The attentional cost of external rhythmical cues and their impact on gait in Parkinson’s disease: effect of cue modality and task complexity

Abstract

Summary Changes in gait performance in 153 subjects with PD using three rhythmical cues (auditory, visual and somatosensory) were measured during a simple walking task and a dual walking task in the home. Subjects were 'on' medication and were cued at preferred step frequency. Accelerometers recorded gait and walking speed, step amplitude and step frequency were determined from raw data. Data were analysed with SAS using linear regression models. Gait performance during a single task reduced with cues in contrast to a dual task where PD subjects appeared to benefit from rhythmical cues (increased speed and step length). Effects were dependent on cue modality with significant improvements for auditory cues compared to others. A significant short-term carry-over effect of cues reduced 3 weeks later. Cues may reduce attentional demands by facilitating attentional allocation, accounting for differences of cue seen during single and dual task. Furthermore cue modality may influence attentional demand which is an important consideration for rehabilitation.

At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease

“…Many single-session studies have confirmed the benefit of visual cues (high-contrast transverse floor lines) [21][22][23][24]. However these open-loop feedback systems may not have long-term effects [25] unless a dedicated physical training program is established, as demonstrated in a patient trained to walk on floor cues reaching 120 percent of the uncued stride length over a 1-month period [26]. Closed-loop feedback systems do not require training program monitoring and may lead to long-term motor skills learning and enhancement of adaptive cerebral plasticity, particularly with the use of visual information on which the generation of motor plans is dependent in patients with PD [27].…”

Cueing for freezing of gait in patients with Parkinson's disease: A rehabilitation perspective

“…43,44 Despite this, external auditory cues were able to improve gait even during a dual task, as a result of which two working mechanisms of cueing were suggested. 45,46 Firstly, external cues may reduce the need to internally plan and prepare movements, taking on an executive role and decreasing cognitive load. Secondly, cues may act to focus attention particularly during the performance of more complex tasks and thus aid in gait prioritization.…”

E-health Support in People with Parkinson’s Disease with Smart Glasses: A Survey of User Requirements and Expectations in the Netherlands

“…First, with respect to external cueing, complicated situations that demand increased cognitive processes do indeed aggravate gait impairments in PD [23,24]; however, external cueing has also been shown to facilitate double task walking [25]. In principle, cueing training could be implemented using smart glass technology and as such facilitate conditions for goal-based exercise training to improve gait and gait-related activities for people with PD [26].…”