Training Based On Declarative Memory Cues Improved Gait In Patients With Parkinson's Disease
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      Deficits in automatic motor control, characteristic of Parkinson's disease (PD), contribute
      to progressive impairment in gait performance. The use of declarative memory cues in order to
      promote the engagement of attention and activation of the next movement in gait may minimize
      the consequences of lack of automatic control. The purpose of this study is to verify the
      long-term efficiency of a new strategy based on declarative memory cue to improve the gait
      performance and independence in daily life activities (DLA) in patients with PD.
    

Detailed description: 
      Background: Deficits in automatic motor control, characteristic of Parkinson's disease (PD),
      contribute to progressive impairment in gait performance. The use of declarative memory cues
      in order to promote the engagement of attention and activation of the next movement in gait
      may minimize the consequences of lack of automatic control.

      Objectives: To verify the long-term efficiency of a new strategy based on declarative memory
      cue to improve the gait performance and independence in daily life activities (DLA) in
      patients with PD.

      Design: Parallel prospective, single blind, randomized clinical trial. Setting: Brazilian
      Parkinson Association. Participants: Forty-four patients with PD in stages 2-3 of disease
      evolution according to Hoehn and Yahr Classification Interventions: The experimental training
      (ET) consisted of eight gait training sessions, twice a week, using the declarative memory
      cues strategy (DMCS). The control training (CT) consisted of a similar gait training without
      DMCS.

      Primary outcome measure: Gait performance in terms of speed and stride length. Secondary
      outcome measure: Independence in DLA according to Section II of the Unified Parkinson's
      Disease Rating Scale.

      Randomization: Participants were randomized into a control group (CG), which performed the
      CT, and an experimental group (EG), which performed the ET, through blinded drawing of names.

      Statistical analysis: The gait performance and ADL independence before, 2 and 60 days after
      the end of training were compared for CG and EG using Repeated-measures analysis of variance
      (RM-ANOVA).
    

Intervention name(s): Experimental Training; Control Training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The ET consisted of 3 phases being that the first one (Phase 1) was done only in the first session.
Phase 1: patients received a short and simple explanation about the deficiency in automatic movement resulting from PD. Following explanation, the patient memorized a sequence of declarative cues. Phase 2: the patient organized a sequence of cues using cards illustrating the subcomponent movements (key movement) involved in taking steps.
Phase 3: the patient had to train using declarative cues as a gait performance aid through 8 sets follow the instruction "Walk in your ordinary speed. Use the key movements and going to saying each of them while you make them. The declarative cues had to be evoked verbally by the patients themselves, during gait, triggering the corresponding movement.; The CT consisted of 3 phases, being the first one (Phase 1) was done only in the first session of training, and the other two (Phase 2 and 3) were repeated at each of the 8 sessions.
Phase 1: Patients received a short and simple explanation about the deficiency in automatic movement resulting from PD.
Phase 2: Patients received a general verbal attentional instruction of "pay attention to your steps and try to walk as better as you can", before starting the walk.
Phase 3: motor training of gait, where the patient had to perform 8 sets, following the instruction "Walk in your ordinary speed, paying attention to your steps" in the identical trajectories of ET. Additional instructions or cues were not provided.
Other intervention name(s): Declarative memory cues strategy (DMCS)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Parkinson Disease; Gait; cues; memory; training