Effectiveness of Treadmill Training Alone Versus Treadmill Training with External Clues on Improving Gait and Functional Ability in Parkinson's Patient

. It is characterized by postural instability, slowing of movement and tremor. Treadmill Training with Visual clues extensively used as an intervention to improve gait and Functional mobility. Objective: To compare the Treadmill training alone versus treadmill training with visual clues on improve gait and functional ability in Parkinson's disease. Methods: It is assessor blind randomized controlled trial conducted in CMA Research and Teaching th hospital, Lahore from 6th June 2022 to 6 January 2023.The sample size of 74 were divided into two groups. Group A received treadmill training session for 30 minutes while. The Group B received treadmill training with external clues like visual, auditory, etc. Each Participant received total 56 sessions for 28 weeks. The outcome measures was functional Activity measures with Wisconsin gait scale for Gait and Motor Aspects of Experiences of Daily Living (M-EDL) questionnaire. The Data were assessing at baseline by using these two scales. Results: The between groups comparison of post value showed that Group B showed a signi�cant (<0.05) improvement in the (M-EDL) scale for the activities of daily living and signi�cant (<0.05) improvement in the step length, stance width, hip hiking, pelvic rotation, external rotation, and toe clearance. Conclusions: It was concluded that the treadmill training with external clues is better as compared to the treadmill training alone for improving the gait and functional ability in the Parkinson patient.

elderly people get affected by this disease.The risk is getting higher up to 4% in ages above 80 years old [3].The patho-physiology of the Parkinson's disease explains that this disease occure due to the damage or necrosis in the substantia nigra brain part and the mostly degenerated the dopaminergic neuron.which is the brain region responsible for the synthesis of the neurotransmitter dopamine (DA), decreasing the synaptic cleft [4].Patients with Parkinson's disease usually walk or move with very slow speed.Patients The between groups comparison of post value showed that Group B showed a signi cant (<0.05) improvement in the (M-EDL) scale for the activities of daily living and signi cant (<0.05) improvement in the step length, stance width, hip hiking, pelvic rotation, external rotation, and toe clearance.Conclusions: It was concluded that the treadmill training with external clues is better as compared to the treadmill training alone for improving the gait and functional ability in the Parkinson patient.

A R T I C L E I N F O A B S T R A C T M E T H O D S
usually walk with the bend posture, with restricted or no arm swing and patient walk with short steps that shu e alternatively.These are signs make the patients of Parkinson at a higher risk of fall

R E S U L T S
of normality test was shown that data were normally distributed.After ful lling the assumption of the parametric tests, so the paired sample t-test was used for pre-post analysis.While to compare the both groups independent t-test was applied.
The level of signi cance in the study was set at p<0.05. Figure 1 shows CONSORT diagram of the study.
The total participant of the group was n=74 in which n=56 (75%) were in both Groups and n=18 (25%) were female.We had 55 (76.38%) normal individuals with reference to BMI range (18.5-24.9)and 17 (23.61%)participants were underweight with BMI range (<18.5).In the results, we have found that 41(55.5%)participants had the symptoms for less than 1 year, 30(40.5%)participants had the symptoms of Parkinsonism between 1 year to 5 years and 3(4.1%) participants were having symptoms for more than 5 years.It was observed that Wisconsin gait scale, Step length, Stance width, External rotation, Pelvic rotation, Hip hiking, Toe Clearance and Motor Experience of Daily Living scale Values was signi cantly improved (p<0.001) in both the experimental and control group after 28th weeks intervention (Table 1).

Improving
Gait and Functional Ability in Parkinson's Patient I N T R O D U C T I O N Parkinson's disease is a progressive neurological disease caused by degeneration of nerve cells in Substantia Nigra.It is characterized by postural instability, slowing of movement and tremor.Treadmill Training with Visual clues extensively used as an intervention to improve gait and Functional mobility.Objective: To compare the Treadmill training alone versus treadmill training with visual clues on improve gait and functional ability in Parkinson's disease.Methods: It is assessor blind randomized controlled trial conducted in CMA Research and Teaching th hospital, Lahore from 6th June 2022 to 6 January 2023.The sample size of 74 were divided into two groups.Group A received treadmill training session for 30 minutes while.The Group B received treadmill training with external clues like visual, auditory, etc.Each Participant received total 56 sessions for 28 weeks.The outcome measures was functional Activity measures with Wisconsin gait scale for Gait and Motor Aspects of Experiences of Daily Living (M-EDL) questionnaire.The Data were assessing at baseline by using these two scales.Results:

in gait
[5].People with PD can still be able to learn in a feed-forward manner.andwehave given total 56 sessions.The Patient from Both Gender was included with Age range from 50 to 65 years.Patients with Idiopathic Parkinson's disease.Patients with Disease severity of II to V on the Hoehn and Yahr Scale and with minimum assistance and support are required.Parkinson patient was able to stand without any support and to walk on a treadmill (with body weight support, if required).Patients having the e cient ability to see the cues.A Patients with Parkinson disease wheel-chair bond and bed-ridden were excluded from this study.Patients with any other neurologic orthopedic disorder-affecting gait and postural stability also were excluded from this study.It was calculated by using the data from past studies; it was used to measured outcome tool with epitool software.TheEstimated Sample size was calculated after adding the dropout ration overall sample size was 74[11].The Patients who participated in this study ful lled the inclusion criteria.We have used convenient sampling method to select the patients and all selected individual were randomly allocated to group A and Group B by using the Lottery method.This distribution process is hidden at assessor level.It's a single blinded study where only the assessor was blind about the study procedure.
parameters[10].The visual clues with treadmill training impact the motor learning process and develop a normal pattern of the movement that helps walk properly and to increase the speed of the walk .ithypothesizedthat the use of the visual clues help develop the normal synergy movement and help the patient develop the better improve the gait, balance and functional activity.This study was Single blinded randomized controlled trial registered in the Iranian registry of clinical trial no IRCT20220414054537N1.The study was started after approval from the Research Ethical Committee The S u p e r i o r U n i v e r s i t y w i t h R e f e r e n c e N o REC/FAHS/DPT/B(AP)/June 2022/991 .The patients with Parkinson disease were recruited from Chaudhary Muhammad Akram research and Teaching Hospital, Lahore th from June 5 , 2022.The trial took 28 weeks to complete th and follow-up measurements were taken in January 6 , 2023.We have applied a continuous treatment session around 7 months Experiences of Daily Living (M-EDL) questionnaire for functional activity with inter-rater reliability was 0.93 and for intra-rater reliability was 0.99 -1.00[14].Outcome measurements: Statistical analysis was performed and the Data were analyzed using SPSS version 22.0.The result

Table 1 :
Pre-Post analysis of control and Experimental group separately DOI: https://doi.org/10.54393/pjhs.v4i10.1085Ghafoor F et al., Improving Gait and Functional Ability in Parkinson's Patient PJHS VOL. 4 Issue.10 October 2023 Copyright © 2023.PJHS, Published by Crosslinks International Publishers D I S C U S S I O N

Table 2 :
Comparison Between Experimental and Control GroupBoth Treadmill training alone versus Treadmill training with external clues has shown the Positive effect on improving the functional ability and gait including its parameters like step length, stance width, hip hiking, toe clearance, external rotation at hip and pelvic rotation.When we applied the between group analysis was done it showed that signi cant improvement has seen in Experimental Group B. Our recent study results has shown that Treadmill training along with external clues were more effective in improving the walking speed as compare to the treadmill training alone.Parkinson's patients in experimental group showed a signi cant difference as compare to the control group after 28 weeks of continuous treatment plan.It has observed that patients of experimental group now has shown the better performance in doing their daily life work and the quality of life of these individual has been improved.P a t i e n t s i n ex p e r i m e n t a l g r o u p s h owe d b e t te r performance in daily living task and activities compare with control group.Our result shows similarity with the research conducted byZhao et al., and Frazzitta et al.They concluded that external rhythmical clues showed a signi cant result by improving the walking speed without any fall.The Gait pattern of such individual has emerged and signi cant difference has seen[15, 16].Luessi et al., conducted a study in 2012 and the main objectives of the study was to evaluate the effectiveness of treadmill treading along with visual clues on walking speed and gait parameters.They concluded that a signi cant difference has observed in the walking speed and velocity of the gait while giving the visual clues.Their result also suggested that with visual clues overall performance of patients at treadmill signi cantly improved.Our Research nding also provided the same result because the step length of the individual was signi cantly improved in experimental group.The overall comparative results between Control and experimental group showed that ration of swing to stance ration signi cantly improved and it helped the patients to walk with more con dence and attention[9].In patients with Parkinson's disease it has observed that waking disturbance and balance both things correlate with each other any di culty in walking directly affected the static and dynamic balance of the individuals.Our study has showed that experimental group patients after receiving treadmill training with external clues showed a signi cant improvement in static and dynamic balance.We observed in our study the single and double leg support during walking has signi cantly improved and patients tend to walk and complete gait cycle and long distance walk with less double support and the risk of fall also reduced signi cantly.These results are coherent with the study by Magdi et al.The conducted a meta-analysis of different published research on all available search engine and the result of the study has showed that cueing techniques provide the signi cant improvement in balance activity, walking and functional activities as compare to non-cueing techniques in Parkinson patients[10].Calabro et al., conducted a study and result showed that Cueing techniques provided the better signi cant improvement in the gait training and it helped to reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity.The cuing technique along with treadmill training provides the patients with better motor control of their body and improves the gait mechanisms.External clues help provide the restore the function and proper signaling in the cerebrum area, cerebellum and basal ganglia.A study byChawla et al., also concluded the same results.Our recent study showed the same result in which our experimental group provided a signi cant improvement in mental relearning process and helped to develop a new connection to understand a normal way of walking with optimal speed and improvement in gait parameters[17, 18].The results of our study showed the bene cial effects and helped improve the functional activities like daily living tasks with proper normal speed and attention.The Patient of Parkinson has showed the signi cant improvement in the walking speed and the static and dynamic balance.Cuing during the treadmill walk helped the patients in group B to control their body movement especially of lower limb.The results have showed that patients with Parkinson's disease present with the poor balance, slow speed and a history of falls but with proper cues helped the patients to manage to control their body in well manner and provided the patients with a strong base to walk with con dence without any fall history this study is coherent with the study by Sherron et DOI: https://doi.org/10.54393/pjhs.v4i10.1085Improving Gait and Functional Ability in Parkinson's Patient PJHS VOL. 4 Issue.10 October 2023