In Parkinson’s disease (PD), gait disturbance is one of the most disabling characteristics of the disease since the quality of life diminishes with increasing fall frequency; the overall quality of life diminishes with developing gait disturbance. It is estimated that more than 70% of patients fall during the course of the disease and such events often result in fractures, often leading to another morbidity.
Along with the classical PD, there are other diseases with similar characteristics observed in the PD: atypical Parkinsonian disorders (APD). Popular APDs are multiple system atrophy (MSA), progressive supranuclear palsy, corticobasal syndrome, etc. The diseases are commonly referred to as Parkinsonism, despite of differences in etiology and treatment plans. Although the PD has the clinical features commonly associated with Parkinsonism, there is a broader spectrum of disease represented by a collection of phenotypically-similar neurodegenerative conditions that mimic core features of PD, including gait pattern. Thus, it is a challenge to distinguish a specific disease among various diseases with similar clinical presentation.
In this study, we have tried to find difference in similar gait patterns displayed by between the PD group and the MSA group. From September 2016 to August 2018, 76 patients were selected among those who visited the hospital for evaluation of Parkinsonism. We evaluated the patients’ gait patterns using Zebris® gait analysis system (Fig. 1). The spatiotemporal parameters of gait were estimated from the vertical pressures measured on a force platform housed within a treadmill. The patient pool was filled as the diagnosis was given; 11 patients without clear diagnosis were excluded, then the patients diagnosed with non-Parkinsonism, such as syphilis and depression, and the patients with diagnosis other than PD and MSA were excluded. Total of 17 PD patients and 17 MSA patients were recruited for the study, but 6 patients from each group were excluded due to severe gait disability with gait velocity slower than 1.0km/hr.
We gathered and analyzed step length, difference in step length, stride length, step width, stance phase percentage, swing phase percentage, cadence, lateral symmetry, and double stance phase percentage. The statistical analysis is made via Mann-Whitney U-test, using SPSS 21.0 In this study, there was a statistically significant difference in lateral symmetry between the PD group and the MSA group (Table 1), indicating that the PD patients had more deviated center of gravity than the MSA patients at the time of initial evaluation of the disease (Fig. 2); median values with standard deviation are 16.51±11.24 for PD and 2.31±9.23 for MSA.
This study indicates that there may be differences in gait pattern between Parkinson’s disease and multiple systemic atrophy patient groups, which may be extended to further research to help distinguish a specific disease among various Parkinsonian diseases. |
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Gait analysis by Zebris® system used for the study
Stem-and-Leaf Plot for Lateral Symmetry for PD and MSA. The median value with standard deviation are indicated: 16.51 ± 11.24 for PD and 2.31 ± 9.23 for MSA
Statistical Analysis for PD and MSA using Mann-Whitney U Test. The analysis results indicate that only the lateral symmetry measured from the gait analysis platform has a statistically significant difference between the PD and the MSA groups with U-value = 24.000, p-value 0.017, suggesting that the PD patients had more deviated center of gravity than the MSA patients at the time of initial evaluation of the disease
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