The attentional cost of external rhythmical cues and their impact on gait in Parkinson’s disease: effect of cue modality and task complexity
First Online: 28 June 2007 Received: 10 November 2006 Accepted: 05 May 2007 DOI:
Cite this article as: Rochester, L., Nieuwboer, A., Baker, K. et al. J Neural Transm (2007) 114: 1243. doi:10.1007/s00702-007-0756-y Summary
Changes in gait performance in 153 subjects with PD using three rhythmical cues (auditory, visual and somatosensory) were measured during a simple walking task and a dual walking task in the home. Subjects were ‘on’ medication and were cued at preferred step frequency. Accelerometers recorded gait and walking speed, step amplitude and step frequency were determined from raw data. Data were analysed with SAS using linear regression models. Gait performance during a single task reduced with cues in contrast to a dual task where PD subjects appeared to benefit from rhythmical cues (increased speed and step length). Effects were dependent on cue modality with significant improvements for auditory cues compared to others. A significant short-term carry-over effect of cues reduced 3 weeks later. Cues may reduce attentional demands by facilitating attentional allocation, accounting for differences of cue seen during single and dual task. Furthermore cue modality may influence attentional demand which is an important consideration for rehabilitation.
Keywords: Cues, gait, Parkinson’s disease, attention, dual-task interference, stimulus-response compatibility References Behrmann, M, Geng, J, Shomstein, S 2004 Parietal cortex and attention Curr Opin Neurobiol 14 212 217 CrossRef PubMed Bloem, B, Valkenburg, V, Slabbekoorn, M, van Dijk, J 2001 The multiple tasks test. Strategies in Parkinson’s disease Exp Brain Res 137 478 486 CrossRef PubMed Bond, J, Morris, M 2000 Goal-directed secondary motor tasks: their effects on gait in subjects with Parkinson’s disease Arch Phys Med Rehabil 81 110 116 PubMed Cools, R, Barker, R, Sahakian, B, Robbins, T 2001 Mechanisms of cognitive set flexibility in Parkinson’s disease Brain 124 2503 2512 CrossRef PubMed Cunnington, R, Iansek, R, Bradshaw, J, Phillips, JG 1995 Movement-related potentials in Parkinson’s disease. Presence and predictability of temporal and spatial cues Brain 118 935 950 CrossRef PubMed Cunnington, R, Iansek, R, Bradshaw, JA 1999 Movement-related potentials in Parkinson’s disease: external cues and attentional strategies Mov Disord 14 63 68 CrossRef PubMed
Deane K, Jones D, Clarke C, Playford D, Ben-Shlomo Y (2001b) Physiotherapy versus placebo or no intervention in Parkinson’s disease. The cochrane database of systematic reviews. Issue 3: Art. No. CD 002817
Deane K, Jones D, Ellis-Hill C, Clarke C, Playford E, Ben-Shlomo Y (2001a) Physiotherapy for patients with Parkinson’s disease: a comparison of techniques. The cochrane database of systematic reviews. Issue 1: Art. No. CD002815
Debaere, F, Wenderoth, N, Sunaert, S, Van Hecke, P, Swinnen, SP 2003 Internal vs external generation of movements: differential neural pathways involved in bimanual coordination performed in the presence or absence of augmented visual feedback Neuroimage 19 764 776 CrossRef PubMed Folstein, M, Folstein, S 1975 “Mini-Mental State” A practical method for grading the cognitive state of patients for the clinician J Psychiatr Res 12 189 198 CrossRef PubMed Goverover, Y 2004 Categorisation, deductive reasoning, and self-awareness: association with everyday competence in persons with acute brain injury J Clin Exper Neuropsychol 26 737 749 CrossRef Hoehn, M, Yahr, M 1967 Parkinsonism: onset, progression and mortality Neurology (Cleveland) 5 427 442 Howe, TE, Lovgreen, B, Cody, F, Ashton, V, Oldham, J 2003 Auditory cues can modify the gait of persons with early-stage Parkinson’s disease: a method for enhancing parkinsonian walking performance? Clin Rehabil 17 363 367 CrossRef PubMed Hughes, A, Daniel, S, Kilford, L, Lees, A 1992 Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases J Neurol Neurosurg Psychiatry 55 181 184 CrossRef PubMed Kritikos, A, Leahy, C, Bradshaw, J, Iansek, R, Phillips, J, Bradshaw, J 1995 Contingent and non-contingent auditory cueing in Parkinson’s disease Neuropsychologia 33 1193 1203 CrossRef PubMed Lim, I, van Wegen, E, de Goede, C, duetekom, M, Nieuwboer, A, Willems, A, et al. 2005 Effects of external rhythmical cueing on gait in patients with Parkinson’s disease: a systematic review Clin Rehabil 19 695 713 CrossRef PubMed Litvan, I 1999 Extrapyramidal disorders and frontal lobe function Miller, BL Cummings, JL eds. The human frontal lobes: functions and disorders Guilford Press London 402 421 McIntosh, G, Brown, S, Rice, R, Thaut, M 1997 Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson’s disease J Neurol Neurosurg Psychiatry 62 22 26 CrossRef PubMed Morris, M, Iansek, R, Matyas, T, Summers, J 1996 Stride length regulation in Parkinson’s disease. Normalization strategies and underlying mechanisms Brain 119 551 568 CrossRef PubMed Nieuwboer, A Kwakkel, G Rochester, L Jones, D Van Wegen, E The Rescue Consortium et al. 2007 Impact of a therapeutic cueing program in the home on gait related mobility in Parkinson’s disease. A randomised clinical trial J Neurol Neurosurg Psychiatry 78 134 140 CrossRef PubMed O’Shea, S, Morris, M, Iansek, R 2002 Dual task interference during gait in people with Parkinson’s disease: effects of motor versus cognitive secondary tasks Phys Ther 82 888 897 PubMed Rochester, L, Hetherington, V, Jones, D, Nieuwboer, A, Willems, AM, Kwakkel, G, et al. 2004 Attending to the task: interference effects of functional tasks on walking in Parkinson’s disease and the role of cognition, depression, fatigue and balance Arch Phys Med Rehabil 85 1578 1585 CrossRef PubMed Rochester, L, Hetherington, V, Jones, D, Nieuwboer, A, Willems, AM, Kwakkel, G, et al. 2005 The effect of external rhythmical cues (auditory and visual) on walking during a functional task in the home in people with Parkinson’s disease Arch Phys Med Rehabil 86 999 1006 CrossRef PubMed Thaut, M, McIntosh, G, Rice, R, Miller, R, Rathbun, J, Brault, J 1996 Rhythmic auditory stimulation in gait training for Parkinson’s disease patients Mov Disord 11 193 200 CrossRef PubMed Weeks, R, Honda, M, Catalan, M, Hallet, M 2001 Comparison of auditory, somatosensory, and visually instructed and internally generated finger movements: a PET study NeuroImage 14 219 230 CrossRef PubMed White, D, Wagenaar, R, Ellis, T 2006 Monitoring activity in individuals with Parkinson’s disease: a validity study J Neurol Phys Ther 30 12 21 PubMed Willems, A, Nieuwboer, A, Chavret, F, Desloovere, K, Dom, R, Kwakkel, G, et al. 2006 The use of rhythmic auditory cues to influence gait in patients with Parkinson’s disease, the differential effect for freezers and non-freezers, an explorative study Disabil Rehabil 28 721 728 CrossRef PubMed Yogev, G, Giladi, N, Peretz, C, Springer, S, Simon, E, Hausdorff, J 2005 Dual tasking, gait rhythmicity, and Parkinson’s disease: which aspects of gait are attention demanding? Eur J Neurosci 22 1248 1256 CrossRef PubMed