Young William R, Shreve Lauren, Quinn Emma Jane, Craig Cathy, Bronte-Stewart Helen
Department of Clinical Sciences, Brunel University, London, UK.
Department of Neurology and Neurological Sciences, Stanford University, CA, USA.
Neuropsychologia. 2016 Jul 1;87:54-62. doi: 10.1016/j.neuropsychologia.2016.04.034. Epub 2016 May 6.
Gait disturbances are a common feature of Parkinson's disease, one of the most severe being freezing of gait. Sensory cueing is a common method used to facilitate stepping in people with Parkinson's. Recent work has shown that, compared to walking to a metronome, Parkinson's patients without freezing of gait (nFOG) showed reduced gait variability when imitating recorded sounds of footsteps made on gravel. However, it is not known if these benefits are realised through the continuity of the acoustic information or the action-relevance. Furthermore, no study has examined if these benefits extend to PD with freezing of gait. We prepared four different auditory cues (varying in action-relevance and acoustic continuity) and asked 19 Parkinson's patients (10 nFOG, 9 with freezing of gait (FOG)) to step in place to each cue. Results showed a superiority of action-relevant cues (regardless of cue-continuity) for inducing reductions in Step coefficient of variation (CV). Acoustic continuity was associated with a significant reduction in Swing CV. Neither cue-continuity nor action-relevance was independently sufficient to increase the time spent stepping before freezing. However, combining both attributes in the same cue did yield significant improvements. This study demonstrates the potential of using action-sounds as sensory cues for Parkinson's patients with freezing of gait. We suggest that the improvements shown might be considered audio-motor 'priming' (i.e., listening to the sounds of footsteps will engage sensorimotor circuitry relevant to the production of that same action, thus effectively bypassing the defective basal ganglia).
步态障碍是帕金森病的常见特征，其中最严重的一种是步态冻结。感觉提示是用于促进帕金森病患者行走的常用方法。最近的研究表明，与跟着节拍器行走相比，没有步态冻结（nFOG）的帕金森病患者在模仿在砾石上行走的脚步声的录音时，步态变异性降低。然而，尚不清楚这些益处是通过声学信息的连续性还是动作相关性实现的。此外，没有研究考察这些益处是否也适用于有步态冻结的帕金森病患者。我们准备了四种不同的听觉提示（在动作相关性和声学连续性方面有所不同），并让19名帕金森病患者（10名无步态冻结，9名有步态冻结（FOG））跟着每种提示原地踏步。结果表明，动作相关提示（无论提示的连续性如何）在降低步幅变异系数（CV）方面具有优势。声学连续性与摆动期CV的显著降低相关。提示的连续性和动作相关性单独都不足以增加冻结前的踏步时间。然而，在同一提示中结合这两个属性确实产生了显著改善。这项研究证明了使用动作声音作为有步态冻结的帕金森病患者的感觉提示的潜力。我们建议，所显示的改善可能被视为音频运动“启动”（即，听脚步声会激活与产生相同动作相关的感觉运动回路，从而有效地绕过有缺陷的基底神经节）。
