New Freezing Of Gait Questionnaire Research Articles

Executive Control of Walking in People With Parkinson’s Disease With Freezing of Gait

Background Walking abnormalities in people with Parkinson’s disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. Objective To investigate the influence of FoG status on automaticity of walking in people with PD. Methods Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD−FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. Results PD+FoG had greater PFC activation during both single and dual-task walking than PD−FoG (P = .031). There were no differences in gait between PD−FoG and PD+FoG. Both groups decreased gait speed (P = .029) and stride length (P < .001) during dual-task walking compared with single-task walking. Conclusions These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.

The efficacy of cognitive-cycling dual-task training in patients with early-stage Parkinson's disease: A pilot study.

Recent studies have suggested that cognitive-motor dual-task (DT) training might improve gait performance, locomotion automaticity, balance, and cognition in patients with Parkinson's disease (PD). We aimed to investigate the efficacy of cognitive-cycling DT training in patients with early-stage PD. Participants were scheduled to perform cognitive tasks simultaneously with the cycling training twice per week for eight weeks for a total of 16 sessions during their on-states. Clinical assessments were conducted using the unified Parkinson's disease rating scale (UPDRS), modified Hoehn and Yahr stage, Timed Up and Go (TUG) test, gait and cognitive performances under dual-task paradigm, the new freezing of gait questionnaire, Schwab and England Activities of Daily Living scale, 39-item Parkinson's disease questionnaire, and cognitive performance. Thirteen eligible patients were enrolled in the study. The mean age was 60.64±5.32 years, and the mean disease duration was 7.02±3.23 years. Twelve PD patients completed 16 serial cognitive-cycling sessions for two months. After 16 sessions of training (T2), the UPDRS III scores improved significantly in both the off- and on-states, and TUG were significantly less than those at pretraining (T0). During both the single-task and the DT situations, gait performance and spatial memory cognitive performance significantly improved from T0 to T2. The present study demonstrated that cognitive-cycling DT training improves the motor functions, gait and cognitive performances of PD patients.

A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait.

Exercises with motor complexity induce neuroplasticity in individuals with Parkinson's disease (PD), but its effects on freezing of gait are unknown. The objective of this study was to verify if adapted resistance training with instability - exercises with motor complexity will be more effective than traditional motor rehabilitation - exercises without motor complexity in improving freezing-of-gait severity, outcomes linked to freezing of gait, and brain function. Freezers were randomized either to the adapted resistance training with instability group (n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. The primary outcome was the New Freezing of Gait Questionnaire. Secondary outcomes were freezing of gait ratio (turning task), cognitive inhibition (Stroop-III test), motor signs (Unified Parkinson's Disease Rating Scale part-III [UPDRS-III]), quality of life (PD Questionnaire 39), anticipatory postural adjustment (leg-lifting task) and brain activation during a functional magnetic resonance imaging protocol of simulated anticipatory postural adjustment task. Outcomes were evaluated before and after interventions. Only adapted resistance training with instability improved all the outcomes (P < 0.05). Adapted resistance training with instability was more effective than traditional motor rehabilitation (in improving freezing-of-gait ratio, motor signs, quality of life, anticipatory postural adjustment amplitude, and brain activation; P < 0.05). Our results are clinically relevant because improvement in the New Freezing of Gait Questionnaire (-4.4 points) and UPDRS-III (-7.4 points) scores exceeded the minimally detectable change (traditional motor rehabilitation group data) and the moderate clinically important difference suggested for PD, respectively. The changes in mesencephalic locomotor region activation and in anticipatory postural adjustment amplitude explained the changes in New Freezing of Gait Questionnaire scores and in freezing-of-gait ratio following adapted resistance training with instability, respectively. Adapted resistance training with instability is able to cause significant clinical improvement and brain plasticity in freezers. © 2020 International Parkinson and Movement Disorder Society.

Repetitive Motor Control Deficits Most Consistent Predictors of Conversion to Freezing of Gait in Parkinson's Disease: A Prospective Cohort Study.

The onset of freezing of gait (FOG) represents a turning point in the lives of patients with Parkinson's disease (PD). FOG increases fall risk and is associated with worse physical and mental health related quality of life, thus increasing disease burden. Moreover, therapeutic studies aiming to ameliorate freezing have had limited success. In a step towards pre-emptive therapy to delay or prevent the onset of FOG, this prospective cohort study set out to uncover clinical markers of conversion to FOG. Investigate clinical markers of conversion to FOG. Sixty PD patients without FOG were followed up for two years and underwent extensive clinical testing each year. FOG classification was made with the New Freezing of Gait Questionnaire. Clinical predictors of conversion to FOG were investigated using univariate analysis and through building a multivariable model using all measured components. Twelve patients developed FOG during the study (Incidence: 11.5% per year). Due to the large number of predictors, univariate analyses did not survive multiple comparison correction, precluding strong inference on any one predictor. Overall, the effect sizes suggested that motor deficits including difficulties with repetitive movement scaling (AUC: 0.71), coordination (AUC: 0.73) and consistency (AUC: 0.76) as well as gait asymmetry (AUC: 0.79) and variability (AUC: 0.71) were most predictive of conversion. Further, converters reported more subjective cognitive difficulty (AUC: 0.74), although their measured performance was similar to non-converters. Multivariable analyses further showed that the two components most consistently selected in the predictive model were: 1) an MDS-UPDRS component with worse axial motor, hand use and non-motor symptoms; and 2) finger tapping abnormalities. Conversion to FOG was predicted mainly by objective and clinical measures of motor dyscontrol, as non-motor disturbances were surfacing. Although based on a small cohort with limited converters, this novel finding informs future studies aimed at FOG prevention.

Do Patients With Parkinson’s Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality?

Background. People with Parkinson’s disease and freezing of gait (FOG+) have more falls, postural instability and cognitive impairment compared with FOG−. Objective. To conduct a secondary analysis of the V-TIME study, a randomized, controlled investigation showing a greater reduction of falls after virtual reality treadmill training (TT + VR) compared with usual treadmill walking (TT) in a mixed population of fallers. We addressed whether these treadmill interventions led to similar gains in FOG+ as in FOG−. Methods. A total of 77 FOG+ and 44 FOG− were assigned randomly to TT + VR or TT. Participants were assessed pre- and posttraining and at 6 months’ follow-up. Main outcome was postural stability assessed by the Mini Balance Evaluation System Test (Mini-BEST) test. Falls were documented using diaries. Other outcomes included the New Freezing of Gait Questionnaire (NFOG-Q) and the Trail Making Test (TMT-B). Results. Mini-BEST scores and the TMT-B improved in both groups after training (P = .001), irrespective of study arm and FOG subgroup. However, gains were not retained at 6 months. Both FOG+ and FOG− had a greater reduction of falls after TT + VR compared with TT (P = .008). NFOG-Q scores did not change after both training modes in the FOG+ group. Conclusions. Treadmill walking (with or without VR) improved postural instability in both FOG+ and FOG−, while controlling for disease severity differences. As found previously, TT + VR reduced falls more than TT alone, even among those with FOG. Interestingly, FOG itself was not helped by training, suggesting that although postural instability, falls and FOG are related, they may be controlled by different mechanisms.

The New Freezing of Gait Questionnaire: Unsuitable as an Outcome in Clinical Trials?

Freezing of gait (FOG) is a common gait deficit in Parkinson's disease. The New Freezing of Gait Questionnaire (NFOG-Q) is a widely used and valid tool to quantify freezing of gait severity. However, its test-retest reliability and minimal detectable change remain unknown. To determine the test-retest reliability and responsiveness of the NFOG-Q. Two groups of freezers, involved in 2 previous rehabilitation trials, completed the NFOG-Q at 2 time points (T1 and T2), separated by a 6-week control period without active intervention. Sample 1 (N = 57) was measured in ON and sample 2 (N = 14) in OFF. We calculated various reliability statistics for the NFOG-Q scores between T1 and T2 as well as correlation coefficients with clinical descriptors to explain the variability between time points. In sample 1 the NFOG-Q showed modest reliability (intraclass correlation coefficient = 0.68 [0.52-0.80]) without differences between T1 and T2. However, a minimal detectable change of 9.95 (7.90-12.27) points emerged for the total score (range 28 points, relative minimal detectable change of 35.5%). Sample 2 showed largely similar results. We found no associations between cognitive-related or disease severity-related outcomes and variability in NFOG-Q scores. We conclude that the NFOG-Q is insufficiently reliable or responsive to detect small effect sizes, as changes need to go beyond 35% to surpass measurement error. Therefore, we warrant caution in using the NFOG-Q as a primary outcome in clinical trials. These results emphasize the need for robust and objective freezing of gait outcome measures.

PEOPLE LIVING WITH PARKINSON DISEASE WITH AND WITHOUT FREEZING: DIFFERENCES USING THE NEURO-QOL MEASUREMENT SYSTEM

Parkinson disease (PD) is the second most common neurodegenerative disease and approximately half of those diagnosed with PD will experience freezing of gait (FOG). FOG is a severe motor disturbance that prevents stepping despite the intention to do so and may be associated with anxiety, decreased cognitive functioning, depression, and poorer quality of life. In this study, we administered the short-form Quality of Life in Neurological Disorders (Neuro-QOL) measurement system to 43 people with PD (28 non-freezers and 15 freezers) and determined freezing status using the New Freezing of Gait-Questionnaire. Freezers had greater motor severity as measured with the MDS-UPDRS-III (p =.003) and poorer balance using the Mini-BESTest (p = .017). Data from the Neuro-QOL battery indicated freezers had greater difficulty with Lower Extremity Function (p = .019) and Upper Extremity Function (p = .027). Freezers also had poorer scores on the Positive Affect and Well-Being (p = .005), Satisfaction with Social Roles and Activities (p = .005), and Stigma (p = .026) scales, but less difficulty on the Communication scale (p = .005) than non-freezers. There were no differences between freezers and non-freezers on the Ability to Participate in Social Roles and Activities, Anxiety, Cognitive Function, Depression, Emotional and Behavioral Dyscontrol, Fatigue, or Sleep Disturbance scales. These findings suggest freezers are less likely to have a positive outlook and satisfaction with their daily lives in combination with poorer functioning. Interventions that target freezing with the potential to improve functioning may result in better quality of life among freezers.

When motor control gets out of hand: Speeding up triggers freezing in the upper limb in Parkinson's disease

IntroductionPatients with Parkinson's disease (PD) can suffer from sudden movement arrests during upper limb tasks. The current study investigated a test to assess freezing of the upper limbs (FOUL) at two speed conditions to improve the sensitivity of FOUL detection. MethodsForty-nine patients with PD and 10 age-matched controls (HC) performed a freezing-provoking writing task, requiring up- and down-stroke writing at varying sizes in-between visual target zones indicating funnel-shapes on a touch-sensitive tablet. They performed five trials at their preferred speed, referred to as the Normal Funnel Task (NFT) and five trials at maximum speed, referred to as the Fast Funnel Task (FFT), in a random order. ResultsBased on a combination of kinematic criteria and video analysis, 183 FOUL episodes were detected in 24 participants (23 PD, 1 HC). The number of patients with FOUL, number of FOUL episodes and percentage time frozen were significantly higher during FFT than NFT. Most FOUL episodes occurred during writing at small (51.6%) and decreasing size (36.3%). Additionally, FOUL outcomes significantly correlated with the Montreal Cognitive Assessment and New Freezing of Gait Questionnaire. ConclusionAs FOUL is more prevalent under higher task demands, these data offer support for the “threshold model”, previously proposed to provide insight in freezing of gait (FOG) and underscoring the presupposed link between FOG and FOUL. As well, this study may provide a novel paradigm to assess FOUL in both laboratory and clinical settings.

Clinical features of freezing of gait in Parkinson's disease patients.

ObjectiveTo clarify the clinical features of freezing of gait (FOG) in Parkinson's disease (PD) patients by classification into two groups: Clinically observed FOG (CFOG) and self‐reported FOG (SFOG).MethodsTwo hundred twenty‐nine PD patients were medically examined in an examination room as well as subjected to a New Freezing of Gait Questionnaire (NFOG‐Q) and analysis of nonmotor symptoms including sleep, cognition, depression, and fatigue.ResultsThe prevalence of CFOG was 17.9%, while 53.7% of the patients without CFOG reported the presence of FOG via the NFOG‐Q. Univariate analysis revealed that CFOG was associated with longer disease duration, motor dysfunction, sleepiness, fatigue, and cognitive dysfunction. These symptoms, excluding akinesia, apathy, rapid eye movement (REM) sleep Behavior Disorder, and cognitive dysfunction, were also associated with SFOG. Multivariate analysis revealed that long PD duration, postural instability, and gait difficulty (PIGD), along with fatigue, were independent factors for SFOG.ConclusionsSFOG and CFOG have many common clinical features. Although the clinical relevance of SFOG remains unclear, careful attention should be paid to related features in clinical practice.

Effects of robot-assisted gait training in patients with Parkinson\u2019s disease: study protocol for a randomized controlled trial

BackgroundRobot-assisted gait training (RAGT) was developed to restore gait function by promoting neuroplasticity through repetitive locomotor training and has been utilized in gait training. However, contradictory outcomes of RAGT have been reported for patients with Parkinson’s disease (PD). In addition, the mechanism of the RAGT treatment effect is still unknown. This study aims to investigate the effects of RAGT on gait velocity in patients with PD and to unveil the mechanisms of these effects.MethodsThis is a prospective, single-blind, single-center, randomized controlled trial. Eligible participants will be randomly allocated to: 1) a Walkbot-S™ RAGT group or 2) a treadmill training group. The participants will receive three 45-min sessions of each intervention per week for 4 weeks. Gait speed during RAGT will be targeted to the maximal speed depending on the participant’s height; the same principle will be applied to the treadmill training group to match the training intensity. The primary outcome measure is gait speed measured by the 10-Meter Walk Test at a comfortable pace under single-task conditions. Secondary outcomes include dual-task interference, the Berg Balance Scale, Timed Up and Go test, the Korean version of the Falls Efficacy Scale-International, New Freezing of Gait Questionnaire, Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale, and functional connectivity measured by resting-state functional magnetic resonance imaging. Baseline assessments (T0) will be conducted to acquire clinical characteristics and outcome measure values before the intervention. Postintervention assessments (T1) will compare immediate efficacies within 3 days after the intervention. Follow-up assessments (T2) will be conducted 1 month after the intervention. Considering an alpha of 0.05 and a power of 80%, the total number of participants to be recruited is 44.DiscussionThis study will reveal the effect of RAGT using an exoskeletal robot, not only on gait speed, but also on gait automaticity, balance function, fall risk, quality of life, and disease severity. In addition, the study will shed new light on the mechanism of the RAGT effect by evaluating changes in gait automaticity and brain functional networks.Trial registrationClinicalTrials.gov, NCT03490578. Registered on 21 March 2018.

Improving gait function and sensorimotor brain plasticity through robotic gait training with G-EO system in Parkinson's disease

Medication resistant-FOG (FOG-R) is a disabling symptom of advanced Parkinson's Disease (PD) and it is largely untreatable. The study purpose was to examine the efficacy of robotic gait training (G-EO system) on FOG-R while analysing neurophysiological changes before and after treatment. Nine patients with advanced PD and history of FOG-R underwent G-EO training (12 sessions, 3 times/week, 4 weeks). Exclusion criteria were: dementia; change of PD medication in the last month; dyskinesias; other neurological disorders; severe orthopaedic and cardiovascular diseases; rehabilitation treatments within 3 months of enrolment. Outcome measures: number and duration of FOG episodes detected both in outpatient clinic during videotaped Timed Up and Go tests (TUG) and at home, by means of a smartphone app; Gait and Falls Questionnaire; New Freezing of Gait Questionnaire; PD Questionnaire-39; Home diary of falls, Mini-BESTest for balance evaluation, UPDRS III, Six-Minutes Walking Test. All patients were tested by Transcranial Magnetic Stimulation (TMS) before and after treatment both in OFF and ON medication states. Sensorimotor plasticity (SMP) was induced by means of the rapid paired associative stimulation (rPAS). Motor evoked potentials (MEPs) were recorded at baseline and for 15 minutes after rPAS. After robotic treatment the gait performance improved in terms of speed, endurance, step rhythm and balance. At home, FOG occurrence and duration decreased by about 50%. Before rehabilitation, SMP was deficient in all subjects both in OFF and ON states. The robotic treatment restored the potentiation of MEPs amplitudes by rPAS both in OFF and ON states. An inverse correlation was found between PD duration and the improvement in MEPs amplitude induced by rPAS, after rehabilitation. Robotic gait training with G-EO System is an effective rehabilitation approach able to improve gait performance and reduce FOG-R in PD patients by shaping SMP.

The Impact Of Freezing Of Gait On Balance Perception And Mobility In Community-Living With Parkinson'S Disease.

This pilot study investigated the impact of freezing of gait, objectively measured with three inertial sensors, on mobility function during seven days of communityliving monitoring in people with Parkinson's disease.Twenty-four subjects with PD, of which 14 experiencing freezing of gait, were recruited in this study. Subjects wore three inertial sensors (Opals, APDM) attached to both feet and the lumbar region for a week of continuous monitoring. Walking bouts, of at least 10s, were first identified, and then features of freezing, quantity and quality of mobility were extracted and averaged across the seven days.Results showed significant impairments in freezing and quality of mobility in the freezers group compared to the nonfreezers. Our measures of average and variability of time spent freezing was associated to the subjects' perception of freezing, assessed with the New Freezing of Gait Questionnaire. These preliminary results are introducing promising measures of mobility impairments measured during community-living in PD.

Basal Ganglia and Prefrontal Regions Influence Postural Control and Cognitive Impairment in Parkinson's Disease

ObjectivePostural instability is one of clinical manifestations caused by the deterioration of basal ganglia (BG) in Parkinson's disease (PD). It has frequently been found in moderate and advanced stages of the disease, simultaneously, impairments of cognition and executive function are also commonly present. Several studies reported interferences between postural control and cognitive tasks passing the prefrontal regions. We aimed to reveal the roles of BG and prefrontal regions in postural control and cognitive impairment in PD patients who exhibit freezing of gait (FOG).MethodsWe measured postural control in 60 patients with Parkinson's disease (PD) in on‐medication (39 PD patients with FOG and 21 PD patients without FOG). A Nintendo Wii balance board was utilized to measure postural stability in terms of center of pressure (CoP). A modified Hoehn and Yahr scale (H&amp;Y) was used to classify clinical staging of PD. Subjects' disease severities were evaluated by using Unified Parkinson's Disease Rating Scale (UPDRS) (part III). Levodopa Equivalent Dose (LED), New Freezing of Gait questionnaire (NFOG‐Q), and Montreal Cognitive Assessment were also assessed. The participants were instructed to stand naturally on the balance platform and look at a marker, which was 3 meters from the board. The subjects were asked to perform counting days backward for a total of 170 seconds. A computer program collected the data automatically (Buated, W., et.al. Gerontology and Geriatric Medicine, 2016). Regression analysis were performed for posturographic and clinical variables to identify relationships of mild cognitive impairment, postural instability and FOG. An important parameter of CoP; path length (PL), which was found to be dominant factor of the balance analysis (Buated, W., et al. The 19th International Congress of Parkinson's Disease and Movement Disorders, 2015), was also calculated. Principal component analysis was used to analyze all clinical variables and determined the statistical significance of the variance.ResultsAssociations between PL and clinical variables were observed in all patients; LED (R2 = 0.150, p = 0.001), H&amp;Y (R2 = 0.060, p = 0.060), duration of disease (R2 = 0.065, p &lt; 0.049) and NFOG‐Q (R2 = 0.108, p = 0.010). In PD patients with FOG, relationship was found in LED (R2 = 0.125, p = 0.032). On the other hand, no relationship was noticed in PD patients without FOG.ConclusionsBasal ganglia and prefrontal regions play important roles in postural control and cognitive function in PD patients. Freezing of gait (FOG), cognitive impairment and postural control are associated with the effects of medication. Among the clinical variables, the correlation between LED and PL was found to be most important. These influences of the interruption of the neural circuitry were expressed in the postural control of PD patients, especially those subjects with FOG symptoms.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Impacts of freezing of gait on forward and backward gait in Parkinson’s disease

Freezing of gait (FOG) is a major risk factor for falls and fall-related injuries in patients with Parkinson’s disease (PD). The characteristics of gait in PD patients with FOG have been studied but remain controversial. To investigate gait characteristics of FOG in PD, this study analyzed the forward and backward walking of patients with PD. Twenty-six patients with PD were recruited [age: 71.0 ± 6.2 years, Hoehn and Yahr stage: 2–3 (median 2.5)]. Based on responses to the New Freezing of Gait Questionnaire, we classified patients into either the “freezer” or “non-freezer” group. Spatiotemporal and kinematic analyses of forward and backward walking were completed using a three-dimensional motion analysis system over an 8 m walkway in the defined “off” state. There was no difference in demographic and clinical characteristics between the freezers (n = 10) and non-freezers (n = 16). Analysis of forward walking revealed no between-group differences, except for faster walking speed among the non-freezers. During backward walking, the freezers exhibited slower walking speed, shorter stride length, and increased asymmetry of step length. Kinematic analysis of backward walking revealed smaller range of motion in hip and ankle joints and lower step height in freezers. Further investigations of backward walking might expand our understanding of the pathophysiology of FOG in patients with PD.

The clinical characteristics and risk factors of frozen gait in Parkinson's disease

Objective o investigate the clinical characteristics and relevant risk factors of freezing gait in patients with Parkinson's disease (PD). Methods A total of 570 consecutive PD patients were registered basic information and evaluated by Unified Parkinson's Disease Rating Scale (UPDRS) and New Freezing of gait questionnaire (NFOG-Q). They were divided into the PD with freezing gait group (188 cases) and non-freezing gait group. Results UPDRS score in each part (UPDRS-Ⅰ, UPDRS-Ⅱ, UPDRS-Ⅲ, UPDRS-Ⅳ) and Hoehn & Yahr stage of the PD freezing gait group was significantly higher than that of the non frozen gait group (P<0.05). Conclusions PD patients with frozen gait group experience more rapid PD progression than those without freezing of gait. The appearance of FOG is associated with the mental behavior and emotion, treatment complication, disease severity, and course of PD. Key words: Parkinson disease/CO; Gait apraxia/CO

An 8-Week Low-Intensity Progressive Cycling Training Improves Motor Functions in Patients with Early-Stage Parkinson's Disease.

Background and PurposeThe effects of high-intensity cycling as an adjuvant therapy for early-stage Parkinson's disease (PD) were highlighted recently. However, patients experience difficulties in maintaining these cycling training programs. The present study investigated the efficacy of cycling at a mild-to-moderate intensity in early-stage PD.MethodsThirteen PD patients were enrolled for 16 serial cycling sessions over a 2-month period. Motor function was assessed using the Unified Parkinson's Disease Rating Scale part III (UPDRS III) and Timed Up and Go (TUG) test as primary outcomes. The Montreal Cognitive Assessment (MoCA), modified Hoehn and Yahr Stage (mHYS), total UPDRS, Falls Efficacy Scale, New Freezing of Gait Questionnaire, Schwab and England Activities of Daily Living, 39-item Parkinson's Disease Questionnaire, Patient Global Impression of Change, and gait performance were assessed as secondary outcomes.ResultsThe age and the age at onset were 59.67±7.24 and 53.23±10.26 years (mean±SD), respectively. The cycling cadence was 53.27±8.92 revolutions per minute. The UPDRS III score improved significantly after 8 training sessions (p=0.011) and 16 training sessions (T2) (p=0.001) in the off-state, and at T2 (p=0.004) in the on-state compared to pretraining (T0). The TUG duration was significantly shorter at T2 than at T0 (p<0.05). The findings of MoCA, total UPDRS, double limb support time, and mHYS (in both the off- and on-states) also improved significantly at T2.ConclusionsOur pioneer study has demonstrated that a low-intensity progressive cycling exercise can improve motor function in PD, especially akinesia. The beneficial effects were similar to those of high-intensity rehabilitation programs.

Cerebellar Volume and Executive Function in Parkinson Disease with and without Freezing of Gait.

Freezing of gait (FOG) affects approximately 50% of people with Parkinson Disease (PD), impacting quality of life and placing financial and emotional strain on the individual and caregivers. People with PD and FOG have similar deficits in motor adaptation and cognition as individuals with cerebellar lesions, indicating the cerebellum may play a role in FOG. To examine potential differences in cerebellar volumes and their relationships with cognition between PD with (FOG+) and without FOG (FOG-). Sixty-three participants were divided into two groups, FOG+ (n = 25) and FOG- (n = 38), based on the New Freezing of Gait Questionnaire. Cognitive assessment included Trail Making, Stroop, Verbal Fluency, and Go-NoGo executive function tasks. All participants completed structural T1- and T2-weighted MRI scans. Imaging data were processed with FreeSurfer and the Spatially Unbiased Infratentorial toolbox to segment the cerebellum into individual lobules. FOG+ performed significantly worse on phonemic verbal fluency (F(1, 22) = 7.06, p = 0.01) as well as the Go-NoGo task (F(1, 22) = 9.00, p = 0.004). We found no differences in cerebellar volumes between groups (F(4, 55) = 1.42, p = 0.24), but there were significant relationships between verbal fluency measures and lobule volumes in FOG-. These findings underscore the need for longitudinal studies to better characterize potential changes in cerebellar volume, cognitive function, and functional connectivity between people with PD with and without FOG.

Speech and gait in Parkinson's disease: When rhythm matters

IntroductionSpeech disturbances in Parkinson's disease (PD) are heterogeneous, ranging from hypokinetic to hyperkinetic types. Repetitive speech disorder has been demonstrated in more advanced disease stages and has been considered the speech equivalent of freezing of gait (FOG). We aimed to verify a possible relationship between speech and FOG in patients with PD. MethodsForty-three consecutive PD patients and 20 healthy control subjects underwent standardized speech evaluation using the Italian version of the Dysarthria Profile (DP), for its motor component, and subsets of the Battery for the Analysis of the Aphasic Deficit (BADA), for its procedural component. DP is a scale composed of 7 sub-sections assessing different features of speech; the rate/prosody section of DP includes items investigating the presence of repetitive speech disorder. Severity of FOG was evaluated with the new freezing of gait questionnaire (NFGQ). ResultsPD patients performed worse at DP and BADA compared to healthy controls; patients with FOG or with Hoehn-Yahr >2 reported lower scores in the articulation, intellibility, rate/prosody sections of DP and in the semantic verbal fluency test. Logistic regression analysis showed that only age and rate/prosody scores were significantly associated to FOG in PD. Multiple regression analysis showed that only the severity of FOG was associated to rate/prosody score. ConclusionsOur data demonstrate that repetitive speech disorder is related to FOG and is associated to advanced disease stages and independent of disease duration. Speech dysfluency represents a disorder of motor speech control, possibly sharing pathophysiological mechanisms with FOG.

Postural sensory correlates of freezing of gait in Parkinson's disease

IntroductionTo elucidate the unique patterns of postural sensory deficits contributing to freezing of gait (FOG) in patients with Parkinson's disease (PD) and to identify postural sensory modalities that correlate with FOG severity. MethodsTwenty-five PD patients with FOG, 22 PD patients without FOG, and 26 age-matched controls were evaluated using a sensory organization test and clinical measures including the Unified Parkinson's Disease Rating Scale motor score, Montreal Cognitive Assessment, Frontal Assessment Battery, Activities-specific Balance Confidence, Beck Anxiety Inventory, Beck Depression Inventory, and Berg Balance Scale. Multivariable logistic regression analysis was performed for posturographic parameters and possible confounders to determine postural sensory contributors to FOG. We also correlated FOG severity, measured using a New Freezing of Gait Questionnaire, with posturographic parameters. ResultsPD patients with FOG showed worse postural sensory processing compared with those without FOG. In particular, the inability to use the vestibular information (odds ratio [OR] 1.447; 95% confidential interval [CI]: 1.120, 1.869) and poor control over the perturbed somatosensory inputs (OR 2.904; 95% CI: 1.028, 8.202) significantly contributed to FOG. Among PD patients with FOG, FOG severity was correlated with higher reliance on visual information (ρ = −0.432, p = 0.039). ConclusionsPostural sensory deficits involving specific sensory modalities are strongly associated with FOG. Quantitative measurement of postural sensory deficits in PD patients with FOG may provide a better understanding of pathomechanisms of FOG and increase the efficacy of sensory cueing strategies for alleviating FOG, by more accurately identifying suitable patients for rehabilitative therapies.

A Randomized Controlled Feasibility Trial of a Specific Cueing Program for Falls Management in Persons With Parkinson Disease and Freezing of Gait.

Freezing of gait (FOG) increases fall risk in persons with Parkinson disease (PD). Cueing improves gait parameters associated with freezing, but it is unclear whether a cueing program can address falling. We used a parallel-groups delayed- (n = 12) or immediate-start (n = 9) randomized controlled trial design to evaluate a cueing exercise program for FOG and falls in participants with PD. Each group received preintervention falls monitoring, followed by a 6-month standardized, home-based, cueing exercise and education program. Participant questionnaires rated program value and compliance. Freezing was measured with the New Freezing of Gait Questionnaire (NFOGQ). Falls were recorded by weekly diaries. Self-reported adherence was high; 83% of participants reported exercising after 6 months. Participants reported that the program was beneficial (89%), walking improved (78%), falls were fewer (73%), and self-management of freezing improved (61%). Mean (standard deviation) NFOGQ scores were 14.8 (5.0), for the immediate (n = 10), and 16.0 (7.7) for the delayed group (n = 9), after 6 months (difference -1.0 [95% confidence interval, -7.9 to 6.0; P = 0.78]). With baseline NFOGQ scores as a covariate, the estimate of difference was -0.7 (95% confidence interval, -6.1 to 4.7; P = 0.79). The relative rate of falls for immediate compared with delayed groups was 1.22 (95% confidence interval, 0.45 to 3.26). The cueing program intervention is acceptable and participants feel they improve; however, this small feasibility study lacks statistical power to detect important changes in falls rates or FOG severity. A larger study is warranted to further investigate the potential to influence FOG and falls.Video Abstract available for more insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A105).