Strategies to Use Among Patients With PD During Gait Training

Researchers recently sought to identify mechanisms that sustain gait improvement among patients with Parkinson disease (PD) and found that cueing strategies, which include reshaping of sensorimotor rhythms and fronto-centroparietal and temporal connectivity, are useful.  

“Rhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic [PD], said Rocco Salvatore Calabro, MD, PhD, and colleagues. “However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood.” 

In order to identify the mechanisms that sustain gait improvement among patients with PD who practice RAS gait training, Dr Calabro and colleagues conducted a study. They enrolled 50 patients with PD. The participants were assigned to two different modalities, including treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. The research team measured clinical, kinematic, and electrophysiological effects of both the gait trainings. 

“We found a greater improvement in Functional Gait Assessment (P < 0.001), Tinetti Falls Efficacy Scale (P < 0.001), Unified Parkinson Disease Rating Scale (P = 0.001), and overall gait quality index (P < 0.001) following RAS than non_RAS training,” explained Dr Calabro and colleagues.  

Further study findings showed RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle. Additionally, RAS gait training resulted in a greater improvement of fronto-centroparietal and temporal electrode connectivity than the non_RAS gait training.

“The findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity,” the study authors concluded. “Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum.” 

According to Dr Calabro and colleagues, identifying these mechanisms is crucial. They explained that these mechanisms help create patient-tailored, RAS-based rehabilitative approaches for patients with PD.  

—Julie Gould  

Reference:

Calabro RS, Naro A, Filoni S, et al. Walking to your right music: a randomized controlled trial on the novel use of treadmill plus music in Parkinson's disease [published online June 7, 2019]. J Neuroeng Rehabil. 2019 Jun 7;16(1):68. doi: 10.1186/s12984-019-0533-9