Model-based Cueing-as-needed for Walking in Parkinson's Disease

Study Overview
=================
Brief Summary
-----------------
Correcting of the lack of regularity in steps is a key component of gait rehabilitation in Parkinson's disease. The proposal is to introduce adaptive spatial auditory cueing (ASAC) based on verbal instruction lengthen the step automatically delivered when the stride length decreased below a predetermined threshold. The present study compared the effect of usual rhythmic auditory cueing versus ASAC used during a walking training in Parkinson's disease.

Detailed Description
-----------------
Correcting of the lack of regularity in steps is a key component of gait rehabilitation in Parkinson's disease. The proposal is to introduce adaptive spatial auditory cueing (ASAC) based on verbal instruction lengthen the step automatically delivered when the stride length decreased below a predetermined threshold. The present study compared the effect of usual rhythmic auditory cueing versus ASAC used during a walking training in Parkinson's disease. Fifteen patients with Parkinson's disease performed both interventions in randomized order, one week apart: a 20-minute walking training with rhythmic auditory cueing, in form of a metronome adjusted on 110% of the patient's own cadence, or ASAC delivered when the stride length is less than 110% of the patient's own stride length. Assessment criteria were walking distance covered during the intervention, speed, step length, cadence, coefficients of variation of step length and step duration, and indexes of spatial and temporal asymmetry during a walking test before and just after the intervention.

Official Title
-----------------
Model-based Cueing-as-needed for Walking in Parkinson's Disease

Conditions
-----------------
Parkinson Disease, Walking, Difficulty, Gait, Festinating

Intervention / Treatment
-----------------
* Other: 20-minute gait training


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: the diagnosis of idiopathic PD based on the United Kingdom-Parkinson's Disease Society Brain Bank criteria; stage 2 or 3 on the Hoehn and Yahr scale; comfortable walking speed over 10 meters ≤ 1 m/s; ability to walk over 20 minutes without aids or antiparkinsonian medications; a stable antiparkinsonian medication regime; cognitive abilities to understand the verbal instructions for a walking test according to the investigator's judgment; written consent for the participation. Exclusion Criteria: intercurrent disease other than PD, affecting gait; any intercurrent medical condition preventing them from participating in two consecutive gait training one week apart; medical diagnosis of hearing loss; non-affiliation to the social security regime.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Pilot single-blind randomized cross-over study, with the subject blind as to the hypothesis
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rhythmic auditory cueing<br>The rhythmic auditory cueing (RAC) is a constant stimulation (bip signal) delivered by a numeric metronome, which is adjusted on 110% of the patient's own cadence. | Other: 20-minute gait training<br>* All subjects undergo two 20-minute gait trainings using two different kinds of auditory cueing (temporal or spatial), one week apart (D1 and D8).<br>|
| Experimental: Adaptive spatial auditory cueing<br>Adaptive spatial auditory cueing (ASAC) is a verbal instruction stimulation delivered by an application when the stride length of the patient is less than a predetermined threshold, during two consecutive strides. The instruction is given in the patient's native language, which is French: allongez le pas (i.e. lengthen the step). The predetermined threshold is 110% of the patient's own stride length. | Other: 20-minute gait training<br>* All subjects undergo two 20-minute gait trainings using two different kinds of auditory cueing (temporal or spatial), one week apart (D1 and D8).<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Walking speed | Speed in free walking condition over 10 meters barefoot, without any assistance | Before and just after the intervention | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Basal Ganglia Diseases, Gait analysis, Gait Speed, Cues, Exercise Therapy