Cueing for people with Parkinson's disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives

Ginis, Pieter; Nackaerts, Evelien; Nieuwboer, Alice; Heremans, Elke

doi:10.1016/j.rehab.2017.08.002

Cited by 217 publications

(196 citation statements)

References 57 publications

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“…Our results may also have translational implications. Presentation of salient cues to patients with Parkinson's disease can improve symptoms, for example by overcoming freezing of gait (Gilat et al, 2018;Ginis et al, 2017). If elevated DA levels constitute an underlying mechanism, then our data indicate that adding cues may recruit otherwise silent VTA DA neurons, which are less affected by neurodegeneration than SNc neurons (Surmeier et al, 2017) and could partially compensate in regions where SNc and VTA projections overlap.…”

Section: Kremer Et Al Multiplexed Damentioning

confidence: 75%

Context-dependent multiplexing by individual VTA dopamine neurons

Kremer

Flakowski

Rohner

et al. 2018

Preprint

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52Dopamine (DA) neurons of the ventral tegmental area (VTA) track external cues and 53 rewards to generate a reward prediction error (RPE) signal during Pavlovian conditioning. Here 54 we explored how RPE is implemented for a self-paced, operant task in freely moving mice. The 55 animal could trigger a reward-predicting cue by remaining in a specific location of an operant 56 box for a brief time before moving to a spout for reward collection. In vivo single-unit recordings 57 revealed phasic responses to the cue and reward in correct trials, while with failures the activity 58 paused, reflecting positive and negative error signals of a reward prediction. In addition, a 59 majority of VTA DA neurons also encoded parameters of the goal-directed action (e.g. 60 movement velocity, acceleration, distance to goal and licking) by changes in tonic firing rate. 61 Such multiplexing of individual neurons was only apparent while the mouse was engaged in 62 the task. We conclude that a multiplexed internal representation during the task modulates VTA 63 DA neuron activity, indicating a multimodal prediction error that shapes behavioral adaptation 64 of a self-paced goal-directed action. 65 66 93 19 . In brief, mice had to find an unmarked "trigger zone" in the operant box and remain there 94 two seconds, which would activate a light cue. Once the cue was presented, the animal had 95 four seconds to collect the reward by licking for a drop of fat solution at a spout located at the 96 other side of the box. The animal could engage in the next trial at its own pace. We performed 97 single-unit recordings of the VTA and video recorded the movement of the mouse. We found 98 that VTA DA neurons multiplexed phasic responses to salient events with tonic activity 99 reflecting parameters of the motor output. 100 101 102 4 Results 103Operant spatial task and behavioral performance. We injected a virus expressing cre-104 dependent channelrhodopsin (ChR2) and implanted a 16-channel optrode mounted into a 105 microdrive into the VTA of DAT-Cre mice (Fig. 1a). After recovery, we started the pre-training 106 phase that lasted five to ten days where the mice were conditioned in a cue-reward paradigm 107 (Fig.1b,c). The mice learned to associate a randomly occurring 4s light stimulus (cue) with the 108 availability of a drop of a fat solution (5% of lipofundin, BBraun, Sempach, Switzerland). We 109 then switched to the cue-guided spatial navigational task for five to twenty days ( Fig. 1c bottom 110 timeline), where the cue was triggered once the mouse had spent 2s in a small (4x4cm), 111 unmarked trigger zone (TZ) of the operant chamber (grey dotted square in Fig.1b). To collect 112 the reward the mouse had to move to the other end of the box. 113 Within a few sessions, all mice found the TZ and the reward rate increased whereas 114 the median inter-reward interval decreased in the first days ( Fig. 1f and Fig. S1). Since the 115 median inter-reward interval was insensitive to slow initiation or occasional breaks, we chose i...

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Section: Kremer Et Al Multiplexed Damentioning

confidence: 75%

Context-dependent multiplexing by individual VTA dopamine neurons

Kremer

Flakowski

Rohner

et al. 2018

Preprint

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“…With wearable technology, it could be possible to sense a sudden deterioration in gait pattern that would anticipate a FOG episode and then deliver an immediate cue at that time, to prevent the occurrence of FOG. This has been referred to as intelligent cueing, as recently described in a comprehensive review …”

Section: Assessing the Presence And Severity Of Fog With Wearable Senmentioning

confidence: 99%

Clinical and methodological challenges for assessing freezing of gait: Future perspectives

Bloem²,

et al. 2019

Self Cite

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A BS TRACT: Freezing of gait, defined as sudden and usually brief episodes of inability to produce effective stepping, often results in falls and is both disabling and common in parkinsonism. In this narrative review, sprung from the 2nd International Workshop on freezing of gait in Leuven, we summarize the latest insights into clinical and methodological challenges for assessing freezing of gait. We also highlight the role of emerging wearable technology to improve the management of this debilitating symptom.

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“…Cueing can be defined as a mechanism of applying a spatial or a temporal stimulus to facilitate initiating or maintaining motor activity [32]. Numerous studies have shown that external cueing can improve the amplitude and timing of the intended movement by increasing body position/movement awareness, making it a suitable modality for gait and posture rehabilitation [25,26,[36][37][38][39][40]. In addition, cueing has also been increasingly used in helping with the initiation of a movement [41].…”

Section: Cueing For Rehabilitation In Pdmentioning

confidence: 99%

“…For people in the early stage of disease severity, external cues can compensate for small deviations from their normal gait pattern thereby maintaining optimal gait quality and preventing deconditioning through training. Severely affected individuals with PD rely on external cues to compensate for deficits in the automatic control mechanisms (i.e., the ability to automatically generate normal stride length in a timely manner) thus improving gait and reducing the incidence of falls and freezing of gait [30,32,37,55].…”

Section: Effect Of Disease Stage On Cueing Strategymentioning

confidence: 99%

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Muthukrishnan

Abbas

Shill

et al. 2019

Sensors

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Progressive gait dysfunction is one of the primary motor symptoms in people with Parkinson's disease (PD). It is generally expressed as reduced step length and gait speed and as increased variability in step time and step length. People with PD also exhibit stooped posture which disrupts gait and impedes social interaction. The gait and posture impairments are usually resistant to the pharmacological treatment, worsen as the disease progresses, increase the likelihood of falls, and result in higher rates of hospitalization and mortality. These impairments may be caused by perceptual deficiencies (poor spatial awareness and loss of temporal rhythmicity) due to the disruptions in processing intrinsic information related to movement initiation and execution which can result in misperceptions of the actual effort required to perform a desired movement and maintain a stable posture. Consequently, people with PD often depend on external cues during execution of motor tasks. Numerous studies involving open-loop cues have shown improvements in gait and freezing of gait (FoG) in people with PD. However, the benefits of cueing may be limited, since cues are provided in a consistent/rhythmic manner irrespective of how well a person follows them. This limitation can be addressed by providing feedback in real-time to the user about performance (closed-loop cueing) which may help to improve movement patterns. Some studies that used closed-loop cueing observed improvements in gait and posture in PD, but the treadmill-based setup in a laboratory would not be accessible outside of a research setting, and the skills learned may not readily and completely transfer to overground locomotion in the community. Technologies suitable for cueing outside of laboratory environments could facilitate movement practice during daily activities at home or in the community and could strongly reinforce movement patterns and improve clinical outcomes. This narrative review presents an overview of cueing paradigms that have been utilized to improve gait and posture in people with PD and recommends development of closed-loop wearable systems that can be used at home or in the community to improve gait and posture in PD.

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Cueing for people with Parkinson's disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives

Cited by 217 publications

References 57 publications

Context-dependent multiplexing by individual VTA dopamine neurons

Context-dependent multiplexing by individual VTA dopamine neurons

Clinical and methodological challenges for assessing freezing of gait: Future perspectives

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

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