Start date: 1. November 2020
Funding source: DFG-Einzelförderung / Sachbeihilfe (EIN-SBH)
In cooperation with: UK Erlangen – Department for molecular neurology
Gait impairment and reduced mobility are typical symptoms of advanced Parkinson´s disease (PD) and atypical parkinsonian disorders (APD). In the latter, these symptoms develop even earlier and are more pronounced, exacerbate the impaired balance, increase risk of falling and reduce performance of activities of daily living. For a patient, the emergence of gait disorders represents a pivotal motor milestone in the development of parkinsonian syndromes indicating a transition to sustained disability and reduced quality of life. Impaired physical activity and sedentary behavior are associated with reduced walking bouts and increased time spent in sitting or lying posture. Therefore, a vicious cycle begins, which is linked to higher mortality rate also in normal elderly people. In contrast, increased activity levels are the basis for independence, delayed onset of decline and lower fall risk.
For gait impairment in PD and ADP, non‐pharmacological interventions like gait specific physiotherapy (PT) are increasingly recognized as complementary treatment options. Up to now, a bundle of exercise‐based interventions has been studied for PD and the scientific evidence for their efficacy is growing.
However, for APD, controlled studies which address the effect of PT on APD are still missing. A first pilot study showed an improvement of gait parameters after PT intervention measured by a mobile sensor-based gait analysis system in a lab environment (cite?). Due to the recent advancements in sensor technology, mobile gait analysis systems can now measure gait specific parameters in home-monitoring and free-living environments to assess therapy effects.
Therefore, the aim of this project is to determine whether gait focused in-hospital PT followed by home‐based exercises is effective in improving gait function in patients with APD in comparison to standard PT. It is highly important to address these issues in order to investigate which PT approach (duration, type, inpatient vs. home‐based, frequency) provides the largest benefit for APD patients. Because APD are orphan diseases, a multicentric study will be performed, recruiting patients at the Movement Disorder Units (MDUs) in Innsbruck (MUI), Erlangen (UKER), Lausanne (CHUV) and Nijmegen (RUMC – funded by dutch grants).
To develop and implement new algorithms for the quantification of PT effects using mobile, sensor-based gait analysis systems in laboratory as well as home and free-living environments, the clinical partners are collaborating with the Machine Learning and Data Analytics Lab of the Friedrich Alexander University Erlangen Nuernberg (FAU) together with the Laboratory of Movement Analysis and Measurement of the Lausanne Ecole Polytechnique Federale (EPFL).