Bracing for persons with Parkinson disease: A case series with clinical reasoning

Research output: Contribution to journalArticle

Abstract

Introduction: Approximately 50,000 Americans are diagnosed with Parkinson disease (PD) each year, with more than half a million persons affected. This chronic progressive disease causes limitations across the model of disablement for this population of individuals. Because of the disease pathology and concomitant impairments, postural instability is present and gait is typically slow with high variability of spatial/temporal gait kinematics. Objective: The purpose of this study was to investigate the impact of a hinged orthosis with a Tamarack joint and adjustable check strap (TCS) ankle-foot orthosis (AFO) on functional gait capacity, electromyography (EMG), and quality of life (QOL) in select individuals with PD. Materials and Methods: Participants in this study were three men, all diagnosed with PD more than 5 years ago. Each participant was fitted with custom bilateral TCS-AFOs and trained in proper gait kinematics while wearing the orthoses. The study was 10 weeks long with three 45-minute gait training sessions. Each participant had an individual home walking program that used 30 minutes of daily focused walking as a target goal. Outcomes tested initially, at week 5, and at week 10 included gait endurance (6-minute walk test), computerized gait analysis (GAITRite; CIR Systems, Havertown, PA, USA), functional balance (Dynamic Gait Index [DGI]), lower-limb muscle activity (EMG), and QOL (Parkinson Disease Questionnaire 8 [PDQ-8]). Results: All three participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL. Conclusions: This case series reported a novel use of AFOs in addressing gait dysfunction in persons with PD. Considering the progressive nature of PD and the need for interventions that can create a long-term impact, lower-limb bracing may be an intervention with potential. The persons in this case report were all trained with a TCS-AFO that was designed to facilitate gait and provide beneficial somatosensory feedback. Each of the participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL.

Original languageEnglish (US)
Pages (from-to)95-102
Number of pages8
JournalJournal of Prosthetics and Orthotics
Volume27
Issue number3
DOIs
StatePublished - Jul 27 2015

Fingerprint

Gait
Parkinson Disease
Electromyography
Durability
Quality of Life
Foot Orthoses
Orthotic Devices
Public address systems
Kinematics
Gait analysis
Biomechanical Phenomena
Ankle
Walking
Lower Extremity
Pathology
Larix
Muscle
Feedback
Chronic Disease
Joints

Keywords

  • clinical reasoning
  • gait
  • orthoses
  • Parkinson disease

ASJC Scopus subject areas

  • Biomedical Engineering
  • Rehabilitation
  • Orthopedics and Sports Medicine

Cite this

Bracing for persons with Parkinson disease : A case series with clinical reasoning. / Shearin, Staci M.; Smith, Patricia; Querry, Ross; McCain, Karen.

In: Journal of Prosthetics and Orthotics, Vol. 27, No. 3, 27.07.2015, p. 95-102.

Research output: Contribution to journalArticle

@article{906fae0b0d044f0099837ea4e30fa37a,
title = "Bracing for persons with Parkinson disease: A case series with clinical reasoning",
abstract = "Introduction: Approximately 50,000 Americans are diagnosed with Parkinson disease (PD) each year, with more than half a million persons affected. This chronic progressive disease causes limitations across the model of disablement for this population of individuals. Because of the disease pathology and concomitant impairments, postural instability is present and gait is typically slow with high variability of spatial/temporal gait kinematics. Objective: The purpose of this study was to investigate the impact of a hinged orthosis with a Tamarack joint and adjustable check strap (TCS) ankle-foot orthosis (AFO) on functional gait capacity, electromyography (EMG), and quality of life (QOL) in select individuals with PD. Materials and Methods: Participants in this study were three men, all diagnosed with PD more than 5 years ago. Each participant was fitted with custom bilateral TCS-AFOs and trained in proper gait kinematics while wearing the orthoses. The study was 10 weeks long with three 45-minute gait training sessions. Each participant had an individual home walking program that used 30 minutes of daily focused walking as a target goal. Outcomes tested initially, at week 5, and at week 10 included gait endurance (6-minute walk test), computerized gait analysis (GAITRite; CIR Systems, Havertown, PA, USA), functional balance (Dynamic Gait Index [DGI]), lower-limb muscle activity (EMG), and QOL (Parkinson Disease Questionnaire 8 [PDQ-8]). Results: All three participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL. Conclusions: This case series reported a novel use of AFOs in addressing gait dysfunction in persons with PD. Considering the progressive nature of PD and the need for interventions that can create a long-term impact, lower-limb bracing may be an intervention with potential. The persons in this case report were all trained with a TCS-AFO that was designed to facilitate gait and provide beneficial somatosensory feedback. Each of the participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL.",
keywords = "clinical reasoning, gait, orthoses, Parkinson disease",
author = "Shearin, {Staci M.} and Patricia Smith and Ross Querry and Karen McCain",
year = "2015",
month = "7",
day = "27",
doi = "10.1097/JPO.0000000000000065",
language = "English (US)",
volume = "27",
pages = "95--102",
journal = "Journal of Prosthetics and Orthotics",
issn = "1040-8800",
publisher = "American Academy of Orthotists and Prosthetists (AAOP)",
number = "3",

}

TY - JOUR

T1 - Bracing for persons with Parkinson disease

T2 - A case series with clinical reasoning

AU - Shearin, Staci M.

AU - Smith, Patricia

AU - Querry, Ross

AU - McCain, Karen

PY - 2015/7/27

Y1 - 2015/7/27

N2 - Introduction: Approximately 50,000 Americans are diagnosed with Parkinson disease (PD) each year, with more than half a million persons affected. This chronic progressive disease causes limitations across the model of disablement for this population of individuals. Because of the disease pathology and concomitant impairments, postural instability is present and gait is typically slow with high variability of spatial/temporal gait kinematics. Objective: The purpose of this study was to investigate the impact of a hinged orthosis with a Tamarack joint and adjustable check strap (TCS) ankle-foot orthosis (AFO) on functional gait capacity, electromyography (EMG), and quality of life (QOL) in select individuals with PD. Materials and Methods: Participants in this study were three men, all diagnosed with PD more than 5 years ago. Each participant was fitted with custom bilateral TCS-AFOs and trained in proper gait kinematics while wearing the orthoses. The study was 10 weeks long with three 45-minute gait training sessions. Each participant had an individual home walking program that used 30 minutes of daily focused walking as a target goal. Outcomes tested initially, at week 5, and at week 10 included gait endurance (6-minute walk test), computerized gait analysis (GAITRite; CIR Systems, Havertown, PA, USA), functional balance (Dynamic Gait Index [DGI]), lower-limb muscle activity (EMG), and QOL (Parkinson Disease Questionnaire 8 [PDQ-8]). Results: All three participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL. Conclusions: This case series reported a novel use of AFOs in addressing gait dysfunction in persons with PD. Considering the progressive nature of PD and the need for interventions that can create a long-term impact, lower-limb bracing may be an intervention with potential. The persons in this case report were all trained with a TCS-AFO that was designed to facilitate gait and provide beneficial somatosensory feedback. Each of the participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL.

AB - Introduction: Approximately 50,000 Americans are diagnosed with Parkinson disease (PD) each year, with more than half a million persons affected. This chronic progressive disease causes limitations across the model of disablement for this population of individuals. Because of the disease pathology and concomitant impairments, postural instability is present and gait is typically slow with high variability of spatial/temporal gait kinematics. Objective: The purpose of this study was to investigate the impact of a hinged orthosis with a Tamarack joint and adjustable check strap (TCS) ankle-foot orthosis (AFO) on functional gait capacity, electromyography (EMG), and quality of life (QOL) in select individuals with PD. Materials and Methods: Participants in this study were three men, all diagnosed with PD more than 5 years ago. Each participant was fitted with custom bilateral TCS-AFOs and trained in proper gait kinematics while wearing the orthoses. The study was 10 weeks long with three 45-minute gait training sessions. Each participant had an individual home walking program that used 30 minutes of daily focused walking as a target goal. Outcomes tested initially, at week 5, and at week 10 included gait endurance (6-minute walk test), computerized gait analysis (GAITRite; CIR Systems, Havertown, PA, USA), functional balance (Dynamic Gait Index [DGI]), lower-limb muscle activity (EMG), and QOL (Parkinson Disease Questionnaire 8 [PDQ-8]). Results: All three participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL. Conclusions: This case series reported a novel use of AFOs in addressing gait dysfunction in persons with PD. Considering the progressive nature of PD and the need for interventions that can create a long-term impact, lower-limb bracing may be an intervention with potential. The persons in this case report were all trained with a TCS-AFO that was designed to facilitate gait and provide beneficial somatosensory feedback. Each of the participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL.

KW - clinical reasoning

KW - gait

KW - orthoses

KW - Parkinson disease

UR - http://www.scopus.com/inward/record.url?scp=84933040673&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84933040673&partnerID=8YFLogxK

U2 - 10.1097/JPO.0000000000000065

DO - 10.1097/JPO.0000000000000065

M3 - Article

AN - SCOPUS:84933040673

VL - 27

SP - 95

EP - 102

JO - Journal of Prosthetics and Orthotics

JF - Journal of Prosthetics and Orthotics

SN - 1040-8800

IS - 3

ER -