GAIT ANALYSIS IN PATIENTS WITH PARKINSONS-DISEASE AND MOTOR FLUCTUATIONS - INFLUENCE OF LEVODOPA AND COMPARISON WITH OTHER MEASURES OF MOTOR FUNCTION

Although clinical rating scales and simple timed tests of motor functi on are widely used to assess motor response to therapy, gait analysis may provide an alternative measure of this response. We studied 15 pat ients with PD complicated by motor fluctuations, first to determine ch anges in temporal and spatial gait parameters following levodopa, seco ndly to assess the stability of repeated gait measures and timed tests in ''off'' and ''on'' states, and thirdly to determine the use of gai t analysis in the assessment of the dopaminergic response. Gait analys is (velocity, stride length, cadence, and double limb support), clinic al raring scales (modified Webster scale and Hoehn and Yahr stage), an d timed tests of motor function (hand tapping and stand-walk-sit time) were performed before (''off'') and after (''on'') a levodopa challen ge. Stride length and gait velocity increased following medication whe reas cadence and double limb support did not. Most gait measures and t he stand-walk-sit time were stable over three consecutive trials in bo th ''off'' and ''on'' states. Of the gait measures, only cadence in th e ''off'' state changed significantly whereas the tapping count improv ed with repeated trials in both ''off'' and ''on'' states. Changes in stride length, gait velocity, and tapping count following levodopa cor related with changes in clinical rating scales following treatment. Me asurement of gait parameters provides a reliable, objective alternativ e to rating scales and timed tests in assessing the dopaminergic respo nse in patients with PD and motor fluctuations.