Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom (E.L.S., S.L., D.M., L.R., R.M.); Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil (E.L.S.); School of Clinical Sciences, Auckland University of Technology, New Zealand (S.L.); John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, United Kingdom (D.M.); The Newcastle upon Tyne Hospitals, NHS Foundation Trust, United Kingdom (L.R.); and Department of Neurology, Oregon Health & Science University, Portland (R.M.).
J Neurol Phys Ther. 2019 Jan;43(1):50-55. doi: 10.1097/NPT.0000000000000250.
Gait impairments in persons with Parkinson disease (PD) are difficult to manage. Auditory cueing has been shown to be an effective therapy. However, the optimal time to introduce cues with respect to disease stage has not yet been established. This longitudinal study examines the effect of auditory cues on gait characteristics in people with early PD at 2 time points, 3 years apart.
We assessed 25 people with PD from the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation-Parkinson's disease (ICICLE-PD) study. Participants walked with and without an auditory cue set at individual cadence. Characteristics of step velocity, step length, step time, step length variability, and step time variability were collected using an instrumented walkway. In a subset of 9 participants with PD, all assessments were repeated 3 years later. Twenty-nine healthy older adults were assessed at 1 time point to provide comparison data.
At baseline, independent of group, step velocity, step length, and step time improved with auditory cue; however, there was an increase in step time variability, indicating a worsening of gait with the cue. Three years later, in the smaller subset the response to cue was improved, demonstrated by increased step velocity and length but step time variability was no longer increased.
This pilot study indicates that people with early PD have small benefits from auditory cues and the benefit increases as disease progresses. Early in disease the benefit of cue may come at the cost of increased variability. Therefore, the time to introduce an auditory cue in PD rehabilitation may be important to optimize therapeutic effect.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A243).
帕金森病（PD）患者的步态障碍难以治疗。听觉提示已被证明是一种有效的治疗方法。然而，尚未确定针对疾病阶段引入提示的最佳时间。这项纵向研究在 3 年的 2 个时间点上，检查了早期 PD 患者的听觉提示对步态特征的影响。
我们评估了来自 Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation-Parkinson's disease（ICICLE-PD）研究的 25 名 PD 患者。参与者在个人步频下分别使用和不使用听觉提示进行行走。使用仪器化步道收集步速、步长、步时、步长变异性和步时变异性的特征。在 9 名 PD 患者的子集中，所有评估在 3 年后重复进行。29 名健康老年人在 1 个时间点进行评估以提供比较数据。
在基线时，无论分组如何，步速、步长和步时均随听觉提示而改善；然而，步时变异性增加，表明步态随提示而恶化。3 年后，在较小的子集中，对提示的反应得到改善，表现为步速和长度增加，但步时变异性不再增加。
这项初步研究表明，早期 PD 患者从听觉提示中获得较小的益处，随着疾病的进展，益处会增加。在疾病早期，提示的益处可能以变异性增加为代价。因此，在 PD 康复中引入听觉提示的时间可能对优化治疗效果很重要。作者的更多见解视频摘要（请观看视频，补充数字内容 1，可在 http://links.lww.com/JNPT/A243 获得）。
