Oregon Health & Science University, Portland, OR, USA.
Northumbria University, Newcastle upon Tyne, UK.
Neurorehabil Neural Repair. 2020 Dec;34(12):1138-1149. doi: 10.1177/1545968320969940. Epub 2020 Nov 6.
Walking abnormalities in people with Parkinson's disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear.
To investigate the influence of FoG status on automaticity of walking in people with PD.
Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD-FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters.
PD+FoG had greater PFC activation during both single and dual-task walking than PD-FoG ( = .031). There were no differences in gait between PD-FoG and PD+FoG. Both groups decreased gait speed ( = .029) and stride length ( < .001) during dual-task walking compared with single-task walking.
These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.
帕金森病（PD）患者的行走异常表现为运动控制从健康的自动性向补偿性前额叶执行控制转变。行走自动性的间接测量（例如，步间变异性和双重任务成本）表明，冻结步态（FoG）可能与行走自动性降低有关。然而，FoG 状态对实际前额叶皮层（PFC）在行走过程中的活动的影响尚不清楚。
探讨 FoG 状态对 PD 患者行走自动性的影响。
根据 FoG 状态，47 名 PD 患者被分为 2 组，采用新冻结步态问卷进行评估：PD-FoG（n = 23；UPDRS-III = 35）和 PD+FoG（n = 24；UPDRS-III = 43.1）。参与者在没有药物的情况下行走 9 米直道（每端有 180°转弯）80 秒。测试了两种状态下的行走：单任务和双重任务行走（即，同时进行认知任务）。便携式近红外光谱功能系统记录了行走时（包括转弯时）的 PFC 活动。可穿戴惯性传感器用于计算时空步态参数。
PD+FoG 在单任务和双重任务行走时 PFC 激活均高于 PD-FoG（ =.031）。PD-FoG 和 PD+FoG 之间的步态没有差异。与单任务行走相比，两组在双重任务行走时的步速（ =.029）和步长（ <.001）均降低。
这些发现表明，即使没有 FoG 发作，PD+FoG 也存在行走自动性降低。与步态测量相比，行走时 PFC 活动似乎更能识别 PD+FoG 中行走自动性降低。
