Combined auditory and visual cueing provided by eyeglasses influence gait performance in Parkinson Disease patients submitted to deep brain stimulation: a pilot study
Keywords:Parkinson disease, deep brain stimulation, gait
Background: Auditory-visual cueing using portable cueing devices has been effective for gait training in rehabilitation programs with Parkinson patients. However, it is possible that some gait problems arise due to interference from chronic high frequency stimulation with the gait and balance neural networks in patients with Parkinson Disease. Thus, it should be useful to test whether advanced Parkinson Disease patients experiencing gait problems (despite the treatment with medication and high frequency deep brain stimulation) would benefit from therapy using cueing. Methods: Eyeglasses combining auditory-visual cueing were used with 18 patients with advanced Parkinson Disease and treated with medication and deep brain stimulation. Patients were assessed using the Dynamic Gait Index, Timed Up and Go and Six-Minute Walking Test and performance was measured with and without the cueing (with and without eyeglasses on). Results: One way ANOVA on the performance measures indicated that Dynamic Gait Index and Six-Minute Walking Test significantly improved in the cued condition. Since cueing was task specific, and Timed Up and Go includes subtasks such sitting and standing, the combined auditory-visual cueing did not improve performance on such tasks. Conversely, the combined cueing may have worked as distractors during these subtasks. Conclusion: Combined auditory-visual cueing provided by this wearable technology may have practical applicability in rehabilitation therapy. It provided additional benefits on gait in patients with advanced Parkinson Disease with deep brain stimulation in the subthalamic nucleus.
Nieuwboer A, Giladi N. Characterizing freezing of gait in Parkinson's disease: models of an episodic phenomenon. Mov Disord. 2013; 28:1509-1519.
Dibble LE, Lange M. Predicting falls in individuals with Parkinson disease: a reconsideration of clinical balance measures. J Neurol Phys Ther 2006; 30: 60â€“67.
PÃ¶tter-Nerger M, Volkmann J. Deep brain stimulation for gait and postural symptoms in Parkinson's disease. Mov Disord. 2013;28:1609-1615.
Schuepbach WM, Rau J, Knudsen K, Volkmann J, Krack P, Timmermann L, HÃ¤lbig TD, Hesekamp H, et al. EARLYSTIM Study Group. Neurostimulation for Parkinson's disease with early motor complications. N Engl J Med. 2013;368:610-22.
Annic A, Moreau C, Salleron J, Devos D, Delval A, Dujardin K, Touzet G, Blond S, DestÃ©e A, Defebvre L. Predictive factors for improvement of gait by low-frequency stimulation in Parkinson's Disease.2014 J Parkinsons Dis. 2014 [Epud ahead of print]
Griffin HJ, Greenlaw R, Limousin P, Bhatia K, Quinn NP, Jahanshahi M. The effect of real and virtual visual cues on walking in Parkinsonâ€™s. disease. J Neurol. 2011: 258:991â€“1000.
Schlick C, Struppler A, Boetzel K, Plate A, Ilmberger J. Dynamic visual cueing in combination with treadmill training for gait rehabilitation in Parkinson disease. Am J Phys Med Rehabil 2012;91:75-79.
Espay AJ, Baram Y, Dwivedi AK, Shukla R, Gartner M, Gaines L, Duker A, Revilla R. At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease. Journal of Rehabilitation Research & Development 2010; 47: 573-582.
Lopez CWO, Higuera CAE , Fonoff ET, Souza CO , Albicker U, Martinez JAE. Listenmee and Listenmee smartphone application: synchronizing walking to rhythmic auditory cues to improve gait in Parkinsonâ€™s disease. Human Movement Science .2014;37: 147â€“156.
Metman LV, Myre B, Verney N, Hassin-Baer S, Arzbaecher J, Sierens D, Bakay R. Test-retest reliability of UPDRS- III, dyskinesia scales, and timed motor test in patients with advanced ParkinsonÂ´s disease: an argument against multiple baseline assessments. Mov Disord 2004;19:1079-84.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. SugestÃµes para o uso do mini-exame do estado mental no Brasil. Arq Neuro-Psiquiatr 2003;61:777-81.
Slick F. Clinical normative data for the WCST-64 following uncomplicated mild head injury. Neuropsychology. 2007; 7: 247-251
Litvan I, Bhatia KP, Burn DJ, Goetz CG, Lang AE, McKeith I, et al, Movement Disorders Society Scientific Issues Committee. Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders. Mov Disord. 2003;18:467-86
Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967; 17: 427â€“442.
Tinetti ME . Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119â€“126.
Podsiadlo D, Richardson S .The Timed â€œUp & Goâ€: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc.1991;39:142â€“148.
Falvo MJ, Earhart GM. Six-minute walk distance in persons with Parkinson disease: a hierarchical regression model. Arch Phys Med Rehabil. 2009;90:1004-1008
Huang SL, Hsieh CL, Wu RM, Tai CH, Lin CH, Lu WS. Minimal detectable change of the timed ''Up & Go'' test and the dynamic gait index in people with Parkinson disease Phys Ther. 2011; 91:114-121.
Bhatt T, Yang F, Mak MKY, Christina WY, Chan H, Pai YC. Effect of externally cued training on dynamic stability control during the sit-to- stand task in people with Parkinson disease. Phys Ther. 2013; 93(4): 492â€“503.
StegemÃ¶ller EL, Zadikoff C, Rosenow JM, Mackinnon CD. Deep brain stimulation improves movement amplitude but not hastening of repetitive finger movements. Neurosci Lett. 2013; 552:135-139.
Winfree KN, Pretzer-Aboff I, Hilgart D, Aggarwal R, Behari M, Agrawal SK. The effect of step-synchronized vibration on patients with Parkinsonâ€™s disease: case studies on patients with freezing of gait or an implanted deep brain stimulator. IEEE Transactions on Neural Systems and Rehabilitation Engineering 2013; 21:806-811.
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