Objective: The purpose of this study was to investigate whether ankle dorsiflexion training (ADT) for patients with Parkinson’s disease (PD) may improve anticipatory postural adjustments (APAs) during gait initiation (GI).

Background: PD patients have a high risk of falling due to the freezing of gait (FOG), which often occurs at GI. FOG during GI is associated with APAs which are primarily achieved by muscle activity in the ankle dorsiflexors. Recently, several reports have investigated the effectiveness of robotic and functional electrical stimulation assisted ankle dorsiflexion to improve APAs during GI in PD patients. However, no reports are available on the benefit of ADT on improving APAs.

Method: Twenty PD patients were included in the study and were divided half into two groups: the control group received only conventional inpatient rehabilitation and the intervention group received ADT in addition to inpatient rehabilitation. The ADT consisted of strengthening ankle dorsiflexion muscles and transferring weight backward while standing. The intervention period was 4 weeks, and the patients were assessed at baseline (T0) and after 4 weeks (T1). We evaluated APAs using a force platform. The patients started walking after 5 seconds of static standing, and then the trajectory of the center of pressure (COP) was recorded. The COP change, divided into anterior-posterior and medio-lateral components, was calculated as the difference between the maximum displacement before a step and the mean of the baseline; and then this was used as an indicator of APAs. In addition, the subject’s characteristics, Hohen & Yahr severity stage, the Unified Parkinson’s Disease Rating Scale III (UPDRS), and the New FOG of questionnaire (NFOGQ) were measured. We analyzed within-group changes in T0 and T1 outcomes and between-group comparisons of T0 and T1.

Results: In the intervention group, there were significant improvements in the anterior-posterior component of COP change, the sum of items 5 and 6 of the NFOGQ (a sub-item related to start hesitation), and the UPDRS at post-training. At T1, the anterior-posterior component of COP change was significantly greater in the intervention group than in the control group.

Conclusion: ADT may improve APAs and FOG during GI in PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-ankle-dorsiflexion-training-on-anticipatory-postural-adjustments-during-gait-initiation-of-patients-with-parkinsons-disease/