Gait impairments in People with Parkinson’s (PwP) are one of the most debilitating motor symptoms as they result in functional limitations of daily activities, and negatively impact the patient’s quality of life. Emerging evidence suggests that implicit motor learning strategies may help to manage gait impairments. However, few attempts have been made to distinguish which commonly used strategies implicit strategies could be considered. Also, little effort has been made to evaluate the evidence for their efficacy. A scoping review was undertaken to map the available evidence of implicit motor strategies that have been used in PwP and to identify gaps in the literature, which could be addressed in future research.
A systematic search was conducted using the following electronic database: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO (Via Ovid) and PEDro. For grey literature ETHOS British library, ProQuest and Open Grey were searched. Studies were included if they described an implicit motor learning strategy (dual-task training, analogy learning or errorless learning as defined by Kleynen et al. (2014) used with adults with Parkinson’s to manage gait impairments.
Results: Fifteen studies met the inclusion criteria: two systematic reviews, five randomised controlled trials, two protocols of randomised controlled trials, one non-randomised controlled trial. four test-retest experimental studies and one matched case-control study. Most of these studies focused on the dual task training and only one examined analogy learning.
Conclusion(s): This review suggests the available evidence of implicit motor learning strategies to manage gait impairments is limited to dual-task training and analogy learning in patients with mild to moderate Parkinson’s during the “ON” state of medication. Furthermore, no qualitative research of PwP or Physiotherapist’s experience of using such strategies was found
Cost and savings
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This review has implications for both clinical practical and research. Firstly, research is warranted to better understand the current use and acceptability of these strategies in clinical practice. This could then inform the development of a strategy-based intervention for future evaluation.
Top three learning points
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This study forms part of a PhD funded by Jouf University in Saudi Arabia at Exeter University in The United Kingdom.