Objective: To compare Split-Belt treadmill (SBT) training with regular treadmill (tied-belt treadmill, TBT) training to improve freezing related gait deficits and to investigate whether effects are retained at 4 weeks follow-up in people with Parkinson’s disease (PD).

Background: Freezing of gait (FOG) in PD is a disabling symptom, associated with motor (and cognitive) switching deficits. FOG often occurs when switching between asymmetric movement patterns such as during gait initiation and turning. A SBT, where two belts can run at different and changing speeds, has the potential to train changing asymmetric gait patterns within a safe environment.

Method: Fifty-two individuals with PD with and without FOG were randomly assigned to either SBT (n=27) or TBT training (n=25), for 4 weeks, 3x/week. Testing was conducted by blinded assessors before (PRE), after (POST) and at the 4-week-follow-up (RET). Gait kinematics were analyzed during a gait adaptation (GA) task on the SBT, during overground turning and straight walking with and without an additional cognitive task. Severity of FOG was assessed using the FOG-score and New Freezing of Gait Questionnaire (NFOGQ). Linear mixed models were calculated to investigate the time by training-group interactions (with FOG status as an additional factor in a sub-analysis).

Results: A significant time*training-group interaction was found for gait adaptation (step length asymmetry, single task, p<0.001). Post-hoc comparisons revealed that the SBT group significantly improved from PRE to POST (p<0.001) and PRE to RET (p=0.005) whereas the TBT group did not (effect size: time*training-group interaction PRE-POST: 0.97; PRE-RET: 0.51). No significant time*training-group effects were found for the FOG-Score, the NFOGQ and the other outcomes on gait and turning. No significant time*FOG-status interaction was found.

Conclusion: SBT training was superior to TBT training to improve GA in people with PD and effect sizes were large. Training effects were retained 4 weeks after the training. Individuals with FOG improved similarly to patients without FOG. However, these training- specific effects did not transfer to overground and SBT was not beneficial to improve FOG severity. Future SBT interventions should investigate whether adding overground training modalities is beneficial to transfer effects to overground to improve FOG and activities of daily living.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effect-of-split-belt-treadmill-training-on-freezing-related-gait-deficits-in-people-with-parkinsons-disease/