Split-Belt Adaptation and Savings in People With Parkinson Disease.
Elizabeth D Thompson, Darcy S Reisman
PMID 35980730WHAT IT FOUND
Most people with Parkinson disease adapted to split-belt walking and showed savings, meaning they re-learned the pattern faster the second time.
However, individual responses varied widely. Two participants showed almost no adaptation, suggesting a one-size-fits-all approach to gait training is ineffective.
Key findings
01As a group, participants with Parkinson disease demonstrated both adaptation to the split-belt perturbation and savings, evidenced by faster re-adaptation (median 9 strides vs 64 strides) and reduced initial error on the second exposure.
02Individual variability was striking, with two participants showing virtually no adaptation or savings despite having similar baseline walking ability and disease stage as the rest of the group.
03Participants who failed to adapt had the most impaired scores on tests of balance confidence (ABC), functional gait (FGA), and quality of life (PDQ-39), particularly in unpredictable environments.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included only individuals with Hoehn & Yahr stage 2 disease who could walk unassisted for 10 minutes, so results do not generalize to those with more advanced disease or significant mobility impairments. The sample size was small (14 participants), and the variability in response was high, making it difficult to establish precise predictors of adaptation success. The study was conducted entirely on a treadmill, and it is unknown how these implicit adaptation findings translate to overground walking in home or community settings. The study did not include a healthy control group for direct comparison of adaptation rates or savings magnitude.
Declared interests
No conflicts of interest were declared. The work was supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA) of the National Institutes of Health.
The easy way to misread this
Do not assume that all patients with Parkinson disease will benefit from implicit gait adaptation training. The study found that while the group as a whole showed savings, two individuals demonstrated almost no adaptation. A 'one size fits all' approach is not supported by these data.