Visual Cues Promote Head First Strategies During Walking Turns in Individuals With Parkinson's Disease.

Tyler Baker,Jenna Pitman,Rebecca J Reed-Jones,Michael James Maclellan

doi:10.3389/fspor.2020.00022

Tyler Baker, Jenna Pitman + Show 2 more

Open Access

https://doi.org/10.3389/fspor.2020.00022

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Abstract

Anticipatory eye movement promotes cranio-caudal sequencing during walking turns. Clinical groups, such as Parkinson's disease (PD), do not produce anticipatory eye movements, leading to increased risk of falls. Visual cues may promote anticipatory eye movement by guiding the eyes into the turn. This study examined if visual cues could train anticipatory eye movement. Ten neurotypical young adults and 6 adults with PD completed three blocks of walking trials. Trials were blocked by visual condition: non-cued baseline turns (5 trials), visually cued turns (10 trials), and non-cued post turns (5 trials). A Delsys Trigno (Delsys, Boston, MA) recorded horizontal saccades at 1024 Hz via electrooculography (EOG). Two Optotrak cameras (Northern Digital Inc., ON, Canada) captured body segment kinematics at 120 Hz. Initiation of segment rotation with respect to ipsilateral foot contact (IFC1) prior to the turn was calculated. Neurotypical young adults (NYA) produced typical cranio-caudal rotation sequences during walking turns. Eyes led (407 ms prior to IFC1), followed by the head (50 ms prior to IFC1), then trunk and pelvis. In contrast, PD produced no anticipatory eye or segment movement at baseline. During pre-trials the eyes moved 96 ms after IFC1 and segment movement was initiated by the pelvis followed by trunk and head segments. After visual cue training however, PD produced anticipatory eye movements 161 ms prior to IFC1, followed by the head 88 ms following IFC1 but ahead of trunk and pelvis onset. These results suggest visual cues assist in producing cranio-caudal control during walking turns in PD.

Highlights

Changing direction, or turning, while walking is a critical aspect of mobility
A neurotypical young adult (NYA) group consisting of 5 male and 5 female volunteers (22.4 +/– 1.4 years), and a group of individuals affected by Parkinson’s disease (PD) consisting of 3 male and 3 female (60.8 +/– 11.7 years) whose H&Y stages ranged from 1-3 (Bhidayasiri and Tarsy, 2012) as assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) questionnaire (Goetz et al, 1995)
The purpose of this study was to explore the use of discrete external visual cues to promote eye movements during a walking turn in a group with PD, reinforcing a head first strategy (Ambati et al, 2016; Spildooren et al, 2017)

Summary

Introduction

Turning, while walking is a critical aspect of mobility. Turns can comprise up to 45 percent of the total steps taken in a given day (Glaister et al, 2007). To complete a turn while walking the central nervous system (CNS) must coordinate reorientation of the body’s segments in the new direction of travel, while at the same time maintaining postural control and the stepping sequence (Patla et al, 1999; Mellone et al, 2016). Turning while walking is defined as having a robust cranio-caudal segment sequence resulting in a head first turning strategy (Spildooren et al, 2017) or steering synergy (Patla et al, 1999; Ambati et al, 2016). This strategy requires independent control of the segments, increasing the complexity

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