycle-to-Cycle Correction Slope Box Plot: SGM Patterns………….37
Discussion………………………………………………………………………………………..38
SW-Phase Gait Variability and Adaptability in PD: Statistical Findings ……………….38
Clinical Implications of SW-Phase Pathology…………………………………………...40
Precision Deficits of SW-Phase: Clinical Findings and Neurological Basis……………………………………………………………………...……………………....40
Limitations……………………………………………………………………………….42
Future Directions: Enhancing SW-Phase Precision Through STEAM Movement
Therapy…………………………………………………………………………………..43
Conclusion……………………………………………………………………………………….45
References………………………………………………………………………………………..46
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