Chen Y-A1,2, Chen L-C2, Tsai C-Y2, Huang C-Y2,3
1Shin Kong Wu Ho-Su Memorial Hospital, Division of Physical Therapy, Department of Rehabilitation, Taipei, Taiwan, 2National Taiwan University, School and Graduate Institute of Physical Therapy, College of Medicine, Taipei, Taiwan, 3National Taiwan University Hospital, Physical Therapy Center, Taipei, Taiwan
Background: Dual-task walking is prevalent in our daily life, defined as walking and performing another task (the suprapostural task) simultaneously. Clinically, patients with Parkinson´s disease (PD) are often instructed to focus on their walking (e.g. walking with big steps) in dual-task situations because of reduced attentional capacity and movement automaticity. However, focus on walking with big steps is not always beneficial to walking and suprapostural performance, especially in non-freezers. It may because focus on taking big steps belongs to internal focus (IF) strategy which would cost much attentional resource in dual-task walking. In contrast to the IF strategy, an external focus (EF) strategy could improve movement automaticity with less attentional resource consumption.
Purpose: The purpose of this study was to investigate the effects of different attentional focus strategies for the walking task (IF vs. EF) on dual-task performance and its related cortical activity in PD with non-freezers.
Methods: Twelve non-freezers with idiopathic PD (mean age: 66.4 ± 1.9; modified Hoehn and Yahr scale: I-III) were recruited in this study. Each participant was requested to stabilize two interlocking sticks (suprapostural task) and walk simultaneously with IF (focus on walking with big steps) and EF (walking toward the sign of destination) strategies. Both behavioral and cortical data, including walking velocity, step length variability, error movement rate (EMR) of the sticks, and relative power of electroencephalography signals in theta (4-8 Hz) and alpha (8-12 Hz) bands were measured. Paired t test (or Wilcoxon signed-rank test) were used for testing the attentional focus effects of each parameter. The alpha value is 0.05 and p 0.05 considered as significant difference.
Results: The EF strategy resulted in smaller step length variability (p 0.01) and EMR (p 0.01) compared to the IF strategy. The walking velocity was not affected by attentional focus strategies. On the other hand, the cortical findings revealed that the EF strategy resulted in smaller theta power in prefrontal-frontal area and alpha power in central-parietal area (all p 0.05). Both behavioral and cortical results indicate the EF strategy of walking task enhanced walking automaticity, suprapostural accuracy, and brain resource switching and integration.
Conclusion(s): In contrast to asking PD to take big steps while walking, an EF strategy of walking task could improve dual-task walking performance with more flexible and effective resource allocation for non-freezers.
Implications: The present study provides an easily apply and appropriate attentional strategy suggestion for non-freezers in PD. This could help non-freezers to optimize their dual-task walking performance with a safe and effective movement strategy.
Keywords: Dual-task, Attention, Electroencephalography
Funding acknowledgements: This work was supported by the Ministry of Science and Technology, R.O.C. Taiwan (grant no. MOST 106-2314-B-002-045-MY2).
Purpose: The purpose of this study was to investigate the effects of different attentional focus strategies for the walking task (IF vs. EF) on dual-task performance and its related cortical activity in PD with non-freezers.
Methods: Twelve non-freezers with idiopathic PD (mean age: 66.4 ± 1.9; modified Hoehn and Yahr scale: I-III) were recruited in this study. Each participant was requested to stabilize two interlocking sticks (suprapostural task) and walk simultaneously with IF (focus on walking with big steps) and EF (walking toward the sign of destination) strategies. Both behavioral and cortical data, including walking velocity, step length variability, error movement rate (EMR) of the sticks, and relative power of electroencephalography signals in theta (4-8 Hz) and alpha (8-12 Hz) bands were measured. Paired t test (or Wilcoxon signed-rank test) were used for testing the attentional focus effects of each parameter. The alpha value is 0.05 and p 0.05 considered as significant difference.
Results: The EF strategy resulted in smaller step length variability (p 0.01) and EMR (p 0.01) compared to the IF strategy. The walking velocity was not affected by attentional focus strategies. On the other hand, the cortical findings revealed that the EF strategy resulted in smaller theta power in prefrontal-frontal area and alpha power in central-parietal area (all p 0.05). Both behavioral and cortical results indicate the EF strategy of walking task enhanced walking automaticity, suprapostural accuracy, and brain resource switching and integration.
Conclusion(s): In contrast to asking PD to take big steps while walking, an EF strategy of walking task could improve dual-task walking performance with more flexible and effective resource allocation for non-freezers.
Implications: The present study provides an easily apply and appropriate attentional strategy suggestion for non-freezers in PD. This could help non-freezers to optimize their dual-task walking performance with a safe and effective movement strategy.
Keywords: Dual-task, Attention, Electroencephalography
Funding acknowledgements: This work was supported by the Ministry of Science and Technology, R.O.C. Taiwan (grant no. MOST 106-2314-B-002-045-MY2).
Topic: Neurology; Disability & rehabilitation; Older people
Ethics approval required: Yes
Institution: National Taiwan University Hospital; National Institutes of Health
Ethics committee: National Taiwan University Hospital Research Ethics Committee; ClinicalTrials.gov
Ethics number: 201701080RINB; NCT03298503
All authors, affiliations and abstracts have been published as submitted.
