To study effect of slope and ground level walking on balance and gait in Parkinson’s patients.

Total number of 30 patients between the age 50-80 years with diagnosed Parkinson’s disease since 1 year were selected by simple random sampling. Berg balance scale, timed up and go and dynamic gait index were used to assess balance and gait pre and post intervention. Participants were divided in 2 groups, Group A was given Slope walking training, Group B was given ground level walking.

After comparing pre and post intervention data using paired and unpaired t test results showed, there was significant improvement on balance(p<0.0001) and gait(p<0.0013) in Parkinson’s patients.

There is significant effect of slope walking than ground level walking on balance and gait in Parkinson’s patients.

Keywords:Balance, Gait, Parkinson’s patient, Slope walking, Ground level walking.

Parkinson’s disease is a progressive disorder of central nervous system with both motor and Non motor symptoms. Parkinson’s disease is common disease that affects an estimated 7 to 8 million people worldwide. Parkinson is the group of disorders with primary disturbances in the dopamine system of basal ganglia. Individuals with Parkinson’s disease demonstrate abnormalities of posture and balance, resulting in postural instability. Patient demonstrate abnormal and inflexible posture response controlling their center of mass within their base of support.[2]Gait disturbances are also common feature. The patient with Parkinson’s disease demonstrate a number of significant gait changes resulting from impoverished movement. An abnormal stooped posture contributes to development of festinating gait pattern, Characterized by a progressive increase in speed with a shorting of stride. Thus the patient takes multiple short steps to catch up with his or her COM to avoid falling, and may eventually break into a run or tort. Gait can be anteropulsive i.e forward festinating gait or less commonly retropulsive that is backward festinating gait. Problems with controlling posture and balance limit independence, community ambulation, and safety[2]. Difficulty in walking is a pathological sign of Parkinson’s disease. Indeed, patients with PD demonstrate impaired ability to walk and to change direction[2]. Walking is an beneficial exercise for people with Parkinson’s disease. Slope surfaces are encountered in both man-made and natural environments. When walking on slopes, the muscles raise or lower the body center-of-mass (COM) while maintaining balance. The altered biomechanical demands of slope walking, particularly with slope angles, require greater activity from lower-limb muscles, such as the gluteus maximus on inclines and rectus femoris and vasti on declines. On slope, metabolic power is increased compared to level-ground walking. Walking on slope is another scenario that induces distinctive gait pattern changes. More specifically, the gait patterns of healthy, young adults on incline and decline surfaces relative to level ground must be looked at more closely. When comparing incline walking to level walking the demands imposed on the human body are different and require various adaptations that have been outlined in the literature and summarized in this paper. Unfortunately, to date virtually no data have been compiled on older adults walking on slope. It is logical to assume while walking on inclines resultant patterns adapted by older adults will be different than those seen in younger populations due to age-related physiological changes. In order to maintain forward progression, maximize safety and assume an overall efficient gait pattern on inclines, a variety of adaptations occur.

The study has been designed to find out effect of 6 weeks of slope walking in Parkinson’s patient. Experimental study was carried out by doing convenient sampling in age of 50-80 years old subjects diagnosed with Parkinson’s disease. Duration of study was 6 weeks inclusion criteria was both male and female, Patient in 1.5 and 2.5 stage of Modified Hoehn-Yahr classification of disability, people who are willing to participate, subject diagnosed with Parkinson’s disease since 1 year and exclusion criteria was individuals Patient with 3^rd 4^th 5^th stage of Modified Hoehn-Yahr classification of disability, Parkinson-Plus syndrome, Non ambulatory patient, Not willing to participate. Patients with severe impairment of walking or balance. Material used were Consent form, Demographic data sheet, Arm chair with and without arm rest, measuring Tape, Stop watch, Various size of cones, Ruler, Footstool.

Approval was obtained from institutional ethical committee before starting procedure and informed consent was taken. A survey on approximately 30 Parkinson’s individuals was done. The consent form filled by the subjects. Study and the procedure was explained to them. The sample size selected on the basis of inclusion criteria. The patient fitting in the inclusion criteria was evaluated by the outcome measures viz. Berg balance scale, dynamic gait index, time up and go. Patient was checked for balance and gait. All patients were divided into two groups- group A and group B. In group A patient was instructed to walk on slope and group B patient was instructed to walk ground level. Effect was compared with ground level walking patient and with slope walking patient. Intervention was given 4 days per week for 20 min.

Duration: 4 days/week for 6 weeks

Warm up: 10 min

Slope/ground level walking: 20 min

Cool down: 5 min

After the complete intervention results were noted according to the scales.

Table no 1: Demographic characteristics of the samples

Table no 2

Graph no: 1