Bracing for persons with Parkinson disease: A case series with clinical reasoning

Introduction: Approximately 50,000 Americans are diagnosed with Parkinson disease (PD) each year, with more than half a million persons affected. This chronic progressive disease causes limitations across the model of disablement for this population of individuals. Because of the disease pathology and concomitant impairments, postural instability is present and gait is typically slow with high variability of spatial/temporal gait kinematics. Objective: The purpose of this study was to investigate the impact of a hinged orthosis with a Tamarack joint and adjustable check strap (TCS) ankle-foot orthosis (AFO) on functional gait capacity, electromyography (EMG), and quality of life (QOL) in select individuals with PD. Materials and Methods: Participants in this study were three men, all diagnosed with PD more than 5 years ago. Each participant was fitted with custom bilateral TCS-AFOs and trained in proper gait kinematics while wearing the orthoses. The study was 10 weeks long with three 45-minute gait training sessions. Each participant had an individual home walking program that used 30 minutes of daily focused walking as a target goal. Outcomes tested initially, at week 5, and at week 10 included gait endurance (6-minute walk test), computerized gait analysis (GAITRite; CIR Systems, Havertown, PA, USA), functional balance (Dynamic Gait Index [DGI]), lower-limb muscle activity (EMG), and QOL (Parkinson Disease Questionnaire 8 [PDQ-8]). Results: All three participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL. Conclusions: This case series reported a novel use of AFOs in addressing gait dysfunction in persons with PD. Considering the progressive nature of PD and the need for interventions that can create a long-term impact, lower-limb bracing may be an intervention with potential. The persons in this case report were all trained with a TCS-AFO that was designed to facilitate gait and provide beneficial somatosensory feedback. Each of the participants demonstrated improvements in gait velocity, endurance, dynamic balance, and QOL.