Improving gait and promoting retention in individuals with Parkinson's disease: a pilot study.

We examined intensive walking practice using two instructional strategies on gait in Parkinson's disease (PD) before and after training and on delayed retention tests. During four training sessions (15 practice trials of walking per session), subjects (N = 6 per group) were given either verbal instruction (VI) to "take a big step" or VI plus augmented feedback (FB). For FB, videotape performance-feedback (from prior trial) supplemented by performance-cues (for subsequent trial) was given after each trial. On pre- and posttests (1 week after training), the only instructions were to "walk as well as you can." For available subjects (N = 7), retention was tested at 3, 6, or 12 months after training. Gait parameters were derived from kinematic analysis of walking during training and testing. From pre- to posttests, stride length, walking velocity and shoulder excursion increased significantly, with no change in cadence. Improvements in stride length and gait velocity above pretest levels were maintained on retention tests. During training and testing, no effects of VI versus VI + FB were found. Although the two instructional strategies did not differ, intensive practice walking with VI improved the gait pattern of individuals with PD and these gait improvements were maintained over an extended period of time.