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    The immediate effects of rhythmic arm swing and finger tapping exercises on gait of Parkinson's patients
    (Colorado State University. Libraries, 2011) Haase, Marion Zoraida, author; Thaut, Michael H., advisor; Davis, William B. (William Barron), committee member; Davalos, Deana B., committee member
    This study investigated the immediate effects of a rhythmic arm swing exercise vs. a rhythmic finger tapping exercise on gait parameters of individuals in the early stages of Parkinson's disease (PD). The study design was a randomized control trial involving three experimental conditions: control group, tapping group and arm swing group. Each patient participated in only one of these experimental conditions. Pre-test and post-test of walking at preferred speed were employed for each participant. All participants were rated between 0 and 2 in the Hoehn and Yahr scale. Tapping participants were instructed to tap on a metal plate (while seated) to the beat of an external auditory cue from a metronome set to 120% pre-test walking cadence, for three, 1-minute intervals with 30 seconds of rest in between each interval. The arm swing participants were instructed to swing their arms (while seated) with the beat from a metronome set to 120% pre-test cadence, for three 1-minute intervals with 30 seconds of rest in between each interval. Control group participants were instructed to remain seated for 4 minutes. Hand and arm function were assessed using the Nine Hole Peg Test (NHPT), motor functions were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV, and balance was assessed using the Berg's Balance Scale. Gait parameters were recorded at the sampling rate of 500Hz with a computerized foot sensor system. The walking data was analyzed off-line by a personal computer with the interface hardware and analysis software. Changes in velocity, stride length and cadence were recorded during the pre-test and the post-test. Primary analysis indicated that the tapping treatment increased the absolute cadence in subjects (mean change = 4.400 steps/min, standard error = 1.399 steps/min, p=0.0051), while the arm swing protocol did not have a significant effect on absolute cadence (mean change = -0.356 steps/min, standard error = 1.234 steps/min, p=0.776). The control condition also resulted in no significant change in absolute cadence (mean change = 0.443 steps/min, standard error = 1.399 steps/min, p=0.755). Secondary analysis involving comparison in change of scores between pre and post tests across groups indicated that the tapping treatment's effect was significantly different from the arm swing protocol's results within the parameter of absolute cadence (p=0.0191). Results suggest immediate effects of the arm-swing exercise on gait parameters are not statistically significant, while a pre-gait tapping protocol resulted in immediate effects (increased absolute cadence) that were of statistical significance. The tapping protocol's effect on cadence suggests that rhythmic finger tapping as a pre-gait exercise may lead to uncued higher step frequencies and gait velocities in Parkinson's disease, and that a seated pre-gait arm-swing exercise may not cause immediate significant changes in gait. A possible explanation for the statistically insignificant change in gait parameters during the arm swing exercise is fatigue - this exercise required more work than the other two conditions, and testing took place immediately after completing the exercise. Other possible confounding variables are the possibly reduced amplitude of the arm swing during the exercise, and the possibility that arm-swing decoupled from locomotive leg movements may have limited effects on gait. Tapping to a beat, however, may have immediate carryover effects perhaps due to its being a non-locomotive motion that can be isolated as a rhythmic pre-gait exercise. These findings suggest that a rhythmic tapping exercise may be beneficial to patients with Parkinson's disease, and may increase their walking cadence. However, arm-swing in PD remains a problem due to it's reduced amplitude as a symptom of the disease, and this negatively affects gait parameters. Further research is necessary to investigate new ways to improve arm-swing and consequently gait parameters in PD patients.