Espay Alberto J, Baram Yoram, Dwivedi Alok Kumar, Shukla Rakesh, Gartner Maureen, Gaines Laura, Duker Andrew P, Revilla Fredy J
Department of Neurology, University of Cincinnati, 260 Stetson St, Suite 3200, Cincinnati, OH 45267-0525, USA.
J Rehabil Res Dev. 2010;47(6):573-81. doi: 10.1682/jrrd.2009.10.0165.
Shuffling and freezing while walking can impair function in patients with Parkinson disease (PD). Open-loop devices that provide fixed-velocity visual or auditory cues can improve gait but may be unreliable or exacerbate freezing of gait in some patients. We examined the efficacy of a closed-loop, accelerometer-driven, wearable, visual-auditory cueing device in 13 patients with PD with off-state gait impairment at baseline and after 2 weeks of twice daily (30 minute duration) at-home use. We measured gait velocity, stride length, and cadence using a validated electronic gait-analysis system. Subjects underwent standard motor assessment and completed a self-administered Freezing of Gait Questionnaire (FOGQ) (range 0-24; lower is better). After training, device use enhanced walking velocity (61.6 ± 20.1 cm/s to 72.6 ± 26.5 cm/s, p = 0.006) and stride length (74.3 ± 16.4 cm to 84.0 ± 18.5 cm, p = 0.004). Upon device removal, walking velocity (64.5 ± 21.4 cm/s to 75.4 ± 21.5 cm/s, p < 0.001) and stride length (79.0 ± 20.3 cm to 88.8 ± 17.7 cm, p = 0.003) exhibited a greater magnitude of change, suggesting immediate residual benefits. Also upon device removal, nearly 70 percent of subjects improved by at least 20 percent in either walking velocity, stride length, or both. An overall improvement in gait was measured by the FOGQ (14.2 ±1.9 to 12.4 ± 2.5, p = 0.02). Although issues related to compliance and response variability render a definitive interpretation of study outcome difficult, devices using closed-loop sensory feedback appear to be effective and desirable nonpharmacologic interventions to improve walking in selected individuals with PD.
行走时拖着脚步走和步态冻结会损害帕金森病(PD)患者的功能。提供固定速度视觉或听觉提示的开环设备可以改善步态,但在某些患者中可能不可靠或会加重步态冻结。我们研究了一种闭环、加速度计驱动、可穿戴的视觉-听觉提示设备对13例基线时存在关期步态障碍的PD患者的疗效,这些患者在家中每天使用该设备两次(每次30分钟),持续2周后再次进行评估。我们使用经过验证的电子步态分析系统测量步态速度、步幅和步频。受试者接受标准运动评估,并完成一份自我管理的步态冻结问卷(FOGQ)(范围为0 - 24;分数越低越好)。训练后,使用该设备可提高行走速度(从61.6±20.1厘米/秒提高到72.6±26.5厘米/秒,p = 0.006)和步幅(从74.3±16.4厘米提高到84.0±18.5厘米,p = 0.004)。取下设备后,行走速度(从64.5±21.4厘米/秒提高到75.4±21.5厘米/秒,p < 0.001)和步幅(从79.0±20.3厘米提高到88.8±17.7厘米,p = 0.003)的变化幅度更大,表明有即时的残余益处。同样在取下设备后,近70%的受试者在行走速度、步幅或两者方面至少提高了20%。通过FOGQ测量,步态总体得到改善(从14.2±1.9降至12.4±2.5,p = 0.02)。尽管与依从性和反应变异性相关的问题使得对研究结果的明确解释变得困难,但使用闭环感官反馈的设备似乎是改善特定PD患者行走能力的有效且理想的非药物干预措施。