Objective: Can repeated exposure to a split-belt treadmill (SBTM) encourage motor learning to improve freezing of gait (FOG) and reduce the number of falls in patients with Parkinson’s disease (PD)?

Background: PD-related gait disorders are challenging to treat because they cannot be optimized with pharmacological intervention alone. An SBTM can be used to adjust the speed of each leg separately and individuals can be prompted to ‘adapt’ to an asymmetric gait and ‘re-adapt’ with return to symmetrical gait in a phenomenon known as ‘after-effect’. We have previously shown the feasibility of SBTM training in PD and have identified that working memory is essential for gait adaptation.

Method: We recruited 28 PD participants with intact working memory and randomized them to either 18 sessions of SBTM or tied-treadmill (TM) training (where belts move at the same speed) over 6 weeks. The belt velocity was reduced on the least affected side by 25% in the SBTM group. The primary outcome measure was the falls incidence over the 4.5 month study period. Secondary objectives include comparison of treadmill gait parameters with over-ground walking, freezing and balance questionnaires and assessment of motor scores in PD.

Results: Twenty-eight participants with treatment-resistant FOG were recruited. Falls rate remained unchanged after treadmill training. However, both TM and SBTM training improved temporal asymmetry (p<0.01), gait asymmetry (p<0.001), stance time(p<0.01) and swing time (p<0.01) after 18 sessions. The improvement lasted 3 months in all parameters except gait asymmetry, which did not improve 3 months after TM training. Only TM training resulted in improved over-ground cadence and gait velocity (p<0.01). Scores on the FOG questionnaire improved significantly after SBTM training (p<0.01) only, but on the Activity and Balance Scale, scores improved with both SBTM and TM training (p<0.01), although improvement in questionnaires was not sustained at 3 months.

Conclusion: Although there was no benefit to the primarily outcome of falls, SBTM was equivalent to TM training in improving several gait parameters. However, only TM training translated to improvements in over-ground walking. SBTM training improved FOG scores. Further studies are needed to understand whether SBTM has a specific benefit to FOG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/split-belt-treadmill-training-to-rehabilitate-freezing-of-gait-and-balance-in-parkinsons-disease/