Attending to External Cues and Movement Strategies in Parkinson Disease
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      People with Parkinson's disease use compensatory strategies to overcome typical gait
      disturbances. These strategies rely on attentional mechanisms, however people with Parkinson
      disease suffer of decline in cognitive function. Therefore, the current study aims at
      exploring brain engagement and focus of attention process during walking with these
      compensatory strategies, in people with Parkinson disease. Such exploration would assist in
      understanding the feasibility of the compensatory strategies in daily lives of people with
      Parkinson's disease.
    

Detailed description: 
      External cues and cognitive movement strategies are common compensatory modes that people
      with Parkinson's disease can use to overcome typical gait disturbances. It is suggested that
      these modes utilize alternative neural pathways, bypassing the impaired basal ganglia motor
      circuits in the brain. In addition, both compensatory modes, in particular the movement
      cognitive strategies, are suggested to rely on attentional mechanisms.

      Cognitive deficits are common in PwP and include among others, impairment of attention,
      particularly in tasks requiring internal control of attention. Considering that gait
      compensatory modes may rely on cognitive function, in particular the cognitive movement
      strategies, it is not clear whether People with Parkinson's disease can engaged with these
      strategies for a prolonged time or distance as in many cases required in daily living.

      Therefore, the objectives of this study are 1) to test the effect of compensatory modes-
      external cueing and cognitive movement strategy on gait in prolonged walking. 2) to test
      whether people with Parkinson's disease can stay engaged and focus their attention to these
      compensatory modes for prolonged time. 3) to test whether subject's cognitive function is
      related to the ability to stay engaged with these compensatory modes. Subjects are recruited
      from a community physical- therapy groups for people with Parkinson's disease. Healthy older
      adults will be recruited from the community and will serve as a control group. Participants
      are invited for two separate evaluation sessions that includes: 1. Assessment of background
      characteristic: demographic details, severity of disease ( assessed by the Unified
      Parkinson's Disease Rating Scale-UPDRS), Levodopa Equivalent Dose (LED), freezing of gait
      questionnaire (FOG-Q) and Montreal cognitive assessment (MoCA).

      2. Evaluation of gait while attending to external cues and cognitive movement strategy.

      3. Evaluation of brain engagement during gait 4. Computerized cognitive assessment
    

Intervention name(s): external cues and cogntive movement strategies
Intervention type(s): Behavioral
Intervention description(s): external cueing are sensory stimuli such as auditory (e.g. rhythmic metronome beats) or or visual (e.g. spaced lines on the floor). Cognitive movement strategies refer to focusing attention on a specific parameter of gait (e.g. step length, arm swing).
In the study participants walk under four walking conditions:1)usuall (baseline) walking 2)walking while attending to external cues wich will be applied via metronome beats. The number of beats per minute is adjusted to each participant's steps number per minute. 3)walking with movement cognitive strategy: participants are requested to focus on their step length- and focus on increasing their step length while walking 4) Dual tasking-walking while performing a cognitive task.
During the four walking conditions Brain engegament will be measured, using the single-channel EEG system (Brain-MARC LTD) described in the follwing outcomes measures section.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Parkinson's disease; Gait; Attention; External cues