Kimura D1, Ito T1
1Kawasaki University of Medical Welfare, Department of Rehabilitation, Kurashiki, Japan
Background: One of the causes of gait disturbance in patients with Parkinson disease (PD) is the impaired gait rhythmicity. The rhythmicity is influenced by some stages of input, process, and output in motor control. As strategies for the impairment, “External cueing” was used for preserving optimal spatiotemporal control of gait and rescue after freezing of gait (FOG). However, some patients was insufficiently effected of external cue on, we investigate the effect of “Internal cueing” to develop optimal cueing interventions for PD patients with FOG.
Purpose: By enrolling elderly individuals, we evaluated the efficacy of rhythm learning for two rhythmic tasks of the upper and lower limbs on rhythm adjustment during walking by comparing the accuracy of rhythm reproduction.
Methods: The participants were 7 elderly individuals (mean ± standard deviation (SD): age, 65.9 ± 2.3 years; MMSE scores, 31.9 ± 0.4; 4 females). All participants were healthy without any neurological or physical problems. The participants were instructed to learn the rhythm for three conditions, namely, normal gait rhythm (control), 10% higher (10% up) than the normal gait rhythm, and 10% lower than the normal gait rhythm (10% down), by using the tapping and stepping tasks on the seat. After learning the rhythm for each condition, the participants were instructed to gait hold with the learned rhythm. The kinematics during walking were monitored using an accelerometer (Micro Stone, MVP-RF8-HC-2000), which was attached to the ankles of both legs of the participants. From the data obtained, the timing of heel contact was calculated as gait rhythmicity. The resulting gait rhythmicity was divided by the presented rhythm during the tasks, and the accuracy of the rhythm during walking was determined.
Results: In the tapping task, the mean values were as follows: control, 99.0% ± 2.7%; 10% fast condition, 95.4% ± 3.7%; and 10% slow condition, 102.3% ± 5.1%. For the stepping task, the values were as follows: control, 103.3% ± 2.7%; 10% fast condition, 100% ± 4.6%; and 10% slow condition, 104.8% ± 2.9%. Both tasks and the conditions under which they were performed showed a significant primary effect on the walking rhythm (task: F(1, 6) = 8.39, p = .027; condition: F(1, 6) = 10394, p .001), and no interaction was observed. Significant differences were found among all the conditions.
Conclusion(s): We evaluated the effect of the rhythm learning methods used for the upper and lower limbs on the walking rhythm. Although the results showed a significant difference, we could not draw a precise conclusion regarding which limb is suitable for rhythm learning, but rhythm learning for the upper limbs was inaccurate.
Implications: When prompting rhythm learning for walking for a patient with, for example, Parkinson's disease, lower limb tasks may be more appropriate than the upper limb tasks.
Keywords: Internal cueing, Parkinson's disease, Cadence
Funding acknowledgements: This work was supported by a grant from the JSPS KAKENHI (No. 16K16474).
Purpose: By enrolling elderly individuals, we evaluated the efficacy of rhythm learning for two rhythmic tasks of the upper and lower limbs on rhythm adjustment during walking by comparing the accuracy of rhythm reproduction.
Methods: The participants were 7 elderly individuals (mean ± standard deviation (SD): age, 65.9 ± 2.3 years; MMSE scores, 31.9 ± 0.4; 4 females). All participants were healthy without any neurological or physical problems. The participants were instructed to learn the rhythm for three conditions, namely, normal gait rhythm (control), 10% higher (10% up) than the normal gait rhythm, and 10% lower than the normal gait rhythm (10% down), by using the tapping and stepping tasks on the seat. After learning the rhythm for each condition, the participants were instructed to gait hold with the learned rhythm. The kinematics during walking were monitored using an accelerometer (Micro Stone, MVP-RF8-HC-2000), which was attached to the ankles of both legs of the participants. From the data obtained, the timing of heel contact was calculated as gait rhythmicity. The resulting gait rhythmicity was divided by the presented rhythm during the tasks, and the accuracy of the rhythm during walking was determined.
Results: In the tapping task, the mean values were as follows: control, 99.0% ± 2.7%; 10% fast condition, 95.4% ± 3.7%; and 10% slow condition, 102.3% ± 5.1%. For the stepping task, the values were as follows: control, 103.3% ± 2.7%; 10% fast condition, 100% ± 4.6%; and 10% slow condition, 104.8% ± 2.9%. Both tasks and the conditions under which they were performed showed a significant primary effect on the walking rhythm (task: F(1, 6) = 8.39, p = .027; condition: F(1, 6) = 10394, p .001), and no interaction was observed. Significant differences were found among all the conditions.
Conclusion(s): We evaluated the effect of the rhythm learning methods used for the upper and lower limbs on the walking rhythm. Although the results showed a significant difference, we could not draw a precise conclusion regarding which limb is suitable for rhythm learning, but rhythm learning for the upper limbs was inaccurate.
Implications: When prompting rhythm learning for walking for a patient with, for example, Parkinson's disease, lower limb tasks may be more appropriate than the upper limb tasks.
Keywords: Internal cueing, Parkinson's disease, Cadence
Funding acknowledgements: This work was supported by a grant from the JSPS KAKENHI (No. 16K16474).
Topic: Human movement analysis; Neurology: Parkinson's disease; Older people
Ethics approval required: Yes
Institution: Kawasaki University of Medical Welfare
Ethics committee: the human research ethics committee
Ethics number: approval number 16-070
All authors, affiliations and abstracts have been published as submitted.
