The starting distance of obstacle circumvention did not affect intersegmental coordination in individuals with Parkinson's disease

Abstract

Background: Obstacle circumvention is a challenging task in Parkinson's disease (PD). Body segments adjustments, such as changing the direction of the trunk, followed by a change in the direction of the head, and modifications in the positioning of the feet, are necessary to circumvent an obstacle during walking. For that, individuals need to identify the distance to the obstacle, its characteristics (such as its dimension), and perform well-coordinated movements. However, PD is characterized by rigidity, which may be increased in the axial axis and compromise the task execution. Also, worsening sensory integration in PD may increase the time to perform these body segments adjustments, thus impairing the movement coordination when starting obstacle circumvention near to the obstacle. Aim: To determine if the starting distance (1.5 m, 3 m, or 5 m) from the obstacle could modify the intersegmental coordination (specifically, the coordination between head, trunk, and pelvis) during the obstacle circumvention steps in individuals with PD. Methods: Fourteen individuals with a diagnosis of idiopathic PD and 15 neurologically healthy individuals (CG) from the community were included in this study. The participants were evaluated in three different gait conditions, according to the starting distance from the obstacle: 1.5 m, 3 m, and 5 m away from the obstacle. Vector coding technique was employed to establish the coupling between head, trunk, and pelvis in the steps immediately before and during obstacle circumvention. Three-way ANOVA's (group, distance, and step) were calculated with the level of significance at p < 0.05. Results: For all couplings of coordination, there were no effects of distance. However, significant main effects of group and steps (p < 0.05) were found for all couplings with different patterns of coordination: head/pelvis (group: in-phase and anti-phase variables; steps: anti-phase variable), head/trunk (group: trunk variable; steps: in-phase and anti-phase variables) and trunk/pelvis (group: anti-phase; steps: trunk and pelvis). Finally, only head/trunk coupling showed an interaction between group*steps. Individuals with PD showed 7.95% lower head movement (p < 0.024) and 14.85% greater trunk movement than CG (p < 0.002). Also, individuals with PD performed 17.56% greater head movement in the step before the circumvention compared to the step during circumvention (p < 0.044). Conclusion: The starting distance from the obstacle did not influence the pattern of axial intersegmental coordination in both groups. However, how these segments interact in the preparation and during the obstacle circumvention are opposite in individuals with PD. While on the previous step to obstacle circumvention, the head movement was greater than the trunk, during the obstacle circumvention step, individuals with PD rotated the trunk more.