Lack of Short-Term Effectiveness of Rotating Treadmill Training on Turning in People with Mild-to-Moderate Parkinson's Disease and Healthy Older Adults: A Randomized, Controlled Study
Since turning is often impaired in Parkinson's disease (PD) and may lead to falls, it is important to develop targeted treatment strategies for turning. We determined the effects of rotating treadmill training on turning in individuals with PD. This randomized controlled study evaluated in-place turns, functional turning (timed-up-and-go), and gait velocity before and after 15 minutes of rotating treadmill training or stepping in place in 26 people with PD and 27 age-matched controls. A subset of participants with PD completed five consecutive days of rotating treadmill training. Fast as possible gait velocity, timed-up-and-go time, turn duration, and steps to turn were impaired in PD compared to controls ( ) and did not improve following either intervention ( ). Preferred pace gait velocity and timing of yaw rotation onset of body segments (head, trunk, pelvis) during turns were not different in PD ( ) and did not change following either intervention. No improvements in gait or turning occurred after five days of rotating treadmill training, compared to one day. The rotating treadmill is not recommended for short-term rehabilitation of impaired in-place turning in the general PD population. 1. Introduction Parkinson’s disease (PD) is a progressive neurodegenerative disease resulting in a variety of motor symptoms. Individuals with PD frequently experience difficulty with gait and turning, with more than half reporting difficulty turning [1–3] which may result in falls and serious injuries [4]. Symptoms of PD are treated using various therapeutic approaches; however, there are currently no effective treatment options that specifically target turning difficulty. Turning difficulties, including increased time to turn and increased number of steps to turn, are present even when individuals with PD are on PD medications [5–10]. Stepping in place on the rotating treadmill has been recommended as a possible rehabilitation option for those with PD [11]. After stepping in place on the rotating treadmill, healthy controls and people with PD show a rotational adaptation response known as podokinetic after-rotation [12–14]. The kinematics of podokinetic after-rotation are similar to those seen during normal in-place turning [11]. It has been suggested that the rotating treadmill may improve turns by serving as an external cue to promote the correct motor programs for successful turning [11]. Immediately after stepping in place on a rotating disk for a total of 15 minutes on one day, turning performance was improved in two people with PD on medication who also
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