Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (ROC).
Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan (ROC).
Eur J Phys Rehabil Med. 2024 Aug;60(4):611-620. doi: 10.23736/S1973-9087.24.08261-3. Epub 2024 May 14.
The difficulties in obstacle walking are significant in people with Parkinson's disease (PD) leading to an increased fall risk. Effective interventions to improve obstacle walking with possible training-related neuroplasticity changes are needed. We developed two different exercise programs, complex walking training and motor-cognitive training, both challenging motor and cognitive function for people with PD to improve obstacle walking.
To investigate the effects of these two novel training programs on obstacle walking and brain activities in PD.
A single-center randomized, single-blind controlled study.
University laboratory; outpatient.
Individuals with idiopathic PD.
Thirty-two participants were randomly assigned to the complex walking training group (N.=11), motor-cognitive training group (N.=11) or control group (N.=10). Participants in training groups received exercises for 40 minutes/session, with a total of 12-session over 6 weeks. Control group did not receive additional training. Primary outcomes included obstacle walking, and brain activities (prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor area (SMA)) during obstacle walking by using functional near-infrared spectroscopy. Secondary outcomes included obstacle crossing, timed up and go test (TUG), cognitive function in different domains, and fall efficacy scale (FES-I).
The motor-cognitive training group demonstrated greater improvements in obstacle walking speed and stride length, SMA activity, obstacle crossing velocity and stride length, digit span test, and TUG than the control group. The complex walking training did not show significant improvement in obstacle walking or change in brain activation compared with control group. However, the complex walking training resulted in greater improvements in Rey-Osterrieth Complex Figure test, TUG and FES-I compared with the control group.
Our 12-session of the cognitive-motor training improved obstacle walking performance with increased SMA activities in people with PD. However, the complex walking training did not lead such beneficial effects as the cognitive-motor training.
The cognitive-motor training is suggested as an effective rehabilitation program to improve obstacle walking ability in individuals with PD.
帕金森病（PD）患者在障碍物行走方面存在困难，导致跌倒风险增加。需要有效的干预措施来改善障碍物行走，同时可能会引起与训练相关的神经可塑性变化。我们开发了两种不同的锻炼方案，复杂行走训练和运动认知训练，这两种方案都挑战了 PD 患者的运动和认知功能，以改善他们的障碍物行走能力。
研究这两种新的训练方案对 PD 患者障碍物行走和大脑活动的影响。
单中心随机、单盲对照研究。
大学实验室；门诊。
特发性 PD 个体。
32 名参与者被随机分配到复杂行走训练组（N=11）、运动认知训练组（N=11）或对照组（N=10）。训练组的参与者每次接受 40 分钟的练习，共 6 周 12 次。对照组不接受额外的训练。主要结局包括使用功能近红外光谱（fNIRS）测量障碍物行走时的障碍物行走速度、步幅和大脑活动（前额叶皮质（PFC）、运动前皮质（PMC）和辅助运动区（SMA））。次要结局包括障碍物穿越速度和步幅、计时起立行走测试（TUG）、不同领域的认知功能和跌倒效能量表（FES-I）。
与对照组相比，运动认知训练组在障碍物行走速度、步幅、SMA 活动、障碍物穿越速度和步幅、数字跨度测试和 TUG 方面的改善更为明显。与对照组相比，复杂行走训练在障碍物行走或大脑激活方面没有显著改善。然而，与对照组相比，复杂行走训练在 Rey-Osterrieth 复杂图形测试、TUG 和 FES-I 方面的改善更为明显。
我们的 12 次认知运动训练改善了 PD 患者的障碍物行走表现，并增加了 SMA 的活动。然而，复杂行走训练并没有像认知运动训练那样产生有益的效果。
认知运动训练被建议作为一种有效的康复方案，以提高 PD 患者的障碍物行走能力。
