Constraints on the kinetic, kinematic and spatiotemporal parameters of gait in Parkinson's disease

The characteristic slow, short stepped, shuffling walking pattern in Parkinson's disease (PB) results from a combination of constraints on locomotor control imposed by neurotransmitter imbalance. Previous research on the pathogenesis of gait disorders in PD has been confined to descriptions of changes in spatiotemporal parameters of the footstep pattern in response to antiparkinsonian medication and attentional strategies. By analysing the changes that occur in kinematics and kinetics with systematic manipulations of dopaminergic status and attention, a fuller understanding of the primary determinants of gait dysfunction in PD can be obtained. We illustrate this point with a case history on a 71 year old hypokinetic woman with PD who demonstrated normalisation of key kinematic and spatiotemporal variables of gait when provided with visual cues at peak-dose of the medication cycle, despite persistent abnormalities in gait kinetics. (C) 1999 Elsevier Science B.V. All rights reserved.