Clinical Neurophysiology xxx (2015) xxx–xxx

Contents lists available at ScienceDirect

Clinical Neurophysiology
journal homepage: www.elsevier.com/locate/clinph

The effects of additional arm weights on arm-swing magnitude and gait

patterns in Parkinson’s disease
Jiyeon Yoon a, Jinse Park b,⇑,1, Kunbo Park c, Geunyeol Jo d, Haeyu Kim e, Wooyoung Jang f,1, Ji Sun Kim g,1,
Jinyoung Youn h,1, Eung Seok Oh i,1, Hee-Tae Kim j, Chang Hong Youm k
a
Department of Physical Therapy, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
b
Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
c
Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
d
Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
e
Department of Neurological Surgery, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
f
Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
g
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
h
Department of Neurology, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
i
Department of Neurology, Chungnam National University Hospital, College of Medicine, Daejun, Republic of Korea
j
Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
k
Department of Coaching, College of Medicine, Dong-A University, Busan, Republic of Korea

a r t i c l e i n f o h i g h l i g h t s

Article history:
 Decreased arm swing is a typical gait characteristic in Parkinson’s disease.
Accepted 6 June 2015
 Adding weight to the arm facilitates limb movements in Parkinson’s disease.
Available online xxxx
 Additional arm weight improves gait disturbance in Parkinson’s disease.

Keywords:
Arm swing
Motion analysis a b s t r a c t
Rehabilitation
Objective: Recently, arm facilitation has been interested in gait rehabilitation. However, there have been
Parkinson’s disease
few studies concerning arm facilitation in patients with Parkinson’s disease (PD). The aim of our study
was to investigate the effect of increasing arm weights on gait pattern in patients with PD.
Methods: Twenty-seven patients with PD were enrolled, and they underwent gait analysis using a
three-dimensional motion capture system. Sandbags were applied to the distal forearms in all partici-
pants. We compared gait parameters including arm swing, pelvic motion, spatiotemporal data, and rel-
ative rotational angle between the weighted and unweighted gaits.
Results: The total arm-swing amplitude and pelvic rotation were significantly higher when walking with
additional arm weights than without arm weights. Cadence, walking speed, stride length, and swing
phase were significantly higher, whereas stride time, double-support time, and stance phase were signif-
icantly lower, when walking with additional arm weights than without arm weights.
Conclusions: We conclude that adding weights to the arm during walking may facilitate arm and pelvic
movements, which results in changes to gait patterns. The therapeutic use of additional arm weights
could be considered for gait rehabilitation in PD to improve gait impairment.
Significance: Arm-swing facilitation using weight load improved gait in Parkinson’s disease.
Ó 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights
reserved.

1. Introduction

⇑ Corresponding author at: Department of Neurology, Haeundae Paik Hospital, Gait disturbance and postural instability have been thoroughly
Inje University, 875 Haeun-daero, Haeundaegu, Busan 612-030, Republic of Korea.
described in Parkinson’s disease (PD). Slow velocity with shuffling,
Tel.: +82 51 797 2082; fax: +82 51 797 0640.
E-mail address: jinsepark@gmail.com (J. Park).
dragging steps, small stride/step length, forward-stooped gait, and
1
KOJYP study group. decreased arm swing are typical gait characteristics in PD.

http://dx.doi.org/10.1016/j.clinph.2015.06.005
1388-2457/Ó 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Please cite this article in press as: Yoon J et al. The effects of additional arm weights on arm-swing magnitude and gait patterns in Parkinson’s disease. Clin
Neurophysiol (2015), http://dx.doi.org/10.1016/j.clinph.2015.06.005
2 J. Yoon et al. / Clinical Neurophysiology xxx (2015) xxx–xxx
Rhythmic arm swings are connected to movements of the head,
trunk, and pelvis, and they play an important role for postural sta-
bility and energy efficiency during walking (Dietz et al., 2001;
Gutnik et al., 2005). The reduction of arm swing is one of major
characteristics in patients with PD, and arm swing would be lost
in the early stage of PD (Roggendorf et al., 2012).
A variety of gait trainings in rehabilitation program for patients
with PD have been performed to improve gait function and mobil-
ity by using a treadmill, assistive devices, and cueing strategies
such as verbal, visual, or auditory cueing (Kegelmeyer et al.,
2013; Spaulding et al., 2013). Recently, there is a growing interest
on arm movements in patients with PD, such as arm-swing asym-
metry or amplitude (Lewek et al., 2010; Roggendorf et al., 2012).
Therefore, increasing arm swing also is one of the important pur-
poses of gait rehabilitation for PD patients. Meyns et al. reported
that arm facilitation in rehabilitation program for patients with
PD is very important, but, to date, there is little information regard-
ing this (Meyns et al., 2013).
A vast amount of evidence has suggested that an added load to
the body has an effect on altered gait parameters, and it improved
postural balance (Donker et al., 2005; Duysens et al., 2000). The
added weight to the arms would be effective in changing arm
movements, and it could lead to influence on the interaction
between limb movements during walking (Donker et al., 2005).
This change of arm movement could result in the improvement
of gait parameters and pelvic motion. To our knowledge, previous
reports have only investigated healthy subjects, and little is known
regarding the facilitation of arm movement in patients with PD.
The aim of this study was to investigate whether additional arm
weight could alter the gait patterns as well as arm-swing ampli-
tude during walking in PD. We hypothesized that additional arm
weight would increase arm-swing amplitude, and it would
improve the spatiotemporal parameters and pelvic motion in
patients with PD.
2. Methods
2.1. Study participants
Twenty-seven patients with PD (15 males and 12 females)
meeting the United Kingdom Parkinson’s Disease Society Brain
Bank diagnostic criteria were enrolled for this study (Hughes
et al., 1993). Basic demographic and clinical information were
obtained including disease duration, body mass index (BMI), and
disease severity. Clinical severity was assessed by the United
Parkinson’s Disease Rating Scale part III (UPDRS III) and Hoehn
and Yahr (H&Y) stage. The demographic data of participants are
presented in Table 1. Inclusion criteria for participants were as fol-
lows: (1) in H&Y stages 2–3; (2) complaining of gait disturbance
but able to walk without assistance; and (3) having proper cogni-
tion to understand the study information. Exclusion criteria were
recommended for (1) any primary orthopedic, neurological dis-
eases, and visual disturbances other than PD, and (2) having com-
plaints that affect independent walking. All patients with PD were
on medication. The study was approved by the institutional review
board at the Haeundae Paik Hospital (Busan, Korea). All patients
understood the study procedure and purpose, and they gave writ-
ten informed consent before participation.
2.2. Gait analysis
An eight-camera three-dimensional motion analysis system
(Vicon, Fareham, UK) was used at a sample rate of 100 Hz for the
quantification of arm swing, pelvic motions, and spatiotemporal
parameters. Heel strike and toe-off were obtained from two force
Please cite this article in press as: Yoon J et al. The effects of additional arm weights on arm-swing magnitude and gait patterns in Parkinson’s disease. Clin
Neurophysiol (2015), http://dx.doi.org/10.1016/j.clinph.2015.06.005
Table 1
Participants’ characteristics.
Mean ± SD Range
Age (years) 74.0 ± 5.7 64–90
Gender 15 males/12 females
Height (cm) 157.5 ± 8.2 142.2–175.4
Weight (kg) 57.9 ± 9.4 42.3–74.7
BMI (kg/m2) 23.3 ± 2.7 17.5–28.5
Duration (month) 22.2 ± 20.7 0.5–71
H&Y stage 2.5 ± 0.5 2–3
UPDRS III (points) 22.8 ± 7.7 10–43
BMI: Body mass index; H&Y stage: Hoehn and Yahr stage; UPDRS III: Unified
Parkinson’s disease scale part 3.
plates (AMTI, Watertown, MA, USA) synchronized with the Nexus
program (version 1.7) for data collection at 1000 Hz, and the events
of gait cycle were recorded simultaneously. In total, 16 retroreflec-
tive markers were used to indicate the segments. Twelve markers
were attached on the anterior and posterior superior iliac spines,
femoral epicondyle, and malleolus, second metatarsal head, and
posterior calcaneus bilaterally for the kinematics of lower extrem-
ities. For the amplitude of arm swing, four markers were bilaterally
placed on acromion processes and on the middle point of ulna and
radius. The marker placement was performed by one experienced
researcher to minimize the error.
2.3. Procedures
Prior to performing the dynamic trials, all participants under-
took a static trial to determine the movement of the pelvis, upper,
and lower limbs. Each PD patient who took part in this study
walked barefoot along a 20-foot walkway at an individually pre-
ferred pace, and the patient performed five trials with and without
arm weights (in random order). Two sandbags weighing 0.45 kg
(Sammons Preston, Bolingbrook, IL, USA) were used as arm
weights. The patients with PD wore sandbags with Velcro straps
on the distal one-third portion of the forearm bilaterally.
Unfortunately, there was no report about the appropriate weight
on the patient with PD. Several previous studies for healthy sub-
jects related to the arm weight used a 1.2- or 1.8-kg weight on each
arm. Considering that our subjects are old and weak, we selected
0.45 kg.
No specific instructions regarding gait posture as well as arm
swing were provided to participants. Each participant took a break
for 1 min between tasks to minimize the fatigue.
2.4. Data analysis
Motion data capture and post-processing of marker trajectories
were performed using the Nexus 1.7 software (Vicon, Fareham,
UK). The tri-planar motions of pelvis were calculated relative to
the global coordinate system, and arm swing was calculated by
the angle between the arm and virtual vertical axis. The kinematics
of pelvic motions was presented for sagittal, coronal, and trans-
verse planes defined as anterior–posterior tilt, obliquity, and rota-
tion, respectively. Each pelvic motion was calculated as the
amplitude (maximum–minimum values).
The arm swing was divided into anteversion and retroversion of
the shoulder joint. The anteversion was defined for maximum pos-
itive values, and the retroversion was done for minimum negative
values (Fig. 1(a)). In addition, all arm-swing amplitudes including
total, anteversion, and retroversion were calculated as the average
of the left and right side. The relative angle of the shoulder relative
to the pelvis was obtained by subtracting the virtual shoulder line
through the markers on the acromion from the pelvis within each
single step (Fig. 1(b)). The right step indicates from left heel strike
 J. Yoon et al. / Clinical Neurophysiology xxx (2015) xxx–xxx 3

Fig. 1. Arm swing is divided into anteversion (+) and retroversion () by the angle calculated between the arm perpendicular axis and virtual vertical axis by generated pelvis
(a) lateral view). The relative angle between the shoulder and pelvis is calculated between the virtual shoulder line and pelvic line (b) view from above).

to right heel strike, and the left step does the reverse. The angle is Table 2
closer to 0°, which indicates that the pelvis and shoulder rotation is Comparison of the arm and pelvic kinematics with and without arm weights in PD
patients.
in phase (Huang et al., 2011). The total arm-swing amplitude and
total amplitude of the relative angle between the shoulder and pel- Without arm With arm P
vis were calculated as maximum minus minimum values during weight weight

one-stride cycle. Arm swing (°)

We also evaluate the effect to arm-swing asymmetry. The sym- Anteversion 10.15 ± 9.63 17.98 ± 9.16 0.000*
Retroversion 6.47 ± 9.08 10.06 ± 8.15 0.000*
metry angle (SA), as proposed by Zifchock et al. (2006), is used to
Amplitude 16.61 ± 10.19 28.45 ± 12.80 0.000*
evaluate the arm-swing asymmetry in patients with PD during
Pelvic kinematics (°)
gait. The SA was calculated by the following equation:
Pelvic tilt 2.93 ± 1.13 2.84 ± 1.36 0.553*
   Pelvic obliquity 3.98 ± 1.43 4.12 ± 5.09 0.559*
  X 
45  arctan L  Pelvic rotation 5.78 ± 2.16 6.70 ± 2.63 0.013*
 X R 

SA ¼ 
90   100ð%Þ Relative rotational angle (°)
  Shoulder pelvis 7.36 ± 4.05 8.50 ± 4.61 0.126

XL and XR are the angles of the left and right arm swing, respectively.
A higher SA value indicates higher asymmetry.
All patients completed at least five gait cycles for each trial, and
the third trial was used for analysis. We obtained spatiotemporal
data from the software including cadence, walking speed, stride
time, stride length, double support, swing phase, and stance phase.
The arm-swing amplitude and asymmetry, the relative angle
between the shoulder and pelvis, and kinematic pelvic motion
have been mentioned earlier.
2.5. Statistical analysis
SAS software package (version 9.1, Cary, NC, USA) was used to
perform the statistical analysis. For considering the difference of
walking speed in each trial, we compared the gait parameters
including arm and pelvic kinematics, and spatiotemporal parame-
ters between with and without arm weights using paired t-test.
The level of significance was set at p < 0.05.
3. Results
3.1. Arm swing and pelvic kinematics
Table 2 summarizes the result of paired t-test for arm and pelvic
kinematic parameters. Anteversion and retroversion of arm swing
were significantly longer when walking with arm weights.
Consequently, arm-swing amplitude also showed a significant
increase when patients with PD walked with arm weights
Please cite this article in press as: Yoon J et al. The effects of additional arm weights on arm-swing magnitude and gait patterns in Parkinson’s disease. Clin
Neurophysiol (2015), http://dx.doi.org/10.1016/j.clinph.2015.06.005
amplitude
Paired t-test was used for the comparison of change on each scale score between
two groups. These values represented with the standard deviations.
*
p < 0.05.
(p < 0.05). Most patients except three patients showed increasing
arm-swing amplitude, and this effect developed immediately from
the first trial to the last trial. In pelvic kinematics, pelvic rotation
showed a significant increase with the use of arm weights
(p < 0.05). There was no difference in pelvic tilt and obliquity
between gaits with and without arm weights. There was an
increasing tendency to the relative angles between the shoulder
and pelvis during the right and left step when patients with PD
walked with arm weights; however, there was no statistical signif-
icance. Arm-swing asymmetry did not significantly differ between
two conditions (p > 0.05). In total, the SA increased in 14 of 27
patients, and it decreased in 13.
3.2. Spatiotemporal parameters
Table 3 shows the spatiotemporal parameters. All spatiotempo-
ral variables were significantly different between gaits with and
without arm weights. Cadence, walking speed, stride length, and
swing phase of gait cycle were greater for gaits with weights than
without weights (p < 0.05). Stride time, double-support time, and
stance phase of gait cycle were less for gaits with arm weights than
without arm weights (p < 0.05).
We evaluated the correlation between arm-swing amplitude
and gait parameters. Pearson correlation test was used for the
4 J. Yoon et al. / Clinical Neurophysiology xxx (2015) xxx–xxx
Table 3
Comparison of the spatiotemporal parameters with and without arm weights in PD
patients.
Without arm With arm
weight weight
Cadence (steps/min) 101.78 ± 13.44 109.24 ± 12.94
Walking speed (m/s) 0.62 ± 0.19 0.73 ± 0.22
Stride time (s) 1.21 ± 0.21 1.12 ± 0.15
Stride length (m) 0.73 ± 0.21 0.81 ± 0.22
Double support (s) 0.35 ± 0.11 0.29 ± 0.10
Stance phase (% gait cycle) 64.14 ± 4.02 62.79 ± 3.71
Swing phase (% gait cycle) 35.57 ± 4.29 37.12 ± 3.67
Paired t-test was used for the comparison of change on each scale score between
two groups. These values represented with the standard deviations.
*
p < 0.05.
analysis of the relationship between arm swing and gait parame-
ters. Walking speed and stride length showed significant correla-
tion with the total arm-swing amplitude (r = 0.58, r = 0.57,
p < 0.05). The other gait parameters including cadence, double sup-
port, stride time, swing, and stance phase were not significantly
related to arm swing.
4. Discussion
Our study described the effects of additional arm weights on the
arm swing, pelvic kinematics, and spatiotemporal parameters in
ambulating patients with PD. Several reports demonstrated that
patients with PD showed reduced walking velocity and stride
length and hip joint kinematics compared with healthy controls
in a quantitative gait analysis (Sofuwa et al., 2005). Gait parame-
ters, including kinematic and spatiotemporal data assessed in our
study, are usually impaired in PD.
In this study, arm-swing amplitude was increased with the use
of weights. This finding is in line with those of previous studies,
which investigated the effects of adding weights during walking
in healthy controls (Duysens et al., 2000). Arm swing plays an
important role for counterbalancing the movements of contralat-
eral pelvis and lower limb, although arm swing is not regarded
as an essential prerequisite for walking (Zehr and Duysens,
2004). Additional arm weights could change the inertia moments
and the natural pendular frequency of upper extremities.
Increased angular acceleration of arm swing was associated with
increases in the angular displacement of shoulder joints, and
greater anterior acceleration of shoulder joints resulted in greater
arm retraction (Pontzer et al., 2009). Adding mass to the upper
or lower limbs changed arm movements as a compensatory mech-
anism for maintaining stable gait (Bonnard and Pailhous, 1991).
We postulated that increased retraction may contribute to
increased total arm swing in our study. This is in line with the
results found by Behrman et al. who reported that deliberately
increased arm swing was the effective strategy to improve walking
pattern such as increased velocity (Behrman et al., 1998). The addi-
tional sandbags to the wrist could act as a sensory input, and the
perception of altered arm swing through repetitive walking could
activate the motor cortex for locomotion.
However, some previous studies contrast with our results.
Arm-swing amplitude decreases to compensate forearm mass
and to minimize the energy cost, although adding arm mass has
been known to increase the muscular recruitment of the upper
limbs (Donker et al., 2002). However, upper limb movements could
be changed under various walking speeds on the treadmill in
healthy people (Donker et al., 2005, 2002; Pontzer et al., 2009).
In that study, the weight of arm loading was four times more,
and gait speed also was much faster than our study (>1.5 km/h).
Please cite this article in press as: Yoon J et al. The effects of additional arm weights on arm-swing magnitude and gait patterns in Parkinson’s disease. Clin
Neurophysiol (2015), http://dx.doi.org/10.1016/j.clinph.2015.06.005
We postulated that light adding mass on self-preferred gait would
be effective to arm facilitation in PD.
Arm swing is often regarded as a way of counteracting free ver-
p tical moments caused by the swing legs (Li et al., 2001). In partic-
ular, arm retroversion provides gait stabilization by minimizing
0.000* body rotation at the initial swing phase. In patients with PD,
0.000* prominent impairment in arm retroversion was found to be an
0.000*
0.007*
early sign of gait disturbance (Roggendorf et al., 2012). The arm
0.000* retroversion happens throughout the swing phase from the
0.004* pre-swing of ipsilateral foot-off (Murray et al., 1967). For this rea-
0.001* son, we speculated that an increased retroversion by additional
arm weights might result in an increased swing phase and a
decreased stance phase. In addition, this change of gait cycle might
lead to gait stabilization consequently.
Our results also showed that pelvic rotation increased, at <1°,
and the relative angle between the shoulder and pelvis for trunk
motion did not differ when walking with arm weights, compared
with that without weights. The pelvis plays a role as a mobile link
between the two lower limbs, and an increased pelvic rotation dur-
ing swing phase adds to step length (Lovejoy, 2005). The increase
of the relative angle between the shoulder and pelvis indicates that
the shoulder line moves more at an antiphase with the pelvic line.
This mild increase could have an effect on the increased pelvic
rotation by improved coordination between the shoulder and pel-
vis. We postulated that the greater pelvic rotation in our result
may be a cause for the increased stride length. However, adding
arm weights did not significantly change the trunk coordination
in PD patients. PD patients walked using a similar strategy as
patients with low back pain who keep the stiff trunk and swing
the arm more (Huang et al., 2011).
Cadence is defined as the number of steps per minute. An
increase in cadence may be considered as an increased stride fre-
quency and walking speed. In addition, walking speed is deter-
mined by the combination of stride length and frequency (Huang
et al., 2010). In our study, cadence, walking speed, and stride
length were increased, and the stride time was decreased when
walking with arm weights. This indicates that adding arm weights
results in the improvement of gait by increasing the stride length
as well as frequency. Although cadence is considered to be
increased in PD, evidence is controversial. Some reports showed
normal or decreased cadence in PD (Morris et al., 1996).
Unfortunately, we did not compare the cadence between normal
controls and PD group. As per our result, we assumed that cadence
might not be increased in participants compared with normal con-
trols. Further studies are warranted comparing cadence with nor-
mal controls.
Dietz and Michel verified that patients with PD preserve basic
quadrupedal limb coordination (Dietz and Michel, 2008). The
authors suggest that the arm and leg are coupling via the activity
of spinal interneuron. Neural connections between the upper and
lower limbs exist, which increases muscle activation in another
limb during rhythmic tasks (Huang and Ferris, 2009; Kawashima
et al., 2008). In addition, Bruijn et al. found that arm and leg move-
ments contribute to control the body angular momentum com-
pared with the pelvis or thorax movement (Bruijn et al., 2008).
Our results showed that arm-swing amplitude was correlated
with stride length, which is in accordance with previous reports.
With such findings, the alteration of spatiotemporal parameters
when walking with arm weights might be explained in respect of
synchronizing the upper and lower limb movements. Based on pre-
vious reports, we speculated that an increased arm movement may
facilitate lower limb movement especially stride length via
spino-bulbar-spinal reflex pathway.
There were several limitations in this study. We did not com-
pare the results with a control group, so we could not exclude a
placebo effect from the added weights. In addition, we considered
 J. Yoon et al. / Clinical Neurophysiology xxx (2015) xxx–xxx
proximal arms and forearm as one mechanical segment for arm
swing; hence, the elbow motion and the arm length were ignored.
The sandbag with the same weight was applied to all participants
who had various body metrics, so we did not control the
arm-swing symmetry and could not investigate the best appropri-
ate weight to improve gait parameters. We only compared changes
in short-term responses, thus making it difficult to confirm
whether the effects will continue for a long time. Further studies
should investigate the effects of various weights to improve the
arm-swing symmetry during walking and the long-term effect of
adding arm weights for the gait training in patients with PD.
In conclusion, adding arm weights during walking is useful in
facilitating the arm swing, and it improves the gait patterns in
patients with PD. Therefore, the effort of the upper limb may influ-
ence lower limb rehabilitation in patients with PD.
Acknowledgement
This research is supported by Soonchunhyang University
hospital.
Conflicts of interest: The authors have no potential conflicts of
interest to report concerning this article, and they have nothing
to disclose.
References
Behrman AL, Teitelbaum P, Cauraugh JH. Verbal instructional sets to normalise the
temporal and spatial gait variables in Parkinson’s disease. J Neurol Neurosurg
Psychiatry 1998;65:580–2.
Bonnard M, Pailhous J. Intentional compensation for selective loading affecting
human gait phases. J Mot Behav 1991;23:4–12.
Bruijn SM, Meijer OG, van Dieen JH, Kingma I, Lamoth CJ. Coordination of leg swing,
thorax rotations, and pelvis rotations during gait: the organisation of total body
angular momentum. Gait Posture 2008;27:455–62.
Dietz V, Fouad K, Bastiaanse CM. Neuronal coordination of arm and leg movements
during human locomotion. Eur J Neurosci 2001;14:1906–14.
Dietz V, Michel J. Locomotion in Parkinson’s disease: neuronal coupling of upper
and lower limbs. Brain 2008;131:3421–31.
Donker SF, Daffertshofer A, Beek PJ. Effects of velocity and limb loading on the
coordination between limb movements during walking. J Mot Behav
2005;37:217–30.
Donker SF, Mulder T, Nienhuis B, Duysens J. Adaptations in arm movements for
added mass to wrist or ankle during walking. Exp Brain Res 2002;146:26–31.
Please cite this article in press as: Yoon J et al. The effects of additional arm weights on arm-swing magnitude and gait patterns in Parkinson’s disease. Clin
Neurophysiol (2015), http://dx.doi.org/10.1016/j.clinph.2015.06.005
5
Duysens J, Clarac F, Cruse H. Load-regulating mechanisms in gait and posture:
comparative aspects. Physiol Rev 2000;80:83–133.
Gutnik B, Mackie H, Hudson G, Standen C. How close to a pendulum is human upper
limb movement during walking? Homo 2005;56:35–49.
Huang HJ, Ferris DP. Upper and lower limb muscle activation is bidirectionally and
ipsilaterally coupled. Med Sci Sports Exerc 2009;41:1778–89.
Huang Y, Meijer OG, Lin J, Bruijn SM, Wu W, Lin X, et al. The effects of stride length
and stride frequency on trunk coordination in human walking. Gait Posture
2010;31:444–9.
Huang YP, Bruijn SM, Lin JH, Meijer OG, Wu WH, Abbasi-Bafghi H, et al. Gait
adaptations in low back pain patients with lumbar disc herniation: trunk
coordination and arm swing. Eur Spine J 2011;20:491–9.
Hughes AJ, Daniel SE, Blankson S, Lees AJ. A clinicopathologic study of 100 cases of
Parkinson’s disease. Arch Neurol 1993;50:140–8.
Kawashima N, Nozaki D, Abe MO, Nakazawa K. Shaping appropriate locomotive
motor output through interlimb neural pathway within spinal cord in humans. J
Neurophysiol 2008;99:2946–55.
Kegelmeyer DA, Parthasarathy S, Kostyk SK, White SE, Kloos AD. Assistive devices
alter gait patterns in Parkinson disease: advantages of the four-wheeled walker.
Gait Posture 2013;38:20–4.
Lewek MD, Poole R, Johnson J, Halawa O, Huang X. Arm swing magnitude and
asymmetry during gait in the early stages of Parkinson’s disease. Gait Posture
2010;31:256–60.
Li Y, Wang W, Crompton RH, Gunther MM. Free vertical moments and transverse
forces in human walking and their role in relation to arm-swing. J Exp Biol
2001;204:47–58.
Lovejoy CO. The natural history of human gait and posture. Part 1. Spine and pelvis.
Gait Posture 2005;21:95–112.
Meyns P, Bruijn SM, Duysens J. The how and why of arm swing during human
walking. Gait Posture 2013;38:555–62.
Morris ME, Iansek R, Matyas TA, Summers JJ. Stride length regulation in Parkinson’s
disease. Normalization strategies and underlying mechanisms. Brain
1996;119:551–68.
Murray MP, Sepic SB, Barnard EJ. Patterns of sagittal rotation of the upper limbs in
walking. Phys Ther 1967;47:272–84.
Pontzer H, Holloway JH, Raichlen DA, Lieberman DE. Control and function of arm
swing in human walking and running. J Exp Biol 2009;212:523–34.
Roggendorf J, Chen S, Baudrexel S, van de Loo S, Seifried C, Hilker R. Arm swing
asymmetry in Parkinson’s disease measured with ultrasound based motion
analysis during treadmill gait. Gait Posture 2012;35:116–20.
Sofuwa O, Nieuwboer A, Desloovere K, Willems AM, Chavret F, Jonkers I.
Quantitative gait analysis in Parkinson’s disease: comparison with a healthy
control group. Arch Phys Med Rehabil 2005;86:1007–13.
Spaulding SJ, Barber B, Colby M, Cormack B, Mick T, Jenkins ME. Cueing and gait
improvement among people with Parkinson’s disease: a meta-analysis. Arch
Phys Med Rehabil 2013;94:562–70.
Zehr EP, Duysens J. Regulation of arm and leg movement during human locomotion.
Neuroscientist 2004;10:347–61.
Zifchock RA, Davis I, Hamill J. Kinetic asymmetry in female runners with and
without retrospective tibial stress fractures. J Biomech 2006;39:2792–7.