‘Recoupling’ the attentional and motor control of preparatory postural adjustments to overcome freezing of gait in Parkinson’s

Journal of NeuroEngineering and Rehabilitation

Meriel Norris¹  Anna Fielding¹  William Young²  Amy Maslivec³  Mark Wilson⁴ 

[1] College of Health and Life Sciences, Brunel University London, Uxbridge, UK;College of Health and Life Sciences, Brunel University London, Uxbridge, UK;School of Sport and Health Sciences, University of Exeter, EX1 2LU, Exeter, UK;Department of Surgery and Cancer, Imperial College London, London, UK;School of Sport and Health Sciences, University of Exeter, EX1 2LU, Exeter, UK;

关键词: Parkinson’s;    Freezing of gait;    Cueing;    Step initiation;    Anticipatory postural adjustment;    Weight-shifting;    Festination;    Start hesitation;   

DOI  :  10.1186/s12984-020-00776-1

来源: Springer

【 摘 要 】

ObjectivesThis study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG.MethodsThirty-five people with Parkinson’s and FoG attempted to initiate forward walking from a stationary position caused by a freeze (n = 17, FoG-F) or voluntarily stop (n = 18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: (i) explicit verbal instruction, and (ii) implicit movement analogies.ResultsAt Baseline, weight-shift amplitudes were smaller during: (i) unsuccessful, compared to successful step initiations (FoG-F group), and (ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group).ConclusionsHypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.

【 授权许可】

CC BY