Spatiotemporal variability during gait initiation in Parkinson's disease

During gait initiation (GI), consistency of foot placement while stepping is important in making successful transitions from a state of stable static posture to an unstable state of dynamic locomotion. In populations characterized by gait dysfunction and postural instability, such as persons with Parkinson's disease (PD), the ability to generate a consistent stepping pattern during GI may be essential in the prevention of falls. However, little is known about GI variability in persons with PD as compared to their healthy elderly peers. Therefore, this study investigated spatiotemporal variability during the first two steps of GI in 46 persons with idiopathic PD and 49 healthy age-matched adults. Stepping characteristics, including the length, width, and time of the first two steps of GI as well as their coefficients of variation (CV) were compared between groups. Persons with PD initiated gait with significantly shorter steps (swing step length = .463 vs. .537 m, stance step length. =.970 vs. 1.10. m) and higher variability in step length (swing step CV = 8.82 vs. 5.45, stance step CV=6.76 vs. 3.61). Persons with PD also showed significantly higher variability in the time of the swing step (swing step CV=10.0 vs. 7.4). GI variability did not differ significantly between disease stages in persons with PD. Because greater variability in these measures during gait is related to an increased risk of falls, we propose that higher GI variability may play a considerable role in falls frequently observed during transitions from quiet standing in PD.