Objective: The goal of the present study was to quantify individual gait changes by eGaIT during the standardized titration test for subcutaneous apomorphine treatment.

Background: Parkinson’s disease (PD) is a prototypical movement disorder and gait impairments including small steps and shuffling are main characteristics of the disease. However, the assessment of gait is underrepresented in the commonly used UPDRS motor score even though it is a major need for clinical care. The sensor-based gait analysis system eGaIT (embedded gait analysis using IT) offers an objective way to quantify gait changes in PD patients.

Methods: Patients selected for single-dose apomorphine treatment due to motor fluctuations or prior to DBS surgery (dopaminergic response test) were subjected to the standardized apomorphine titration test in dopaminergic off state. Apomorphine was injected every 15 min, resulting in an incremental increases of the cumulative apomorphine dose until proper motor response, dyskinesia, or side-effects occurred. Prior to the first apomorphine injection and every 15 minutes during the titration procedure, disease severity was staged using the Hoehn & Yahr scale and motor performance was clinically evaluated using the UPDRS-III rating. In addition, instrumented gait analysis by eGaIT was performed based on a 2x 10 meter distance walk at a freely chosen walking speed comfortable to the patient. Spatio-temporal gait parameters and PD specific gait signatures were recorded.

Results: We observed a substantial improvement of distinct spatio-temporal stride parameters with increasing doses of apomorphine. Stride speed, length and gait velocity increased with clinical improvement of motor symptoms. In addition, max toe clearance as a sign of shuffling of gait improved in parallel to the response to apomorphine treatment. Repeated measure ANOVA and effect size analysis of strides analyzed during the 2 x 10 meter walk for the individual patient revealed significant improvement of gait parameters correlating to the improvement of the UPDRS motor score.

Conclusions: We show that instrumented spatio-temporal stride parameters derived from a 2 x 10 meter walk are able to measure individual motor responses during the apomorphine quick titration test. Thus, instrumented gait analysis provides complementary and objective measures of treatment efficacy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sensor-based-gait-analysis-diagnostic-application-for-apomorphine-titration/