Dataset Information

Short-Term Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in Parkinson's Disease and Healthy Elderly.

ABSTRACT: Background: Dual-tasking is challenging for people with Parkinson's disease and freezing of gait (PD+FOG) and can exacerbate freezing episodes and falls. Split-belt treadmill training (SBT) is a novel tool to train complex gait and may improve dual-task (DT) walking and turning. Objective: To investigate the single-session effects of SBT on DT walking and DT turning performance in PD+FOG and older adults (OA), compared to regular treadmill training. Methods: Forty-five PD+FOG and 36 OA participated in a single training session (30 min). They were randomized into one of four training groups: (A) SB75-steady belt speed ratio 0.75:1; (B) SB50-steady belt speed ratio 0.5:1; (C) SBCR-changing belt speed ratios between 0.75:1 and 0.5:1; and (D) Tied-Belt (TBT). Over-ground straight-line gait and an alternating turning in place task combined with a cognitive dual-task (DT) (auditory Stroop) were assessed pre- and post-training, and the following day (retention). Constrained longitudinal data analysis was used to investigate the training effects for all participants and for PD+FOG alone. Results: DT gait speed improved at post-training for all groups (p < 0.001). However, SBT (SB50 and SBCR) led to larger post-training improvements compared to TBT, which were still visible at retention (SB50). For mean DT turning speed and Stroop response time while walking, only SBT groups showed significant improvements at post-training or retention. DT stride length, peak DT turning speed, and Stroop performance index while walking also showed larger gains in SBT compared to TBT. Results for PD+FOG alone showed similar effects although with smaller effect sizes. Conclusions: A single session of SBT in PD+FOG and OA showed larger short-term effects on DT walking and turning compared to TBT. Cognitive DT performance was also improved in SBT, likely due to reduced cortical control of gait. These results illustrate the potential for SBT to improve DT during complex gait and possibly reduce fall risk in clinical and healthy populations.

SUBMITTER: D'Cruz N

PROVIDER: S-EPMC7554617 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Short-Term Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in Parkinson's Disease and Healthy Elderly.

D'Cruz Nicholas N Seuthe Jana J Ginis Pieter P Hulzinga Femke F Schlenstedt Christian C Nieuwboer Alice A

Frontiers in neurology 20200930

Background: Dual-tasking is challenging for people with Parkinson's disease and freezing of gait (PD+FOG) and can exacerbate freezing episodes and falls. Split-belt treadmill training (SBT) is a novel tool to train complex gait and may improve dual-task (DT) walking and turning. Objective: To investigate the single-session effects of SBT on DT walking and DT turning performance in PD+FOG and older adults (OA), compared to regular treadmill training. Methods: Forty-five PD+FO ...[more]

PMID: 33101174

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Project description:Single and double exponential models fitted to step length symmetry series are used to evaluate the timecourse of adaptation and de-adaptation in instrumented split-belt treadmill tasks. Whilst the nonlinear regression literature has developed substantially over time, the split-belt treadmill training literature has not been fully utilising the fruits of these developments. In this research area, the current methods of model fitting and evaluation have three significant limitations: (i) optimisation algorithms that are used for model fitting require a good initial guess for regression parameters; (ii) the coefficient of determination (R2) is used for comparing and evaluating models, yet it is considered to be an inadequate measure of fit for nonlinear regression; and, (iii) inference is based on comparison of the confidence intervals for the regression parameters that are obtained under the untested assumption that the nonlinear model has a good linear approximation. In this research, we propose a transformed set of parameters with a common language interpretation that is relevant to split-belt treadmill training for both the single and double exponential models. We propose parameter bounds for the exponential models which allow the use of particle swarm optimisation for model fitting without an initial guess for the regression parameters. For model evaluation and comparison, we propose the use of residual plots and Akaike's information criterion (AIC). A method for obtaining confidence intervals that does not require the assumption of a good linear approximation is also suggested. A set of MATLAB (MathWorks, Inc., Natick, MA, USA) functions developed in order to apply these methods are also presented. Single and double exponential models are fitted to both the group-averaged and participant step length symmetry series in an experimental dataset generating new insights into split-belt treadmill training. The proposed methods may be useful for research involving analysis of gait symmetry with instrumented split-belt treadmills. Moreover, the demonstration of the suggested statistical methods on an experimental dataset may help the uptake of these methods by a wider community of researchers that are interested in timecourse of motor training.

Project description:Aim: Falls commonly occur from trips and slips while walking. Recovery strategies from trips and backward falling slips have been extensively studied. However, until recently, forward falling slips (FFSs) have been considered less dangerous and have been understudied. This study aimed first to create an application to realistically simulate FFSs using a split-belt instrumented treadmill and then to understand the biomechanical requirements for young adults to recover from an FFS. Methods: We developed a semi-automatic custom-made application on D-Flow that triggered FFSs by briefly and unexpectedly increasing the speed (a = 5 m·s-2) of the right belt during stance. To validate the protocol, we tested against criteria defined for an ecologically and experimentally valid FFS: unexpected occurrence of the slip, increased foot velocity, forward loss of balance during the slip and consistent perturbation timing. We evaluated the recovery strategies of 17 young adults by measuring dynamic stability, joint moments and ground reaction force (GRF) vector angles before, during and on 15 steps following the FFS. Results: The application successfully triggered FFSs, according to the criteria we defined. Participants' balance returned to normal for a minimum of three consecutive steps in 10.9 (7.0) steps. Recovery from the FFSs was characterised by larger hip flexor and knee extensor moments to support the centre of mass during the slip, and a longer first recovery step with large hip extensor moments to arrest the fall followed by large knee extensor moments to raise and advance the centre of mass into the next step (p < 0.001 compared with normal gait). Subsequent steps progressively returned to normal. Conclusion: This is the first study to experimentally simulate FFSs meeting the aforementioned criteria, and to measure their effects on the dynamic balance and kinetic parameters. The split-belt instrumented treadmill proved a promising tool to better study the mechanisms of falls and recovery. The required large hip and knee joint moments generally agree with findings on trips and backward falling slips and provide an indication of the functional capacities that should be targeted in fall-prevention interventions. These findings should be used to better understand and target the mechanisms of balance loss and falls in older adults following FFSs.

Dataset Information

Short-Term Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in Parkinson's Disease and Healthy Elderly.

Publications

Short-Term Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in Parkinson's Disease and Healthy Elderly.

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