Yogev-Seligmann Galit, Krasovsky Tal, Kafri Michal
Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel.
Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel.
Front Hum Neurosci. 2022 Aug 18;16:943047. doi: 10.3389/fnhum.2022.943047. eCollection 2022.
Persons with Parkinson's disease (PwP) are advised to use compensatory strategies such as external cues or cognitive movement strategies to overcome gait disturbances. It is suggested that external cues involve the processing of sensory stimulation, while cognitive-movement strategies use attention allocation. This study aimed to compare over time changes in attention allocation in PwP between prolonged walking with cognitive movement strategy and external cues; to compare the effect of cognitive movement strategies and external cues on gait parameters; and evaluate whether these changes depend on cognitive function. Eleven PwP participated in a single-group pilot study. Participants walked for 10 min under each of three conditions: natural walking, using external cuing, using a cognitive movement strategy. Attention and gait variables were extracted from a single-channel electroencephalogram and accelerometers recordings, respectively. Attention allocation was assessed by the% of Brain Engagement Index (BEI) signals within an attentive engagement range. Cognitive function was assessed using a neuropsychological battery. The walk was divided into 2-min time segments, and the results from each 2-min segment were used to determine the effects of time and condition. Associations between cognitive function and BEI signals were tested. Findings show that in the cognitive movement strategy condition, there was a reduction in the % of BEI signals within the attentive engagement range after the first 2 min of walking. Despite this reduction the BEI did not consistently differ from natural and metronome walking. Spatiotemporal gait variables were better in the cognitive movement strategy condition relative to the other conditions. Global cognitive and information processing scores were significantly associated with the BEI only when the cognitive movement strategy was applied. In conclusion, the study shows that a cognitive movement strategy has positive effects on gait variables but may impose a higher attentional load. Furthermore, when walking using a cognitive movement strategy, persons with higher cognitive function showed elevated attentive engagement. The findings support the idea that cognitive and attentional resources are required for cognitive movement strategies in PwP. Additionally, this study provides support for using single-channel EEG to explore mechanistic aspects of clinical interventions.
帕金森病患者（PwP）被建议使用外部提示或认知运动策略等补偿策略来克服步态障碍。有人认为，外部提示涉及感觉刺激的处理，而认知运动策略则使用注意力分配。本研究旨在比较帕金森病患者在采用认知运动策略和外部提示进行长时间步行时，注意力分配随时间的变化；比较认知运动策略和外部提示对步态参数的影响；并评估这些变化是否依赖于认知功能。11名帕金森病患者参与了一项单组试点研究。参与者在三种条件下各步行10分钟：自然步行、使用外部提示、使用认知运动策略。分别从单通道脑电图和加速度计记录中提取注意力和步态变量。注意力分配通过注意力参与范围内的脑参与指数（BEI）信号百分比进行评估。使用神经心理测验组合评估认知功能。步行被分为2分钟的时间段，每个2分钟时间段的结果用于确定时间和条件的影响。测试了认知功能与BEI信号之间的关联。研究结果表明，在认知运动策略条件下，步行前2分钟后，注意力参与范围内的BEI信号百分比有所下降。尽管有这种下降，BEI与自然步行和节拍器步行相比并没有持续差异。相对于其他条件，认知运动策略条件下的时空步态变量更好。仅在应用认知运动策略时，整体认知和信息处理得分与BEI显著相关。总之，该研究表明，认知运动策略对步态变量有积极影响，但可能会带来更高的注意力负荷。此外，当使用认知运动策略步行时，认知功能较高的人表现出更高的注意力参与度。这些发现支持了帕金森病患者的认知运动策略需要认知和注意力资源的观点。此外，本研究为使用单通道脑电图探索临床干预的机制方面提供了支持。
