Washington University in St. Louis School of Medicine, Program in Physical Therapy, United States.
Washington University in St. Louis School of Medicine, Program in Physical Therapy, United States; Washington University in St. Louis School of Medicine, Department of Neurology, United States.
Gait Posture. 2024 Jan;107:275-280. doi: 10.1016/j.gaitpost.2023.10.015. Epub 2023 Oct 21.
Individuals with Parkinson disease and comorbid dementia (PDD) demonstrate gait impairments, but little is known about how these individuals respond to interventions for gait dysfunction. Rhythmic auditory stimulation (RAS), which utilizes music or other auditory cues to alter gait, has been shown to be effective for improving gait in individuals with PD without dementia, but has not been explored in individuals with PDD.
Can individuals with PDD modulate their gait in response to music and mental singing cues?
This single center, cross-sectional, interventional study included 17 individuals with PDD. Participants received Music and Mental singing cues at tempos of 90 %, 100 %, 110 %, and 120 % of their uncued walking cadence. Participants were instructed to walk to the beat of the song. Gait variables were collected using APDM Opal sensors. Data were analyzed using mixed effect models to explore the impact of tempo and cue type (Music vs Mental) on selected gait parameters of velocity, cadence, and stride length.
Mixed effects models showed a significant effect of tempo but not for cue type for velocity (F=11.51, p < .001), cadence (F=11.13, p < .001), and stride length (F=5.68, p = .002). When looking at the marginal means, velocity at a cue rate of 90 % was significantly different from 100 %, indicating participants walked slower with a cue rate of 90 %. Participants did not significantly increase their velocity, cadence, or stride length with faster cue rates of 110 % and 120 % SIGNIFICANCE: Individuals with PDD appear to be able to slow their velocity in response to slower cues, but do not appear to be able to increase their velocity, cadence, or stride length in response to faster cue tempos. This is different from what has been reported in individuals with PD without dementia. Further research is necessary to understand the underlying mechanism for these differences.
患有帕金森病合并痴呆（PDD）的个体表现出步态障碍，但对于这些个体如何应对步态功能障碍的干预措施知之甚少。节奏听觉刺激（RAS）利用音乐或其他听觉提示来改变步态，已被证明对改善无痴呆的帕金森病个体的步态有效，但尚未在 PDD 个体中进行探索。
PDD 个体能否根据音乐和精神歌唱提示调节步态？
这项单中心、横断面、干预性研究纳入了 17 名 PDD 患者。参与者以其无提示行走步频的 90%、100%、110%和 120%的音乐和精神歌唱提示节奏进行行走。参与者被要求按照歌曲的节奏行走。步态变量使用 APDM Opal 传感器收集。使用混合效应模型分析数据，以探讨节奏和提示类型（音乐与精神）对所选速度、步频和步长等步态参数的影响。
混合效应模型显示，节奏对速度（F=11.51，p<0.001）、步频（F=11.13，p<0.001）和步长（F=5.68，p=0.002）有显著影响，但提示类型无显著影响。从边缘均值来看，在提示率为 90%的情况下，速度明显低于提示率为 100%的情况，这表明参与者在提示率为 90%的情况下走得更慢。当提示率为 110%和 120%时，参与者的速度、步频和步长并没有显著增加。
PDD 个体似乎能够根据较慢的提示降低速度，但似乎无法根据较快的提示节奏增加速度、步频或步长。这与无痴呆的帕金森病个体的报告不同。需要进一步研究以了解这些差异的潜在机制。
