Abstract
BackgroundRhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic Parkinson’s disease (PD). However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training.MethodsWe enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical, kinematic, and electrophysiological effects of both the gait trainings.ResultsWe found a greater improvement in Functional Gait Assessment (p < 0.001), Tinetti Falls Efficacy Scale (p < 0.001), Unified Parkinson Disease Rating Scale (p = 0.001), and overall gait quality index (p < 0.001) following RAS than non_RAS training. In addition, the RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle, and a greater improvement of fronto-centroparietal/temporal electrode connectivity than the non_RAS gait training.ConclusionsThe findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity. Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum. Finally, identifying these mechanisms is crucial to create patient-tailored, RAS-based rehabilitative approaches in PD.Trial registrationNCT03434496. Registered 15 February 2018, retrospectively registered.
Highlights
The loss of automaticity and rhythmicity of movements in patients with idiopathic Parkinson’s disease (PD) has been correlated with the presence of different gait abnormalities, including shuffling steps, gait initiation failure, and freezing of gait [33], which all make the gait rehabilitation challenging in these patients [12]
We evaluated α (8–12 Hz) and β (13–28 Hz) frequency range changes in power and coherence within the frontal, centroparietal, and temporal areas induced by treadmill gait training (GaitTrainer3; Biodex, Shirley, NY, US) with and without Rhythmic Auditory Stimulation (RAS) in a group of patients with PD
There were no significant differences in EEG and gait differences between the groups
Summary
The loss of automaticity and rhythmicity of movements in patients with idiopathic Parkinson’s disease (PD) has been correlated with the presence of different gait abnormalities, including shuffling steps, gait initiation failure, and freezing of gait [33], which all make the gait rehabilitation challenging in these patients [12]. Gait rehabilitation in patients with PD is aimed at restoring the cerebral mechanisms that generate a regular walking rhythm These patients have been provided with a walking treadmill equipped with rhythmic auditory stimulation (RAS) to improve gait parameters by harnessing the innate internal timing process (i.e., rhythmic entrainment) through external cues [49, 51, 52, 59, 69, 81, 82, 85]. Auditory cues significantly improve gait parameters [37], probably by providing an external rhythm that bypasses the internal rhythm deficit [49, 54] by engaging complex frontoparietal connections based on complex cortico-BG-cerebellar loops [9] This could compensate for any failure in the mechanisms controlling automatic and rhythmic movement generation [54]. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training
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