parkinson disease gait include festinating gait or shuffling gait

1. PATHOMICHANICS OF
PARKINSON DISEASE GAIT
BY: JWANIKA VANSIYA

2. What is Parkinson’s disease?
• Parkinson’s disease is a progressive neurological condition,
resulting from the degeneration of dopamine producing
neurones in the substantia nigra, which is located within the
basal ganglia, deep in the lower region of the brain, on either
side of the brain stem.

4. .
• Bradykinesia
• Rigidity
• Tremor
• Postural instability
Clinical features

5. .
• Also called Parkinsonian gait or Festinating gait.
• Parkinsonian gait is characterized by small shuffling steps and
a general slowness of movement (hypokinesia), or even the
total loss of movement (akinesia) in the extreme cases.
Parkinson disease gait

6. .
• Tottering gait
• Characteristically shows difficulty in initiating gait, rapid short
shuffling steps with loss of arm swing, stooped stance
propulsion.
• Turning or changing direction is particularly difficult and
typically accompanied by taking multiple small steps.
• Parkinsonian Gait.mp4
Festinating
gait

7. .
• Freezing of Gait (FOG) is typically a transient episode – lasting
less than a minute, in which gait is halted and the patient
complains that his/her feet are glued to the ground.
• ‘ignition disturbances’
Falls
Falls result mainly due to sudden changes in posture, in
particular turning movements of the trunk, or attempts to
perform more than one activity simultaneously with walking or
balancing
Freezing of gait
(FOG)

8. .
Gait characteristics
Spatiotemporal
parameters Kinematics data Kinetic data

9. .
• Velocity (m/s)
• Stride length (m)
• Cadence (stride/min)
• Double support time
• Cycle time (s)
Spatiotemporal parameters

10. .
Normal
Early stance –
Dorsiflexion to planterflexion
Mid stance-
Dorsiflexion
Late stance-
Planter flexion
Parkinsonian gait
Reduction in dorsiflexion
ROM at early stance.
Reduction in planter flexion
ROM during toe off.
Kinematics data
Ankle

11. .
Normal
• Early to mid stance-
Extension to 15 degree
of flexion
• Late stance- knee flexion
with planter flexion
Parkinsonian gait
• Reduced knee extension
during single support
stance.
Kinematics data
knee

12. .
Normal
• Early to mid stance
phase – flexion
• Late stance phase –
extension
Parkinsonian gait
• Lower flexion range
during initial contact
• Decrease hip flexion
ROM in pre swing phase.
Kinematics data
Hip

13. Ankle :
• Reduced ankle moment at loading response.
• Power generation in parkinson disease group deteriorate in
late stance.
Knee:
• Lower power generation during single stance phase of the
gait. This occurs due to limited knee extension during the
stance phase.
• Decreased power absorption at the knee joint during the late
stance and preswing phase.
Kinetics data

14. Hip
• Reduction of max hip extensor moment and decrease hip
power generation in the first double support.
• Also max hip flexion moment and power generation in the
second double support and pre swing reduced.
• Parkinsonian Gait Demonstration.mp4

15. References
• Sofuwa O, Nieuwboer A, Desloovere K, Willems AM, Chavret F,
Jonkers I. Quantitative gait analysis in Parkinson's disease:
comparison with a healthy control group. Archives of physical
medicine and rehabilitation. 2005;86(5):1007-13.
• Svehlik M, Zwick EB, Steinwender G, Linhart WE,
Schwingenschuh P, Katschnig P, et al. Gait analysis in patients
with Parkinson's disease off dopaminergic therapy. Archives of
physical medicine and rehabilitation. 2009;90(11):1880-6.
• Svehlik M, Zwick EB, Steinwender G, Linhart WE,
Schwingenschuh P, Katschnig P, et al. Gait analysis in patients
with Parkinson's disease off dopaminergic therapy. Archives of
physical medicine and rehabilitation. 2009;90(11):1880-6.

16. • Gait disorders evaluation and management
Jeffrey M. Hausdorff , Neil B. Alexander
• The Professional’s Guide to Parkinson’s Disease