The study, “Pavement Patterns Can Be Designed to Improve Gait in Parkinson’s Disease Patients,” was published in the journal Movement Disorders.
A common feature of Parkinson’s disease is freezing of gait, when patients temporarily feel as if their feet are glued to the floor and hesitate or find it difficult to step forward.
The use of a visual stimulus to regulate, or cue, movement has proven effective in helping patients with freezing of gait. Prior studies suggest that transverse (crosswise) and regular lines are more helpful than parallel lines in irregular patterns. Still, such aids appear to be highly individual.
In many countries, the design of public spaces takes into consideration wheelchair users and people with impaired vision, but rarely those with diseases like Parkinson’s that impact movement. Researchers at Charles University and the Czech Technical University, both in the Czech Republic, evaluated types of floor patterns that could be helpful for these people.
Their study included 32 adults with freezing of gait (median age, 67.5) who had the disease for a median duration of 13 years.
All were assessed during “on periods” — times of the day when motor symptoms are under control with medication — and clinically evaluated using measures such as the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, the Parkinson’s Disease Activities of Daily Living Scale, the Gait and Falls Questionnaire, and the Montreal Cognitive Assessment.
Patients were then asked to walk back and forth along an eight-meter track with six different floor patterns, while counting backwards in groups of three numbers (dual task). The floors included a gray carpet with no pattern, a reference pattern consisting of a transverse regular black-and-white chessboard, and four virtual patterns that differed in size — 5 x 5 cm or 50 x 50 cm chessboard floor stones — and in the orientation (diagonal vs. transverse) and regularity of their patterns.
The scientists then calculated such measures as as time walking, number of steps, number of steps in turning, velocity, and step length. They also analyzed the number of correct and incorrect backwards counts, as well as the number and total duration of freezing episodes. Patients were asked to evaluate how the patterns influenced their walking.
Results revealed that transverse floor stones improved time, velocity, number of steps, and step length compared to diagonal ones. Virtual floor stones, with patterns projected on the floor, were also linked with better walking time and gait speed than a real floor.
“This is probably because walking in a virtual reality environment was so unusual for the patients that it drew more attention to the cues given than the real ones,” the researchers wrote.
Walking on the reference pattern (transverse regular black-and-white chessboard) led to increased step length compared to an irregular virtual pattern. According to the patients’ evaluation, the only difference was in the superiority of the reference pattern compared to an irregular or no pattern floor.
No differences in the number and total duration of freezing of gait episodes were recorded among the six floor patterns. “Indeed, 68%–91% of the patients did not experience FoG [freezing of gait] when walking on the 8-m-long track depending on the pattern and single- or dual-task conditions,” the researchers wrote.
Both gait speed and step length were lesser in dual-task walks, a finding likely explained by problems with prioritizing tasks —a difficulty common in Parkinson’s patients with freezing of gait, the researchers said.
“The present findings suggest that [Parkinson’s] patients benefit from using large transversal visual cues, which might be incorporated in floor patterns in both the exterior and the interior,” they wrote, cautioning that their findings need to be validated in real-world studies with more patients.