Departments of Neurology (E.C.H., G.M.E.) and Neuroscience (G.M.E.) and Program in Physical Therapy (A.P.H.), Washington University School of Medicine, St Louis, Missouri.
J Neurol Phys Ther. 2019 Oct;43(4):204-211. doi: 10.1097/NPT.0000000000000288.
Previously, we showed that internal cues (such as singing) produce similar motor benefits as external cues (such as listening to music) for people with Parkinson disease (PD). This study takes that research further by exploring how singing-either aloud or mentally-at different tempos can ameliorate gait, and it offers insight into how internal cueing techniques may enhance motor performance for older adults and people with PD.
Sixty participants aged 50 years and older (30 female) were recruited; 30 had PD and 30 were healthy age-matched controls. Participants completed walking trials involving internal and external cueing techniques at 90%, 100%, and 110% of preferred cadence. The effects of different cue types and rates were assessed in a repeated-measures cross-sectional study by comparing gait characteristics (velocity, cadence, stride length) and variabilities (coefficients of variation of stride length, stride time, single support time).
All participants modified their cadence and stride length during cued conditions, resulting in changes in gait velocity closely reflecting expected changes based upon cue rate. External cues resulted in increased gait variability, whereas internal cues decreased gait variability relative to uncued walking. Variability decreases were more substantial during mental singing at tempos at or above preferred cadence.
Matching movement to one's own voice improves gait characteristics while reducing gait variability for older adults and people with PD. Optimizing the use of internal cues to facilitate movement is an important step toward more effectively meeting the needs of people with gait disorders related to aging or neurological disease.Video Abstract available for more insights from authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A286).
此前，我们发现内部线索（如唱歌）和外部线索（如听音乐）对帕金森病（PD）患者的运动都有相似的益处。本研究进一步探索了不同速度的唱歌（出声或默唱）如何改善步态，并深入了解内部提示技术如何增强老年人和 PD 患者的运动表现。
招募了 60 名年龄在 50 岁及以上的参与者（30 名女性）；其中 30 名患有 PD，30 名是年龄匹配的健康对照者。参与者完成了涉及内部和外部提示技术的行走试验，速度分别为 90%、100%和 110%的个人最佳步频。通过比较步态特征（速度、步频、步长）和变异性（步长、步时、单支撑时间的变异系数），在一项重复测量的横断面研究中评估了不同提示类型和速度的影响。
所有参与者在提示条件下调整了步频和步长，导致步态速度的变化与基于提示速度的预期变化密切相关。外部提示会增加步态变异性，而内部提示与未提示行走相比会降低步态变异性。在以个人最佳步频或以上的速度进行默唱时，变异性降低更为显著。
使运动与自身声音相匹配可改善老年人和 PD 患者的步态特征，同时降低步态变异性。优化内部线索的使用以促进运动是满足与衰老或神经疾病相关的步态障碍人群需求的重要步骤。
