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A motor learning-based intervention to ameliorate freezing of gait in subjects with Parkinson’s disease

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Abstract

Freezing of gait (FOG) is an episodic gait disturbance that is commonly seen in Parkinson’s disease (PD). To date, treatment efficacy is limited. We tested the hypothesis that an intervention that utilizes motor learning provided through intensive cueing can alleviate this symptom. Fifteen subjects with PD suffering from FOG participated in a 6 week progressive motor learning program (three training sessions per week—open trial). A training session included FOG-provoking situations (e.g., turns). Prior to each presumed FOG provocation (e.g., just before a turn), rhythmic auditory stimulation (RAS) was elicited and the subject was trained to walk rhythmically, coordinate left–right stepping and to increase step size, utilizing the RAS cueing. Net training duration increased from week to week and secondary cognitive tasks while walking were added to increase FOG propensity. FOG symptom burden was assessed before, immediately, and 4 weeks after the training period. The mean number of FOG episodes (±SEM) per 10 m of walking in a standardized gait assessment decreased from 0.52 ± 0.29 in the pre-testing to 0.15 ± 0.04 in the post-testing (p < 0.05). The duration of FOG episodes decreased from 4.3 ± 2.1 to 2.6 ± 0.6 s (p < 0.05). Additional measures (e.g., FOG questionnaire, gait speed) varied in their responsiveness to the treatment. These effects were retained 4 weeks after the training. The results of this open label study support the possibility that a motor learning-based intervention is apparently effective in reducing FOG burden, suggesting that RAS can deliver ‘anti-FOG’ training.

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Acknowledgments

We thank the persons who volunteered to participate for their time and effort, and Dr. Anat Mirelman for her input. This study was funded in part by the Michael J. Fox Foundation for the Research of Parkinson’s disease, and by the European Union—Seventh Framework Programme (FP7/2007-2013) under grant agreement n°288516 (CuPiD project).

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical statements

This study has been approved by the Human Studies Committee of Tel Aviv Sourasky Medical Center, and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Author information

Author notes

  1. Meir Plotnik

    Present address: The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

Authors and Affiliations

  1. Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel

    Meir Plotnik, Shirley Shema, Moran Dorfman, Eran Gazit, Marina Brozgol, Nir Giladi & Jeffrey M. Hausdorff

  2. Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Meir Plotnik

  3. Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel

    Meir Plotnik

  4. Department of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Nir Giladi

  5. Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel

    Nir Giladi & Jeffrey M. Hausdorff

  6. Department of Physiotherapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Jeffrey M. Hausdorff

  7. Department of Medicine, Harvard Medical School, Boston, USA

    Jeffrey M. Hausdorff

Authors
  1. Meir Plotnik
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  2. Shirley Shema
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  3. Moran Dorfman
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  7. Jeffrey M. Hausdorff
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Correspondence to Meir Plotnik.

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Plotnik, M., Shema, S., Dorfman, M. et al. A motor learning-based intervention to ameliorate freezing of gait in subjects with Parkinson’s disease. J Neurol 261, 1329–1339 (2014). https://doi.org/10.1007/s00415-014-7347-2

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  • DOI: https://doi.org/10.1007/s00415-014-7347-2

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