Research Paper: The Effect of Cognitive and Motor Dual- Task Training on Improvement of Balance and Some Spatiotemporal Gait Parameters in People With Idiopathic Parkinson's Disease (original) (raw)
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BMC Neurology, 2011
Background: Difficulty performing more than one task at a time (dual tasking) is a common and disabling problem experienced by people with Parkinson disease (PD). If asked to perform another task when walking, people with PD often take shorter steps or walk more slowly. Currently there is uncertainty about whether clinicians should teach people with PD to avoid dual tasking or whether they should encourage them to practice dual tasking with the hope that practice will lead to enhanced performance. This study will address this issue by comparing single to dual task gait training. Methods and design: A prospective randomised clinical trial is being conducted. Sixty participants with idiopathic PD will be recruited, provided they score I-IV on the modified Hoehn and Yahr (1967) scale, and fulfil other inclusion criteria. Participants will be randomly allocated to either a single or dual task gait training group. Both groups will receive 12 hours of walking training over 4 weeks. The single task group will undertake gait training with cueing strategies to increase step length. The dual task group will train to improve step length when walking and performing a variety of added tasks. Both groups will receive a tailored home program for 6 months. Blinded assessors will conduct four assessments: two baseline assessments, one post intervention and one at 6 months follow-up. The primary outcome measure will be step length when dual tasking over 8 m. Secondary outcome measures include: spatiotemporal gait parameters when walking under single and dual task conditions, measures of executive function, the timed up and go test, measures of community mobility, and quality of life. All analyses will be based on intention to treat principle.
PLOS ONE, 2019
Gait impairments in Parkinson's disease (PD) are aggravated under dual task conditions. Providing effective training to enhance different dual task gait performance is important for PD rehabilitation. This pilot study aimed to investigate the effects of cognitive and motor dual task gait training on dual task gait performance in PD. Eighteen PD participants (n = 6 per training group) were assigned to cognitive dual task gait training (CDTT), motor dual task gait training (MDTT), or general gait training (control) group randomly. The training was 30 min each session, 3 sessions per week for 4 weeks. Primary outcomes including gait performance during cognitive dual task, motor dual task, and single walking were assessed at pre-and post-training. The results showed decreased double support time during cognitive dual task walking after CDTT (-17.1±10.3%) was significantly more than MDTT (6.3±25.6%, p = .006) and control training (-5.6±7.8%, p = .041). Stride time variability during motor dual task walking decreased more after MDTT (-16.3±32.3%) than CDTT (38.6±24.0%, p = .015) and control training (36.8±36.4%, p = .041). CDTT also improved motor dual task walking performance especially on gait speed (13.8±10.71%, p = .046) stride length (10.5±6.6%, p = .046), and double support time (-8.0±2.0%, p = .028). CDTT improved single walking performance as well on gait speed (11.4±5.5%, p = .046), stride length (9.2±4.6%, p = .028), and double support time (-8.1±3.0%, p = .028). In summary, our preliminary data showed 12session of CDTT decreased double support time during cognitive dual task walking, and MDTT reduced gait variability during motor dual task walking. Different training strategy can be adopted for possibly different training effects in people with PD.
INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCE AND HEALTH CARE, 2017
BACKROUND: Parkinson disease is a very common neurodegenerative disease that affects more than 2 percent of the population older than 65 years of age. Many persons with Parkinson disease report impaired balance and falls.Patients with Parkinson disease are frequently referred for physical therapy to improve balance control and reduce the risk of falling. The majority of individuals with Parkinson disease will develop problems with postural instability and falls. Traditionally people with Parkinson"s disease were advised to avoid performing dual task while walking AIM: Since both single task and dual task condition have been used for Parkinson"s patient, the purpose of this study is to find out an effective task training to improve balance in Parkinson"s patients METHODOLOGY: An experimental study was conducted on 20 clinically diagnosed idiopathic (stage 3 according to Hoehn&Yahr score)Parkinson"s patient with age of 50-80 years who did not experience motor response fluctuations with mini mental state examination score greater than 24 were included in the study.Patients with uncontrolled Diabetes mellitus, with diagnosed visual and auditory impairment, with diagnosed visual and auditory impairment, unstable cardiorespiratory condition were excluded from the study. PROCEDURE:Written consent regarding their voluntary participation in the study was taken. Mini mental state examination and Berg balance scale was taken pre training for each patient.Then the patients were randomly divided into two groups. Age matched samples were taken in both the groups Group A were asked to perform single task activities and conventional PT treatment, while Group B performed dual task activities and conventional PT treatment.RESULTS: The mean difference of group A = 6 ±1.155 and that of group B = 4.3 ± 0.8233 with "t" value = 3.791 Mean of Group A shows more significant values with p ≤ 0.001 as compared to Group B, suggesting Single task training is more effective in balance training in Parkinson"s patients. CONCLUSION:The study result indicates that both the group showed beneficial effect on balance in patients with Parkinson"s disease but there was additional effect found in Group A trained on Single task training. Thus Single task training is an effective task training to improve balance in Parkinson"s patients
Clinical Rehabilitation, 2020
Objective: Evaluate immediate and long-term effects of highly challenging balance and gait training on pace-, rhythm-, variability-, asymmetry-, and postural control domains of gait for individuals with Parkinson’s disease (PD). Design: Randomized controlled trial - a secondary analysis. Setting: University hospital setting. Participants: One-hundred older adults with mild to moderate PD (Hoehn & Yahr 2 and 3). Intervention: Training group ( n = 51): 10 weeks (3 times/week) of intensive balance and gait training, incorporating dual tasks. Control group ( n = 49): care as usual. Main outcome measures: Spatiotemporal gait variables collected during normal and fast walking on a pressure-sensitive mat. A linear mixed model was used to evaluate training effects post intervention and at the 6 and 12 month follow-up. Results: Immediate training effects in the pace domain of gait were increased step velocity (normal speed: 8.2 cm/s, P = 0.04; fast: 10.8 cm/s, P
Parkinsonism & Related Disorders, 2019
Introduction: Gait deteriorates under dual task conditions in individuals with Parkinson's disease (PD). Therapeutic interventions have the potential to improve dual task performance, although it remains unclear how training affects gait performance under varying cognitive domains. The primary aim of this trial was to determine the effect of an 8-week single-or multi-modal gait and cognitive training intervention on dual task performance across cognitive domains in individuals with PD. Methods: Twenty individuals with PD completed a 24-session single-modal training (SMT, n = 10) or multimodal training (MMT, n = 10). The SMT group performed gait and cognitive training sequentially; the MMT group performed gait and cognitive training simultaneously. Gait was analyzed using motion capture analysis during simultaneous performance of six untrained cognitive tasks. Results: Both SMT and MMT resulted in significant improvements in MDS-UPDRS III scores and gait performance. Improvements in arm swing were more prevalent in the less affected extremity, while improvements in the more affected upper extremity favored the MMT group. Temporal aspects of gait (velocity, step length) improved under all dual task conditions, while postural aspects of gait (step width, arm swing) varied by cognitive task. Conclusions: Both SMT and MMT were effective in improving motor and dual task performance in PD. Improvements in upper extremity gait variables in the MMT group may indicate that the complexity of the training is be beneficial in PD. The different responses in temporal and postural aspects of gait highlights the need for clinicians to train multiple cognitive domains during behavioral therapy.
Factors Associated With Responsiveness to Gait and Balance Training in People With Parkinson Disease
Journal of Neurologic Physical Therapy, 2019
Background and Purpose: Although increasing evidence supports the benefit-of exercise among people with Parkinson disease (PwPD), it is unclear whether a given exercise modality suits all PwPD, given the heterogeneity of the disease. The purpose of this study was to explore factors associated with responsiveness to a highly challenging training intervention that incorporated dual-task exercises. Methods: Forty-seven PwPD (mean age: 73 years; 19 females, Hoehn and Yahr stages 2-3) who had participated in 10 weeks of highly challenging gait and balance training were included. Baseline demographics, disease-related factors, physical and cognitive ability, and perceived health were used for the prediction of percent change in balance performance (the Mini-BESTest) and comfortable gait speed between the pre-and postassessments, using multiple linear regression analyses. Results: Thirty-five percent of the variance of change in balance performance was explained by General Health Perceptions (β = −0.36), the Timed Up and Go test (β = −0.33), and the single-task performance of a cognitive task (β = −0.24). Forty-nine percent of change in gait speed was explained by gait speed while performing a dual task (β = −0.46), dual-task interference while walking (β = 0.43),
Motriz: Revista de Educação Física
To verify the effects of a multimodal exercise program on balance and motor functions, and the differences by sex, in people with Parkinson's disease (PD). Methods: The intervention study, was composed of 16 people with PD, that were assessed before and after 16 weeks of interventions with the multimodal exercise program. The effects were analyzed generally and by sex, using the Wilcoxon Test. The significance level was established at 5%. Results: Overall, there was an improvement in the strength of the lower limbs (LL) (p = 0.035) and upper limbs (UL) (p = 0.009), functional mobility (p = 0.003), gait (p = 0.050), balance (p = 0.001) and in motor scores of UPDRS III (p = 0.005), which categorize motor symptoms of the disease. In regards to sex, women affected muscle strength (p = 0.044) and flexibility of LL (p = 0.028), gait (p = 0.018), and motor aspects of the UPDRS III (p = 0.042). The men presented effects in muscle strength of the UL (p = 0.042). Women and men had a significant increase in functional mobility (p = 0.046 and p = 0.027, respectively) and in balance (p = 0.012 and p = 0.042, respectively). There was no significant difference for both sexes, in body mass and the reach behind the backtest. Conclusion: the multimodal exercise program contributed to the improvement in motor function and balance in men and women with PD. Nevertheless, the effects were more significant in women. The comprehension of the differences between men and women grants us a more directional and efficient approach to their treatment.
Journal of Neurology
Motor–cognitive training in Parkinson’s disease (PD) can positively affect gait and balance, but whether motor–cognitive (dual-task) performance improves is unknown. This meta-analysis, therefore, aimed to establish the current evidence on the effects of motor–cognitive training on dual-task performance in PD. Systematic searches were conducted in five databases and 11 studies with a total of 597 people (mean age: 68.9 years; mean PD duration: 6.8 years) were included. We found a mean difference in dual-task gait speed (0.12 m/s (95% CI 0.08, 0.17)), dual-task cadence (2.91 steps/min (95% CI 0.08, 5.73)), dual-task stride length (10.12 cm (95% CI 4.86, 15.38)) and dual-task cost on gait speed (− 8.75% (95% CI − 14.57, − 2.92)) in favor of motor–cognitive training compared to controls. The GRADE analysis revealed that the findings were based on high certainty evidence. Thus, we can for the first time systematically show that people with PD can improve their dual-task ability through ...
Effects of dance on gait and dual-task gait in Parkinson’s disease
2019
Background Gait impairments in Parkinson's disease (PD) limit independence and quality of life. While dance based interventions could improve gait, further studies are needed to determine if the bene ts generalise to different terrains and when dual-tasking. The aim was to perform a feasibility study of the effects of a dance intervention, based on the Dance for PD®(DfPD®) program, on gait under different dualtasks (verbal uency, serial subtraction) and surfaces (even, uneven), and to determine if a larger scale follow-up RCT is warranted. Methods A dance group (DG; n = 17; age = 65.8 ± 11.7 years) and a control group (CG: n = 16; age = 67.0 ± 7.7 years) comprised of noncognitively impaired (Addenbrooke's score: DG = 93.2 ± 3.6, CG = 92.6 ± 4.3) independently locomoting people with PD (Hoehn & Yahr I-III) participated in the study. The DG undertook a one-hour DfPD®based class, twice weekly for 12 weeks. The CG had treatment as usual. Gait analysis was performed at baseline and post-intervention while walking on two surfaces (even, uneven) under three conditions (regular walking; dual-task: verbal-uency, serial-subtraction). The data was analysed by means of a linear mixed model. ResultsThe DG improved signi cantly compared to the CG in gait velocity, cadence, step-length, and stride-length when even surface walking, with and without a dual-task. On the uneven surface the DG walked more cautiously during regular walking but had improved gait velocity, cadence and step-length when performing serial-subtractions. Conclusions DfPD®-based classes produced clinically signi cant improvement on spatiotemporal gait parameters under dual-task conditions and on uneven surfaces. This could arise from improved movement con dence and coordination; emotional expression; cognitive skills (planning, multitasking), and; utilisation of external movement cues. A large-scale RCT of this program is warranted.Trial registration A protocol for this study has been registered retrospectively at Australian New Zealand Clinical Trials Registry on 12.11.2018. Identi er: ACTRN12618001834246. Background Improving gait is of fundamental importance for people with PD as it is associated with independence and quality of life [1-4]. Amidst many debilitating symptoms, gait disturbances are a frequent cause of disability, and are characterised by reduced gait velocity, cadence, stride length, swing time and arm swing and a consequent increase in the double support phase [1, 3, 4]. Increased muscle rigidity reduces body rotation and encourages abnormal head-trunk intersegmental coordination during walking, thereby affecting gait velocity and turning [5, 6]. Stride time variability, which is a marker for impaired mobility [7], is increased. Given the wide range of potential PD-related gait disturbances and associated functional impairments, it is vital to nd effective gait improvement programs. An effective gait improvement program for people with PD should show bene ts in a variety of real-world conditions. For example, improvements should be evident when walking and talking (dual-task gait) and when walking on different terrains (e.g. on an uneven surface). People with PD are known to have dual-task gait de cits [8]. This is thought to be because dual-tasking relies on executive function and the ability to divide attention [9], both of which are affected by basal ganglia pathology even in early PD [10].