K.C. Liao1, Y.Y. Lee1, J.J. Luh1, C.H. Tai2
1School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, 2National Taiwan University Hospital, Department of Neurology, Taipei, Taiwan

Background: Context-dependent behavior is a phenomenon in which an individual demonstrated superior performance in the environment where a motor task was originally practiced, but showed poorer performance if the task was tested in a new context. Evidence has shown that people with Parkinson’s disease (PD) appear to have difficulty transferring what they learned in one context to a new context, suggesting context-dependent behavior. However, no study has attempted to design effective treatment approaches to reduce context-dependent behavior in people with PD. Earlier verbal memory studies conducted on non-disabled adults have suggested that practicing in multiple environmental contexts could reduce context-dependency. However, benefits of multiple practice contexts on motor learning have not been investigated in people with PD.

Purpose: This study aimed to investigate the effect of gait training in multiple contexts in people with PD.

Methods:  This was single-blinded randomized control trial. Forty individuals with PD were randomized into 1-room or 2-room groups. All participants received 12 gait training sessions, which included 45 minutes of treadmill training and 15 minutes of over-ground gait training within each session. The participants in the 1-room group received all training in the same room (Room A), while those in the 2-room group were trained alternatively in 2 rooms (Room A and B) differed in size and furnishings. The participants were assessed within 1-week before and after the interventions in Room A. The primary outcome of interest was gait performance under the single and dual-task walking conditions. Gait parameters including step length, velocity and cadence were calculated and analyzed. At post-intervention assessment, walking ability was evaluated not only in Room A but also in a new context (Room C) in which the participants had not been before. Repeated measure analysis of variance was used to determine the changes of gait performance before and after training, and in different contexts. The α level was set at 0.05.

Results: After training when tested in Room A, both groups of participants showed significant improvement in step length and velocity under the single and dual-task walking conditions. When comparing the gait performances between Room A and C, moderate effect sizes of group by context interactions were observed in step length (single-walking: p = 0.116, η2 = 0.064; dual-walking: p = 0.126, η2 = 0.062) and velocity (single-walking: p = 0.090, η2 = 0.074; dual-walking: p = 0.136, η2 = 0.059). While the participants in the 1-room group showed a reduced step length and velocity when tested in the new context (Room C), those in the 2-room group presented improved gait performances.

Conclusion(s): The results showed that gait training in a single environmental context may induce context-dependent behavior in people with PD. Training in multiple contexts (i.e., 2 training rooms) may facilitate the generalization of learned walking ability.

Implications:  The findings of this research provided preliminary evidence that training context would affect gait performances in people with PD. Clinicians should take environmental contexts into consideration when designing training programs for people with PD.

Funding, acknowledgements:  This study was supported by the Ministry of Science and Technology of Taiwan (grant number: MOST 106-2314-B-002-044-MY3 and 109-2314-B-002-128 -)

Keywords: Context, Parkinson's disease, gait training

Topic: Neurology: Parkinson's disease

Did this work require ethics approval? Yes
Institution: National Taiwan University Hospital
Committee: Research Ethics Committee of the National Taiwan University Hospital
Ethics number: 201912096RIND

All authors, affiliations and abstracts have been published as submitted.

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