Wheeled and standard walkers in Parkinson's disease patients with gait freezing

Objectives. Compare the efficacy of two walking assistance devices (wheeled walker and standard walker) to unassisted walking for patients with PD and gait freezing. Background. Although numerous walking devices are used clinically, their relative effects on freezing and walking speed have never been systematically tested. Methods. Nineteen PD patients (14 non-demented) walked under three conditions in randomized order: unassisted walking, standard walker, and wheeled walker. Patients walked up to three times in each condition through a standard course that included rising from a chair, walking through a doorway, straightway walking, pivoting, and return. Total walking time, freezing time and number of freezes were compared for the three conditions using mixed models (walking time) and Friedman's test (freezing). The wheeled walker was further studied by comparing the effect of an attached laser that projected a bar of light on the floor as a visual walking cue. Results. Use of either type of device significantly slowed walking compared to unassisted walking. Neither walker reduced any index of freezing. nor the laser attachment offered any advantage to the wheeled walker. The standard walker increased freezing, and the wheeled walker had no effect on freezing. Among the non-demented subjects (n = 14), the same patterns occurred, although the walking speed was less impaired by the wheeled walker than the standard walker in this group. Conclusions. Though walkers may stabilize patients and increase confidence, PD patients walk more slowly when using them, without reducing freezing. Because the wheeled walker was intermediate for walking time and does not aggravate freezing, if walkers are used for these subjects, this type of walker should be favored. (C) 2003 Elsevier Ltd. All rights reserved.