Objective: To determine, through a systematic review, whether repeated perturbation training (RPT) is effective in improving gait performance in healthy older adults (HOA) and people with Parkinson’s Disease (PwPD) focusing on immediate and long-term effects.

Background: Gait impairments are common in both HOA and in PwPD, especially when unexpected adaptations to the environment are required. Traditional rehabilitation programs do not directly address these typical adaptive demands of ambulation in contrast to repeated gait perturbation training (RPT). RPT is a novel reactive form of training with potential for short and long-term consolidation in HOA and PwPD.

Method: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Papers including any form of repeated perturbations during gait and with gait speed, step- or stride length as primary or secondary outcome were included. Studies testing other perturbation paradigms (e.g. static/optical), or pertaining to patients with other neurological conditions were excluded. Only studies with a randomized design were included in the random effects meta-analysis. Of the initial 4422 studies, 9 studies were selected of which 7 were eligible for quantitative analysis, with a total of 248 participants.

Results: The methodological analysis showed that overall studies were of moderate quality in this domain. No significant effects of RPT on gait performance were found immediately after intervention (SMD 0.15, 95%CI -0.12, 0.43, P = 0.28) as well as after a retention period (SMD -0.09, 95%CI -0.40, 0.23, P = 0.59). Five out of seven RPT studies used traditional treadmill as a contrast. The qualitative results did show some favorable effects of individual studies on gait speed, step length and stride length, but more so on outcomes such as gait variability and asymmetry.

Conclusion: This systematic review showed that despite promising effects in individual studies, the pooled effects of RPT on gait and balance were not meaningful in PwPD and HOA. However, the review warrants further studies to be undertaken in this field to obtain more robust results, as most outcomes studied, so far, did not represent truly adaptive gait performance. Also, as RPT draws on implicit learning mechanisms, this approach may be particularly beneficial to tap the remaining learning potential in PwPD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/repeated-gait-perturbation-training-in-healthy-older-adults-and-people-with-parkinsons-disease-a-systematic-review-and-meta-analysis/