Abstract

Background: Parkinson’s disease (PD) results in a distinct, slow, and less steady walking pattern due to changes in posture, poor balance control, reduced muscle strength, reduced endurance, slowed movement (bradykinesia). This case report describes a 6-week novel robotic treadmill system and training protocol focused on key neuromechanical elements required to improve walking performance in an older adult with PD.

Methods: An 82-year-old-female with a 3-year history of PD (Hoehn and Yahr stage 1) was referred to physical therapy (PT) to improve performance and safety of walking. She participated in twice-weekly PT sessions over 8 weeks using a robotic treadmill platform (KineAssist) that allows “self-driven”/intentional movement with body weight support and safety from falls, and the ability to provide resistive forces to improve strength, provide forward-aiding forces to improve speed, and balance perturbations to improve dynamic stability.

Results: Participant showed large-scale improvements across all outcomes assessed. The 6MWT distance improved 51% (318-481m); the TUG time improved 53% (10.3-5.5 sec); the TUG Carry, 50% faster (13.7- 6.8 sec); the TUG Cognitive, 50% faster (13.2- 6.5 sec), the Mini-Best Test improved 8 points (18/28-26/28). The self-selected 10MWT speed improved 196% (0.27- 0.8 m/s) and top walking speed by 120% (1.0-2.2 m/s).

Conclusions: An individualized robotic treadmill gait training protocol was successfully used with an older person with PD, and contributed to marked improvement in her endurance, strength, speed, and dynamic stability, exceeding available minimal clinically important distances for all outcome measures. Neuromechanical challenge via a robotic treadmill, may enable individuals to perform walking related training tasks with reduced fear of physical harm and to develop strategies for safe mobility in their environment.

Keywords: Parkinson’s disease, Robotic treadmill, Gait, Rehabilitation