Assessment and exercise for Freezing of Gait in Parkinson’s Disease

Parkinson's disease (PD) is a neurodegenerative disorder characterized through multiple motor- and non-motor symptoms. Gait disorders and balance deficits are very common in people with PD and often cannot be fully alleviated by standard therapy. The mentioned deficits not only lower the quality of life but also increase the risk for falls. Especially people with PD who experience Freezing of Gait (FOG), an episodic gait disturbance, are at risk and need individualized therapy options. Therefore, exercise and physical therapy have become increasingly important in the rehabilitation of PD. This work aims to investigate the validity and reliability for assessment methods for FOG and check their potential as outcome measures for clinical trials. Furthermore, it explores feasibility and treatment options of the Split-belt treadmill (SBT) as a tool modulate gait asymmetry in people with PD as well as the short-term effects on gait. Study 1 focused on the validity of the German version of the New Freezing of Gait-Questionnaire. It found that the translated version was a valid instrument to assess the severity of FOG in the German-speaking PD population. Study 2 investigated the within-session reliability of the assessment of anticipatory postural adjustment in PD+FOG and found a high variability in the reliability scores, depending on the outcome of interest. Study 3 summarized the current literature on SBT walking in people with PD and showed that people with PD can successfully adapt their gait to the split belts. The final study investigated the short-term effects of one SBT training session and found that SBT with changing conditions was most useful to improve gait adaptation in PD+FOG. This thesis provides some important findings regarding the assessment of FOG and highlights opportunities for suitable outcome measures for clinical studies in this field. Furthermore, it highlights the potential of SBT training for the rehabilitation of PD by showing that it is feasible, safe and above all has positive effects on gait adaptation in people with PD. Those findings give important implications for the selection of outcome measure and the design of training interventions for PD+FOG in future studies.


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