Targeted Rhythmic Auditory Cueing During Treadmill and Overground Gait for Individuals With Parkinson Disease: A Case Series.

BACKGROUND AND PURPOSE: Rhythmic auditory cueing and treadmill walking can improve spatiotemporal gait parameters through entrainment of movement patterns. Careful selection of cue frequencies is necessary if treadmill walking is to be employed, because cadence and step length are differentially affected by walking on a treadmill and overground. The purpose of this study was to describe the treatment of gait impairments for individuals with Parkinson disease, using strategically selected rhythmic auditory cue frequencies on both a treadmill and overground. CASE DESCRIPTION: Three individuals with Hoehn & Yahr stage 2 Parkinson disease participated in this case series. INTERVENTION: All participants completed 6 weeks of gait training, in which each session employed rhythmic auditory cueing during treadmill-based gait training followed by overground gait training. We provided targeted rhythmic auditory cueing with a metronome set to 85% and 115% of their self-selected cadence for treadmill and overground training, respectively. We performed clinical tests of gait and balance prior to, midway, and following training, and at a 3-month follow-up. OUTCOMES: All participants improved overground gait speed (participant 1: +0.27 m/s; participant 2: +0.20 m/s; and participant 3: +0.18 m/s) and stride length (15.7 ± 4.17 cm) with small changes to cadence. Likewise, there were only small changes in balance. DISCUSSION: We hypothesize that the large improvements in gait speed are due to the concomitant increases in stride length. Further research is needed to test the effect of targeted rhythmic auditory cueing during treadmill and overground gait.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A309).

What predicts falls in Parkinson disease?: Observations from the Parkinson's Foundation registry.

BACKGROUND: We undertook this study to identify patients with Parkinson disease (PD) with no or rare falls who may progress to frequent falling by their next annual follow-up visit. METHODS: We analyzed data in the National Parkinson Foundation Quality Improvement Initiative database to identify factors predicting which patients with PD with no or rare falls at the baseline visit will report at least monthly falls at the annual follow-up visit. Multivariable models were constructed using logistic regression. Variables were introduced in 4 blocks: in the 1st block, variables present at or before the baseline visit were entered; in the 2nd, baseline visit assessments; in the 3rd, interventions implemented during baseline visit; and, in the 4th block, changes in comorbidities, living situation, and treatment between visits. RESULTS: Of 3,795 eligible participants, 3,276 (86.3%) reported no or rare falls at baseline visit, and of them, 382 (11.7%) reported at least monthly falls at follow-up visit. Predictors included female sex, <90% diagnostic certainty, motor fluctuations, levodopa treatment, antidepressant treatment, prior deep brain stimulation (DBS), worse quality of life, Hoehn & Yahr stage 2 or 3, worse semantic fluency, and, between visits, addition of amantadine, referral to occupational therapy, social services, or DBS, new diagnoses of cancer or osteoarthritis, and increased emergency visits. CONCLUSIONS: This large-scale analysis identified several predictors of progression to falling in PD. Such identifiers may help target patient subgroups for falls prevention intervention. Some factors are modifiable, offering opportunities for developing such interventions.

Effect of age on visuomotor functional MR imaging.

RATIONALE AND OBJECTIVES: We sought to determine the effect of age on functional MR imaging experiments performed with visual and motor stimulation. We hypothesized that there would be a diminution in the amplitude of fMRI activation with increasing subjects' age. MATERIALS AND METHODS: We used fixed effects models to study the amplitude of activation during a block design visuomotor task in three different age groups: old (mean: 75 years; standard deviation: 6 years), middle-aged (mean: 52 years; standard deviation: 9 years) and young (mean: 29 years; standard deviation: 5 years). Each group included 7 subjects. Regions of interest (ROI) were left primary motor area (LM1), supplementary motor area (SMA), and right and left occipital (RO, LO) visual areas. Individual subjects and group statistical parametric maps (SPMs) were generated for each ROI, and then the mean amplitude of activation was compared using the group analysis and t test. RESULTS: The young age group showed higher amplitude of activation than middle and old age groups in all ROI (P < 0.01 uncorrected). Unpaired two tailed t test results between the groups showed significant differences between middle and young, and old and young age groups in all ROIs (P < or = 0.05), with the exception of old and young age groups in RO region (P = 0.11). CONCLUSION: The group analysis, and unpaired t test results reveal higher amplitude of fMRI activation in the young versus the old and middle-aged groups.

Timing of cortical activation: a latency-resolved event-related functional MR imaging study.

BACKGROUND AND PURPOSE: The time course of cortical activations of different anatomic areas has been demonstrated to reflect, to some degree, the temporal dynamics of the brain network. The purpose of this study was to determine the temporal sequence of the hemodynamic response in the visual, supplemental motor (SMA), and primary motor cortical areas by using a visuomotor reaction time task. METHODS: The reaction times (RTs) of 26 right-handed subjects were recorded in response to a visual cue during an event-related functional MR imaging (fMRI) experiment. Statistical parametric mapping (SPM99) was used, and activation maps were produced for each subject. This was followed by a random-effects group analysis. Using a weighted least-squares approach, we recorded the time at onset of the hemodynamic response of the fMRI activation in four regions of interest: the right occipital (RO) and left occipital (LO) visual cortices, the SMA, and the left sensorimotor area (LM1). Linear regression analysis was done between the RTs and the mean latencies for the four areas. RESULTS: Using the group analysis, the results showed that the first regions to activate were the visual occipital cortices (RO and LO) with mean latency +/- standard error of mean (SEM) of 1.74 +/- 0.05 s and 1.85 +/- 0.08 s, respectively. The visual occipital areas were followed by the SMA of 2.07 +/- 0.16 s and finally the LM1 with a mean latency of 2.1 +/- 0.15 s. There were significant differences in the mean onset of latencies between RO and LO, RO and SMA, and RO and LM1 (P <.05). On performing regression analysis between the RTs and the mean latencies by using the group analysis, there was no significant correlation with any of the four areas. By using an individual subject analysis, the results again showed that the first regions to activate were the visual occipital cortices (RO and LO) with mean latency +/- SEM of 1.75 +/- 0.06 s and 1.84 +/- 0.12 s, respectively, followed by the SMA with a mean latency of 2.19 +/- 0.25 s and finally the LM1 of 2.26 +/- 0.38 s. There was no significant difference between the mean onset latencies. CONCLUSION: The onset of the hemodynamic response started first in the visual cortex (input) followed by the SMA and primary motor cortical area (output). The onset of activation showed no direct correlation with the overall RTs of the subjects, leading one to suggest that the peripheral motor unit may have a greater impact on RT than the central contribution.