From the Guidelines
The most appropriate standardized gait assessment for Parkinson's disease is the Unified Parkinson's Disease Rating Scale (UPDRS) Part III, which includes specific items for gait evaluation, in conjunction with other assessments such as the Timed Up and Go (TUG) test and the 10-Meter Walk Test. These assessments provide a comprehensive evaluation of gait and balance, which are crucial for understanding the full range of gait impairment in Parkinson's disease patients 1. The UPDRS Part III is a widely used and validated scale that measures the severity of parkinsonian symptoms, including gait and balance disturbances 1. The TUG test and 10-Meter Walk Test are also valuable assessments that provide objective measurements of gait speed and balance, which can track disease progression over time and evaluate treatment effectiveness.
When conducting these assessments, it's essential to test patients both in their "on" medication state (when symptoms are well-controlled) and "off" state (when medication effects have worn off) to understand the full range of gait impairment 1. This approach allows clinicians to evaluate the impact of medication on gait and balance and make informed decisions about treatment. Additionally, the use of technology-based assessments, such as wearable sensors and kinematic analysis tools, may provide further insights into gait and balance disturbances in Parkinson's disease patients, although their implementation in clinical practice is still in its early stages 1.
Gait disturbances in Parkinson's disease stem from basal ganglia dysfunction, which affects the automatic motor programs necessary for normal walking, resulting in characteristic features like shuffling steps, reduced arm swing, and freezing of gait 1. The evaluation of gait and balance is critical in the management of Parkinson's disease, as it can help identify patients at risk of falls and other mobility-related complications, and inform the development of targeted interventions to improve gait and balance function.
From the Research
Standardized Gait Assessment for Parkinson's Disease
A standardized gait assessment for Parkinson's disease is crucial for evaluating the progression of the disease and the effectiveness of treatments. The following are key points to consider:
- Gait analysis may provide an alternative measure of motor response to therapy in patients with Parkinson's disease 2.
- Quantitative gait assessment can be used to identify gait disturbances and freezing episodes in patients with Parkinson's disease 3.
- Sensor-based gait analysis can be used to assess gait parameters, such as gait speed and stride length, in patients with Parkinson's disease and atypical parkinsonian disorders 4.
Recommended Gait Measures
A minimum set of gait measures has been recommended for standardization across the field, including:
- Gait speed
- Stride length
- Cadence
- Double limb support
- Stride time
- Stance time 5. These measures can be assessed using standardized protocols, such as the 4×10 m walk test and the Timed Up and Go Test (TUG) 6.
Clinical Relevance of Standardized Gait Tests
Standardized gait tests have been shown to be reliable and clinically relevant, even when performed at the patient's home 6. However, gait parameters may differ between test conditions, such as hospital and home settings 6. Narrow walkways can also result in a significant reduction of gait velocity at home 6.
Key Considerations
When assessing gait in patients with Parkinson's disease, it is essential to consider the following:
- The use of inertial sensors and standardized test settings
- The assessment of gait parameters, such as gait speed and stride length
- The reliability and clinical relevance of standardized gait tests
- The potential differences in gait parameters between test conditions, such as hospital and home settings 2, 3, 4, 5, 6.