Mezzarobba Susanna, Grassi Michele, Pellegrini Lorella, Catalan Mauro, Kruger Bjorn, Furlanis Giovanni, Manganotti Paolo, Bernardis Paolo
Department of Life Sciences, University of Trieste, Trieste, Italy.
Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
Front Neurol. 2018 Jan 4;8:723. doi: 10.3389/fneur.2017.00723. eCollection 2017.
Freezing of gait (FoG) is a disabling symptom associated with falls, with little or no responsiveness to pharmacological treatment. Current protocols used for rehabilitation are based on the use of external sensory cues. However, cued strategies might generate an important dependence on the environment. Teaching motor strategies without cues [i.e., action observation (AO) plus Sonification] could represent an alternative/innovative approach to rehabilitation that matters most on appropriate allocation of attention and lightening cognitive load. We aimed to test the effects of a novel experimental protocol to treat patients with Parkinson's disease (PD) and FoG, using functional, and clinical scales. The experimental protocol was based on AO plus Sonification. 12 patients were treated with 8 motor gestures. They watched eight videos showing an actor performing the same eight gestures, and then tried to repeat each gesture. Each video was composed by images and sounds of the gestures. By means of the Sonification technique, the sounds of gestures were obtained by transforming kinematic data (velocity) recorded during gesture execution, into pitch variations. The same 8 motor gestures were also used in a second group of 10 patients; which were treated with a standard protocol based on a common sensory stimulation method. All patients were tested with functional and clinical scales before, after, at 1 month, and 3 months after the treatment. Data showed that the experimental protocol have positive effects on functional and clinical tests. In comparison with the baseline evaluations, significant performance improvements were seen in the NFOG questionnaire, and the UPDRS (parts II and III). Importantly, all these improvements were consistently observed at the end, 1 month, and 3 months after treatment. No improvement effects were found in the group of patients treated with the standard protocol. These data suggest that a multisensory approach based on AO plus Sonification, with the two stimuli semantically related, could help PD patients with FoG to relearn gait movements, to reduce freezing episodes, and that these effects could be prolonged over time.
冻结步态（FoG）是一种与跌倒相关的致残症状，对药物治疗几乎没有反应或完全没有反应。目前用于康复的方案基于外部感官提示的使用。然而，提示策略可能会导致对环境产生重要依赖。在没有提示的情况下教授运动策略[即动作观察（AO）加可听化]可能代表一种替代/创新的康复方法，这对于注意力的适当分配和减轻认知负荷最为重要。我们旨在使用功能和临床量表测试一种新型实验方案对帕金森病（PD）和冻结步态患者的治疗效果。该实验方案基于AO加可听化。12名患者接受了8种运动手势的治疗。他们观看了八个视频，视频中一名演员执行相同的八个手势，然后尝试重复每个手势。每个视频由手势的图像和声音组成。通过可听化技术，手势的声音是通过将手势执行过程中记录的运动学数据（速度）转换为音高变化而获得的。另一组10名患者也使用了相同的8种运动手势；他们接受了基于常见感官刺激方法的标准方案治疗。所有患者在治疗前、治疗后、治疗后1个月和3个月时均使用功能和临床量表进行测试。数据显示，实验方案对功能和临床测试有积极影响。与基线评估相比，在NFOG问卷和UPDRS（第二部分和第三部分）中观察到显著的性能改善。重要的是，在治疗结束时、治疗后1个月和3个月时均持续观察到所有这些改善。在接受标准方案治疗的患者组中未发现改善效果。这些数据表明，基于AO加可听化的多感官方法，两种刺激在语义上相关，可以帮助患有冻结步态的PD患者重新学习步态运动，减少冻结发作，并且这些效果可以随着时间的推移而延长。
