Auditory cueing of gait initiation in Parkinson's disease patients with freezing of gait
Auditory cueing of gait initiation in Parkinson's disease patients with freezing of gait
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DOI：
10.1016/j.clinph.2013.12.101
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发表时间：
2014-08-01
影响因子：
4.7
通讯作者：
Defebvre, Luc
中科院分区：
文献类型：
--
作者：
Delval, Arnaud;Moreau, Caroline;Defebvre, Luc
目的：进展期帕金森病(PD)患者的步态起始障碍(GI)是一种典型的运动障碍的功能性体征。步态冻结(雾)患者经常表现为未能启动第一步，通常被认为是冻结的一种亚类型。关于GI准备和执行的线索效应的文献仍然存在争议。我们的目的是确定听觉提示是否改善了有FOG病史的PD患者的GI准备和/或执行。方法：我们记录了30名确诊为FOG的PD患者在两种随机条件下的第一步准备和执行情况：自主触发(ST)步态和在关闭和多巴状态下发出声音哔声提示的步态。结果：30例无雾化病史患者和30例健康对照(HCS)进行比较。L-多巴仅略微改善了冰柜中APA的特性，但对改善步态运动不足是有效的。听觉提示有效地改善了冷冻室的步骤准备，他们更频繁地表现出足够的APA。正如在HCS和没有雾的患者中所看到的那样，当应用听觉提示时，患者释放APA的速度更快。然而，暗示对步长没有显著影响。在临床上，听觉提示也改善了冷冻室的启动犹豫。结论：听觉提示改善了PD患者的步骤准备，但没有改善步骤执行。意义：在GI过程中未能将步骤准备和执行联系起来，这可能是PD冰柜中第一步执行能力较差的原因。(C)2013年国际临床神经生理学联合会。爱思唯尔爱尔兰有限公司出版。版权所有。
Objective: Impaired gait initiation (GI) in patients with advanced Parkinson's disease (PD) is a typical functional sign of akinesia. Failure to initiate the first step is frequently presented by patients with freezing of gait (FOG) and is often considered a sub-type of freezing. The literature on the effects of cueing of GI preparation and execution remains controversial. Our objective was to establish whether auditory cueing improves the preparation and/or execution of GI in PD patients with a history of FOG.Methods: We recorded first-step preparation and execution in 30 PD patients with confirmed FOG under two randomised conditions: self-triggered (ST) gait and gait cued by a sound beep in off-and on-dopa conditions. Anticipatory postural adjustments (APAs) were evaluated by monitoring the trajectory of the centre of pressure.Results: We compared the patients with 30 patients without history of FOG and 30 healthy controls (HCs). L-Dopa only slightly improved the characteristics of APAs in freezers but was effective to improve gait hypokinesia. Auditory cueing was effective in improving step preparation in freezers, who showed adequate APAs more frequently. As seen with HCs and patients without FOG, patients released their APAs more quickly when auditory cueing was applied. However, cueing did not have a significant effect on step length. Clinically, auditory cueing also improved start hesitation in freezers.Conclusions: Auditory cueing improved step preparation but not step execution in PD patients.Significance: A failure to link step preparation and execution during GI may explain the poor first-step execution seen in PD freezers. (C) 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.