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P2.072 Modality-speci.c feedback affects gait synchronization during side-by-side walking
Rehabilitation
S61
P2.069 Non-rhythmic auditory stimulation prior to walking may improve gait dynamics in patients with moderate Parkinson’s disease
P2.071 A strategy to cope with gait and balance problems during off periods in Parkinson’s disease (discovered by a patient)
M. Frenkel° , N. Giladi1 , L. Gruendlinger1 , G. Yogev-Seligmann1 , J.M. Hausdorff1,2 1 Tel-Aviv, Israel; 2 Boston, MA, USA
M. Graziano° , A. Bisdorff Esch-sur-Alzette, Luxembourg
Background and Aims: When patients with Parkinson’s disease (PD) walk in time to a metronome using rhythmic auditory stimulation (RAS), their gait generally improves. Interesting carryover effects have also been reported. To gain insight into the mechanisms responsible for these improvements, we tested the hypothesis that administration of RAS while seated, prior to walking, re-enforces rhythmicity and enhances gait. Methods: 23 patients with PD (mean Hoehn and Yahr: 2.4) were studied on two occasions, approximately one week apart, before and after listening to four minutes of RAS (at 110% of their usual cadence) while seated, or to arrhythmic (random) auditory stimulation (A-RAS), i.e., the control intervention. At the four test points, subjects walked at their comfortable rate for two minutes while wearing force-sensitive insoles, with and without a dual task (DT, i.e., serial 7 subtractions). Gait speed and dynamics (e.g., stride time variability, swing time variability) were quantified. Results: After RAS, no significant changes were observed, with or without the DT. In contrast, after A-RAS, swing time variability decreased (from: 2.9±1.0% to 2.7±1.0%, p < 0.046) during usual walking. After A-RAS, DT swing time increased (from 36.2±2.9% to 36.6±2.8%, p < 0.054) and DT stride time variability decreased (from 4.3±2.8% to 3.3±1.7%, p < 0.005). Conclusions: Somewhat surprisingly, non-rhythmic auditory stimulation enhances the gait of patients with moderate PD, while brief exposure to RAS while sitting does not. These findings raise important questions regarding the mechanisms whereby auditory stimulation affects parkinsonian gait (i.e., via pace-making?) and suggest that certain forms are efficacious, even when applied during sitting.
P2.070 Influence of attentional distractors in postural control in patients with acquired brain injury C. Gonzalez-Alted° , O. Robles-Aranda, A. Bilbao-Bilbao, S. PajaresGarcia, P. Casado-Romo, L. Gangoiti-Aguinaga Madrid, Spain Background: There is increasing interest in the effect that cognitive deficits, especially those related to attention, have in postural control, in patients with acquired brain injury (ABI), as well as their repercussion in everyday high level motor activities. Objectives: The main goals of this study were (1) to assess the effect of three attentional tasks in postural control in patients with ABI, and (2) to evaluate the validity of three dual tasks to be used in the clinical practice as diagnostic and rehabilitation techniques for postural control. Methods: Twenty-four individuals, 12 patients [mean age 33.58(8.72)] and 12 control subjects [mean age 34.75(9.06)], with ABI in subacute phases (mean time elapsing since injury 16 months) were assessed on 3 dual task paradigms consisting of visual and auditory attentional tasks of growing processing difficulty combined with force platform in several conditions: eye openness and type of surface. Results: Preliminary results showed a trend to increase body sway when comparing performance on the force platform while naming colors, with the force platform alone (36% of the tasks performed). No other significant changes were observed in body sway when performing the force platform alone and the dual task paradigms (p > 0.05) in any of the conditions, for patients with ABI or controls. Conclusions: Preliminary results show no evidence of attentional deficit repercussions in body sway in this sample population. Further cases are being included to determine whether lack of significant changes in body sway may be due to low sample size.
Background: In extrapyramidal diseases tricks and strategies to ease symptoms are used by patients and taught by therapists. Most of these strategies use sensory cues to overcome freezing episodes (like stepping over the foot of the carer to initiate gait) or strategies like breaking down a complex sequence of movement in parts (e.g. to turn in bed). These strategies are suitable to solve a problem of short duration and cues only work as long as they are present and patients focus their attention on them. Method and Results: A 50 y old male patient with a 20 year history of idiopathic Parkinson’s Disease discovered by chance a strategy to control his violent upper limb tremor appearing in off periods by bouncing a ball with his hands, and later on, noticed that this also allowed him to walk, run, turn and think better during off periods. He uses this strategy several times a day when he feels an off period coming and overcomes better the time until the next dose of medication works again. In the mean time also other patients have successfully applied this strategy. Conclusion: This example of a patient discovering a strategy to cope with “off ” periods raises questions on the pathophysiology of double tasking, strategies and cueing and can inspire research. Professionals can successfully teach these strategies and patients can learn from each other. The EPDA is developing a catalogue on coping strategies discovered by people with PD and makes it publicly available (www.epda.eu.com).
P2.072 Modality-specific feedback affects gait synchronization during side-by-side walking L. Gruendlinger1° , Y. Galil1 , I. Tamir1 , A. Zivotofsky1 , R. Bartsch1 , M. Plotnik1 , J.M. Hausdorff1,2 1 Tel Aviv, Israel; 2 Boston, MA, USA Background: Cueing for Parkinson’s disease patients typically involves setting either cadence, stride length, or speed. Gait synchronization (GS) between two side-by-side walkers imposes constraints on all three measures simultaneously. The sensory modalities mediating GS have not been studied quantitatively. Methods: 14 pairs of height- and gender-matched healthy young adults (age 26±2 yrs) walked together five times along a straight 70 m path with different sensory feedback configurations. Visual, auditory or tactile feedbacks (VF, AF or TF) were manipulated using side blinders, whitenoise earphones, or handholding, respectively. Pairs walked once with all three feedbacks provided (3F), once without any feedback (0F), and once with each modality (VF, AF or TF) available alone. Trunk-attached accelerometer data were used for estimating average cadence and the mutual gait synchronization index (GSI, range: 0−1), using the phase-synchronization method. A GSI reference value was obtained by “crossing” signals from different walks. Results: Average GSI was 0.24±0.22, 0.18±0.18, 0.16±0.19, and 0.15± 0.15 in the 3F, TF, AF, and 0F conditions, respectively, and 0.06±0.09 and 0.06±0.04 for VF and the no-synch reference, respectively (p < 0.02 for 3F vs. all conditions except TF). GSI was bimodally distributed: each walk was either “synchrnonized” or “unsynchronized”. 7 pairs had at least one synchronized walk and 7 others showed no synchronization. Synchronized pairs had significantly lower cadence than unsynchronized ones, except during VF. Conclusions: TF and AF, but not VF, were effective for synchronizing gait in several pairs. Synchronization was associated with slower cadences. Potential clinical implications for optimizing cueing remain to be determined.
S61
P2.069 Non-rhythmic auditory stimulation prior to walking may improve gait dynamics in patients with moderate Parkinson’s disease
P2.071 A strategy to cope with gait and balance problems during off periods in Parkinson’s disease (discovered by a patient)
M. Frenkel° , N. Giladi1 , L. Gruendlinger1 , G. Yogev-Seligmann1 , J.M. Hausdorff1,2 1 Tel-Aviv, Israel; 2 Boston, MA, USA
M. Graziano° , A. Bisdorff Esch-sur-Alzette, Luxembourg
Background and Aims: When patients with Parkinson’s disease (PD) walk in time to a metronome using rhythmic auditory stimulation (RAS), their gait generally improves. Interesting carryover effects have also been reported. To gain insight into the mechanisms responsible for these improvements, we tested the hypothesis that administration of RAS while seated, prior to walking, re-enforces rhythmicity and enhances gait. Methods: 23 patients with PD (mean Hoehn and Yahr: 2.4) were studied on two occasions, approximately one week apart, before and after listening to four minutes of RAS (at 110% of their usual cadence) while seated, or to arrhythmic (random) auditory stimulation (A-RAS), i.e., the control intervention. At the four test points, subjects walked at their comfortable rate for two minutes while wearing force-sensitive insoles, with and without a dual task (DT, i.e., serial 7 subtractions). Gait speed and dynamics (e.g., stride time variability, swing time variability) were quantified. Results: After RAS, no significant changes were observed, with or without the DT. In contrast, after A-RAS, swing time variability decreased (from: 2.9±1.0% to 2.7±1.0%, p < 0.046) during usual walking. After A-RAS, DT swing time increased (from 36.2±2.9% to 36.6±2.8%, p < 0.054) and DT stride time variability decreased (from 4.3±2.8% to 3.3±1.7%, p < 0.005). Conclusions: Somewhat surprisingly, non-rhythmic auditory stimulation enhances the gait of patients with moderate PD, while brief exposure to RAS while sitting does not. These findings raise important questions regarding the mechanisms whereby auditory stimulation affects parkinsonian gait (i.e., via pace-making?) and suggest that certain forms are efficacious, even when applied during sitting.
P2.070 Influence of attentional distractors in postural control in patients with acquired brain injury C. Gonzalez-Alted° , O. Robles-Aranda, A. Bilbao-Bilbao, S. PajaresGarcia, P. Casado-Romo, L. Gangoiti-Aguinaga Madrid, Spain Background: There is increasing interest in the effect that cognitive deficits, especially those related to attention, have in postural control, in patients with acquired brain injury (ABI), as well as their repercussion in everyday high level motor activities. Objectives: The main goals of this study were (1) to assess the effect of three attentional tasks in postural control in patients with ABI, and (2) to evaluate the validity of three dual tasks to be used in the clinical practice as diagnostic and rehabilitation techniques for postural control. Methods: Twenty-four individuals, 12 patients [mean age 33.58(8.72)] and 12 control subjects [mean age 34.75(9.06)], with ABI in subacute phases (mean time elapsing since injury 16 months) were assessed on 3 dual task paradigms consisting of visual and auditory attentional tasks of growing processing difficulty combined with force platform in several conditions: eye openness and type of surface. Results: Preliminary results showed a trend to increase body sway when comparing performance on the force platform while naming colors, with the force platform alone (36% of the tasks performed). No other significant changes were observed in body sway when performing the force platform alone and the dual task paradigms (p > 0.05) in any of the conditions, for patients with ABI or controls. Conclusions: Preliminary results show no evidence of attentional deficit repercussions in body sway in this sample population. Further cases are being included to determine whether lack of significant changes in body sway may be due to low sample size.
Background: In extrapyramidal diseases tricks and strategies to ease symptoms are used by patients and taught by therapists. Most of these strategies use sensory cues to overcome freezing episodes (like stepping over the foot of the carer to initiate gait) or strategies like breaking down a complex sequence of movement in parts (e.g. to turn in bed). These strategies are suitable to solve a problem of short duration and cues only work as long as they are present and patients focus their attention on them. Method and Results: A 50 y old male patient with a 20 year history of idiopathic Parkinson’s Disease discovered by chance a strategy to control his violent upper limb tremor appearing in off periods by bouncing a ball with his hands, and later on, noticed that this also allowed him to walk, run, turn and think better during off periods. He uses this strategy several times a day when he feels an off period coming and overcomes better the time until the next dose of medication works again. In the mean time also other patients have successfully applied this strategy. Conclusion: This example of a patient discovering a strategy to cope with “off ” periods raises questions on the pathophysiology of double tasking, strategies and cueing and can inspire research. Professionals can successfully teach these strategies and patients can learn from each other. The EPDA is developing a catalogue on coping strategies discovered by people with PD and makes it publicly available (www.epda.eu.com).
P2.072 Modality-specific feedback affects gait synchronization during side-by-side walking L. Gruendlinger1° , Y. Galil1 , I. Tamir1 , A. Zivotofsky1 , R. Bartsch1 , M. Plotnik1 , J.M. Hausdorff1,2 1 Tel Aviv, Israel; 2 Boston, MA, USA Background: Cueing for Parkinson’s disease patients typically involves setting either cadence, stride length, or speed. Gait synchronization (GS) between two side-by-side walkers imposes constraints on all three measures simultaneously. The sensory modalities mediating GS have not been studied quantitatively. Methods: 14 pairs of height- and gender-matched healthy young adults (age 26±2 yrs) walked together five times along a straight 70 m path with different sensory feedback configurations. Visual, auditory or tactile feedbacks (VF, AF or TF) were manipulated using side blinders, whitenoise earphones, or handholding, respectively. Pairs walked once with all three feedbacks provided (3F), once without any feedback (0F), and once with each modality (VF, AF or TF) available alone. Trunk-attached accelerometer data were used for estimating average cadence and the mutual gait synchronization index (GSI, range: 0−1), using the phase-synchronization method. A GSI reference value was obtained by “crossing” signals from different walks. Results: Average GSI was 0.24±0.22, 0.18±0.18, 0.16±0.19, and 0.15± 0.15 in the 3F, TF, AF, and 0F conditions, respectively, and 0.06±0.09 and 0.06±0.04 for VF and the no-synch reference, respectively (p < 0.02 for 3F vs. all conditions except TF). GSI was bimodally distributed: each walk was either “synchrnonized” or “unsynchronized”. 7 pairs had at least one synchronized walk and 7 others showed no synchronization. Synchronized pairs had significantly lower cadence than unsynchronized ones, except during VF. Conclusions: TF and AF, but not VF, were effective for synchronizing gait in several pairs. Synchronization was associated with slower cadences. Potential clinical implications for optimizing cueing remain to be determined.