Cubo Esther, Leurgans Sue, Goetz Christopher G
Department of Neurology, Sanatorio del Rosario, Clinica de la Zarzuela, Principe de Vergara 53 28006, Madrid, Spain.
Parkinsonism Relat Disord. 2004 Dec;10(8):507-10. doi: 10.1016/j.parkreldis.2004.05.001.
In a randomized single blind parallel study, we tested the efficacy of an auditory metronome on walking speed and freezing in Parkinson's disease (PD) patients with freezing gait impairment during their 'on' function.
No pharmacological treatment is effective in managing 'on' freezing in PD. Like visual cues that can help overcome freezing, rhythmic auditory pacing may provide cues that help normalize walking pace and overcome freezing.
DESIGN/METHODS: Non-demented PD patients with freezing during their 'on' state walked under two conditions, in randomized order: unassisted walking and walking with the use of an audiocassette with a metronome recording. The walking trials were randomized and gait variables were rated from videotapes by a blinded evaluator. Outcome measures were total walking time (total trial time-total freezing time), which was considered the time over a course of specified length, freezing time, average freeze duration and number of freezes. All outcomes were averaged across trials for each person and then compared across conditions using Signed Rank tests.
Twelve non-demented PD patients with a mean age of 65.8 +/- 11.2 years, and mean PD duration of 12.4 +/- 7.3 years were included. The use of the metronome slowed ambulation and increased the total walking time (P < 0.0005) only during the first visit, without affecting any freezing variable. In the nine patients who took the metronome recording home and used it daily for 1 week while walking, freezing remained unimproved.
Though advocated in prior publications as a walking aid for PD patients, auditory metronome pacing slows walking and is not a beneficial intervention for freezing during their 'on' periods.
在一项随机单盲平行研究中，我们测试了节拍器对帕金森病（PD）“开期”功能时存在冻结步态障碍患者的步行速度和冻结现象的疗效。
尚无药物治疗能有效控制PD患者的“开期”冻结现象。如同视觉提示可帮助克服冻结，有节奏的听觉节拍可能提供有助于使步行节奏正常化并克服冻结的提示。
设计/方法：“开期”存在冻结现象的非痴呆PD患者在两种条件下行走，顺序随机：无辅助行走和使用带有节拍器录音的盒式磁带行走。行走试验随机进行，步态变量由一位不知情的评估者根据录像带进行评分。结局指标为总步行时间（总试验时间 - 总冻结时间），这被视为特定长度过程中的时间、冻结时间、平均冻结持续时间和冻结次数。对每个人的所有结局在各试验中进行平均，然后使用符号秩检验在不同条件间进行比较。
纳入了12名平均年龄为65.8±11.2岁、平均PD病程为12.4±7.3年的非痴呆PD患者。仅在首次就诊时，节拍器的使用使步行速度减慢并增加了总步行时间（P < 0.0005），但未影响任何冻结变量。在9名将节拍器录音带回家并在行走时每天使用1周的患者中，冻结现象仍未改善。
尽管先前的出版物主张将听觉节拍器作为PD患者的步行辅助工具，但听觉节拍器会减慢步行速度，并非“开期”冻结的有益干预措施。
