Department of Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium.
Neuroscience. 2012 Apr 5;207:298-306. doi: 10.1016/j.neuroscience.2012.01.024. Epub 2012 Jan 18.
Freezing of gait (FOG) is one of the most disabling symptoms in Parkinson's disease (PD), and cueing has been reported to improve FOG during straight-line walking. Studies on how cueing affects FOG during turning are lacking. Given the asymmetrical nature of turning and the asymmetrical disease expression, we aimed to gain a new perspective on how unilateral cueing may alleviate FOG.
To explore disease dominance and turning side as contributing factors to turning problems and FOG and to investigate the effect of unilateral cueing.
In the first study, 13 PD patients with FOG (freezers) and 13 without FOG (nonfreezers) turned toward their disease-dominant and nondominant side (off medication). During the second study, 16 freezers and 14 nonfreezers turned with and without a unilateral auditory cue at -10% of preferred cadence. Total number of steps, turn duration, cadence, and FOG episodes were measured using VICON.
Cadence, but not FOG frequency, was higher when turning toward the disease-dominant side. FOG started more frequently (64.9%) on the inner side of the turning cycle. Unilateral cueing seemed to prevent FOG in most patients, irrespective of the side at which the cue was offered. A carryover effect was found for cadence during turning, but the effect on FOG disappeared when the cue was removed.
The occurrence of FOG is not influenced by turning toward the disease-dominant or nondominant side, which is confirmed by the fact that it does not make a difference at which side unilateral cueing is applied. Cueing reduces FOG during turning, but these effects disappear dramatically after cue removal. This raises further questions as to the influence of training on cue dependency and on the feasibility of either continuous application of cues or using cognitive strategies as an alternative.
冻结步态（FOG）是帕金森病（PD）中最致残的症状之一，提示已被报道可改善直线行走时的 FOG。关于提示如何影响转弯时的 FOG 的研究尚缺乏。鉴于转弯的不对称性和疾病表现的不对称性，我们旨在获得新的视角，了解单侧提示如何减轻 FOG。
探索疾病优势和转弯侧作为导致转弯问题和 FOG 的因素，并研究单侧提示的效果。
在第一项研究中，13 名有 FOG（冻结者）和 13 名无 FOG（非冻结者）的 PD 患者在停药时向疾病优势侧和非优势侧（非优势侧）转弯。在第二项研究中，16 名冻结者和 14 名非冻结者在以 -10%的首选步速转弯时，有无单侧听觉提示。使用 VICON 测量总步数、转弯持续时间、步速和 FOG 发作次数。
向疾病优势侧转弯时，步速而非 FOG 频率更高。FOG 更频繁地（64.9%）在转弯周期的内侧开始。单侧提示似乎可以预防大多数患者的 FOG，而与提示提供的侧无关。在转弯过程中发现了对步速的延续效应，但当去除提示时，对 FOG 的影响消失。
向疾病优势或非优势侧转弯不会影响 FOG 的发生，这从单侧提示在哪个侧应用没有区别这一事实得到证实。提示可减少转弯时的 FOG，但在去除提示后，这些效果会急剧消失。这进一步引发了关于训练对提示依赖性的影响以及连续应用提示或使用认知策略作为替代的可行性的问题。
