Does Cueing Training Improve Physical Activity in Patients With Parkinson’s Disease?

Abstract

Background. Patients with Parkinson’s disease (PD) are encouraged to stay active to maintain their mobility. Ambulatory activity monitoring (AM) provides an objective way to determine type and amount of gait-related daily activities. Objective . To investigate the effects of a home cueing training program on functional walking activity in PD. Methods. In a single-blind, randomized crossover trial, PD patients allocated to early intervention received cueing training for 3 weeks, whereas the late intervention group received training in the following 3 weeks. Training was applied at home, using a prototype cueing device. AM was applied at baseline, 3, 6, and 12 weeks in the patient’s home, to record body movements. Postures and motions were classified as percentage of total time spent on (a) static activity, further specified as % sitting and % standing, and (b) % dynamic activity, further specified as % walking, % walking periods exceeding 5 seconds (W>" xbd="1983" xhg="1960" ybd="1440" yhg="1401"/>5s) and 10 seconds (W>10s). Random coefficient analysis was applied. Results. A total of 153 patients participated in this trial. Significant improvements were found for dynamic activity (β= 4.46; P < .01), static activity (β=-3.34; P < .01), walking (β= 4.23; P < .01), W>5s (β = 2.63; P < .05), and W>10s (β = 2.90; P < .01). All intervention effects declined significantly at 6 weeks follow-up. Conclusion. Cueing training in PD patients’ own home significantly improves the amount of walking as recorded by AM. Treatment effects reduced after the intervention period, pointing to the need for permanent cueing devices and follow-up cueing training.

Keywords

Parkinson’s disease rehabilitation physical activity gait cueing activity monitoring

References

Hirtz D. , Thurman DJ , Gwinn-Hardy K. , Mohamed M. , Chaudhuri AR , Zalutsky R.

How common are the "common" neurologic disorders?

Neurology . 2007;68:326-337.

De Lau LM , Giesbergen PC , De Rijk MC , Hofman A. , Koudstaal PJ , Breteler MMB. Incidence of parkinsonism and Parkinson disease in a general population: the Rotterdam Study. Neurology . 2004;63:1240-1244.

Gelb DJ , Oliver E. , Gilman S. Diagnostic criteria for Parkinson disease. Arch Neurol . 1999;56:33-39.

Herman T. , Giladi N. , Gruendlinger L. , Hausdorff JM Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson’s disease: a pilot study. Arch Phys Med Rehabil. 2007;88:1154-1158.

Stankovic I. The effect of physical therapy on balance of patients with Parkinson’s disease. Int Rehabil Res . 2004; 27:53-57.

Brichetto G. , Pelosin E. , Marchese R. , Abbruzzese G. Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study. Clin Rehabil . 2006;20:31-35.

Morris ME Locomotor training in people with Parkinson disease. Phys Ther. 2006;86:1426-1435.

Nieuwboer A. , Kwakkel G. , Rochester L. , et al. Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. J Neurol Neurosurg Psychiatry. 2007;78:134-140.

Rubinstein TC , Giladi N. , Hausdorff JM The power of cueing to circumvent dopamine deficits: a review of physical therapy treatment of gait disturbances in Parkinson’s disease. Mov Disord . 2002;17:1148-1160.

10.

Lim I. , Van Wegen E. , De Goede C. , et al. Effects of external rhythmical cueing on gait in patients with Parkinson’s disease: a systematic review. Clin Rehabil . 2005;19:695-713.

11.

Salarian A. , Russmann H. , Vingerhoets FJ , Burkhard PR , Aminian K. Ambulatory monitoring of physical activities in patients with Parkinson’s disease. IEEE Trans Biomed Eng. 2007;54:2296-2299.

12.

White DK , Wagenaar RC , Del Olmo ME , Ellis TD Test-retest reliability of 24 hours of activity monitoring in individuals with Parkinson’s disease in home and community. Neurorehabil Neural Repair. 2007;21:327-340.

13.

White DK , Wagenaar RC , Ellis TD Monitoring activity in individuals with Parkinson disease: a validity study . J Neurol Phys Ther. 2006;30:12-21.

14.

Van Wegen E. , De Goede C. , Lim I. , et al. The effect of rhythmic somatosensory cueing on gait in patients with Parkinson’s disease. J Neurol Sci. 2006;248:210-214.

15.

Hoehn MM , Yahr MD Parkinsonism: onset, progression and mortality. Neurology . 1967;17:427-442.

16.

Rochester L. , Hetherington V. , Jones D. , et al. The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease. Arch Phys Med Rehabil. 2005;86:999-1006.

17.

Van Wegen E. , Lim I. , De Goede C. , et al. The effects of visual rhythms and optic flow on stride patterns of patients with Parkinson’s disease. Parkinsonism Relat Disord. 2006 ; 12:21-27.

18.

Willems AM , Nieuwboer A. , Chavret F. , et al. 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. Disab Rehabil. 2006;28:721-728.

19.

Goldstein H. , Browne W. , Rasbash J. Multilevel modelling of medical data. Stat Med. 2002;21:3291-3315.

20.

Shrout PE , Fleiss JL Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420-428.

21.

Fleiss JL The Design and Analysis of Clinical Experiments. New York, NY: Wiley; 1986.

22.

Bland JM , Altman DG Statistical methods for assessing agreement between two methods of clinical measurements. Lancet. 1986;1:307-310.

23.

Pate RR , Pratt M. , Blair SN , et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407.

24.

Giladi N. , Balash Y. The clinical approach to gait disturbances in Parkinson’s disease; maintaining independent mobility. J Neural Transm Suppl. 2006;70:327-332.

25.

Goodwin VA , Richards SH , Taylor RS , Taylor AH , Campbell JL The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord . 2008;23:631-640.

26.

Bussmann JB , Martens WL , Tulen JH , Schasfoort FC , Van den Berg-Emons HJG , Stam HJ Measuring daily behavior using ambulatory accelerometry: the Activity Monitor . Behav Res Methods Instrum Comput. 2001;33:349-356.

27.

De Goede CJ , Keus SH , Kwakkel G. , Wagenaar RC The effects of physical therapy in Parkinson’s disease: a research synthesis. Arch Phys Med Rehabil. 2001;82:509-515.

28.

Van Peppen RP , Kwakkel G. , Wood-Dauphinee S. , Hendriks HJ , Van der Wees PJ , Dekker J. The impact of physical therapy on functional outcomes after stroke: what’s the evidence? Clin Rehabil. 2004;18:833-862.

29.

Willems AM , Nieuwboer A. , Chavret F. , et al. Turning in Parkinson’s disease patients and controls: the effect of auditory cues. Mov Disord. 2007 ;22:1871-1878.

30.

Almeida QJ , Frank JS , Roy EA , Patla AE , Jog MS Dopaminergic modulation of timing control and variability in the gait of Parkinson’s disease. Mov Disord. 2007;22:1735-1742.

31.

Moore ST , MacDougall HG , Gracies JM , Ondo WG Locomotor response to levodopa in fluctuating Parkinson’s disease . Exp Brain Res. 2008;184:469-478.

32.

Azulay JP , Mesure S. , Amblard B. , Blin O. , Sangla I. , Pouget J. Visual control of locomotion in Parkinson’s disease. Brain. 1999;122:111-120.

33.

Cerasa A. , Hagberg GE , Peppe A. , et al. Functional changes in the activity of cerebellum and frontostriatal regions during externally and internally timed movement in Parkinson’s disease. Brain Res Bull. 2006;71:259-269.

34.

Chuma T. , Faruque Reza M. , Ikoma K. , Mano Y. Motor learning of hands with auditory cue in patients with Parkinson’s disease. J Neural Transm. 2006;113:175-185.