Acute and Chronic Effect of Acoustic and Visual Cues on Gait Training in Parkinson's Disease: A Randomized, Controlled Study.

Roberto De Icco,Eliana Berra,Claudio Pacchetti,Cristina Tassorelli,Monica Bolla,Giorgio Sandrini

doi:10.1155/2015/978590

Roberto De Icco, Eliana Berra + Show 4 more

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https://doi.org/10.1155/2015/978590

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Abstract

In this randomized controlled study we analyse and compare the acute and chronic effects of visual and acoustic cues on gait performance in Parkinson's Disease (PD). We enrolled 46 patients with idiopathic PD who were assigned to 3 different modalities of gait training: (1) use of acoustic cues, (2) use of visual cues, or (3) overground training without cues. All patients were tested with kinematic analysis of gait at baseline (T0), at the end of the 4-week rehabilitation programme (T1), and 3 months later (T2). Regarding the acute effect, acoustic cues increased stride length and stride duration, while visual cues reduced the number of strides and normalized the stride/stance distribution but also reduced gait speed. As regards the chronic effect of cues, we recorded an improvement in some gait parameters in all 3 groups of patients: all 3 types of training improved gait speed; visual cues also normalized the stance/swing ratio, acoustic cues reduced the number of strides and increased stride length, and overground training improved stride length. The changes were not retained at T2 in any of the experimental groups. Our findings support and characterize the usefulness of cueing strategies in the rehabilitation of gait in PD.

Highlights

Parkinson’s disease (PD) is a degenerative neurologic disorder characterized by motor and nonmotor symptoms
For instance, are believed to provide an external rhythm that bypasses internal rhythm deficit [6] and visual cues engage the visualcerebellar motor pathway to facilitate the generation of a better gait pattern [7], whereas sensory cues enable the voluntary activation of the dorsolateral premotor control system, bypassing the failure of supplementary motor area in controlling automatic movement [8, 9]
Visual cues caused a decrease in the number of strides, an increase in the percentage of time spent in the swing phase with a corresponding reduction in the time spent in the stance phase, and a reduction in the gait speed (Table 3)

Summary

Introduction

Parkinson’s disease (PD) is a degenerative neurologic disorder characterized by motor and nonmotor symptoms. Many symptoms respond well to antiparkinsonian drugs, gait and balance impairment often show a poor response to pharmacological treatment. In this frame, physical therapy acquires an important role in contributing to the management of this kind of symptoms. Cues are defined as external stimuli of different type, that is, instructional, auditory, visual, and sensory, and are applied to improve gait performance via the activation of different strategies of motor control. For instance, are believed to provide an external rhythm that bypasses internal rhythm deficit [6] and visual cues engage the visualcerebellar motor pathway to facilitate the generation of a better gait pattern [7], whereas sensory cues enable the voluntary activation of the dorsolateral premotor control system, bypassing the failure of supplementary motor area in controlling automatic movement [8, 9]

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