title: The effect of rhythmic somatosensory cueing on gait in patients with Parkinson's disease.
abstract: OBJECTIVE
  Gait and gait related activities in patients with Parkinson's disease (PD) can be improved with rhythmic auditory cueing (e.g. a metronome). In the context of a large European study, a portable prototype cueing device was developed to provide an alternative for rhythmic auditory cueing: rhythmic somatosensory cueing (RSC, a miniature vibrating cylinder attached to the wrist). We investigated whether PD patients could adapt their walking pattern using RSC under conditions of changing walking speed and the presence of potentially distracting visual flow while walking on a treadmill.
  
  
  METHODS
  A total of 17 patients with PD participated (mean age 63.4+/-10.3 years; Hoehn-Yahr score 2.5+/-0.9, mean Unified Parkinson's Disease Rating Scale score 49.8+/-13.7, mean disease duration 7.7+/-5.1 years). They performed systematic walking speed manipulations under 4 conditions in a random order: (1) no cue, no visual flow, (2) no cue, visual flow, (3) cue, no visual flow and (4) cue, visual flow. Visual flow in the form of a virtual corridor that moved at the current walking speed was projected on a 2 x 2 m rear-projection screen. The cueing rhythm was set at -10% of preferred stride frequency at each speed. Stride frequency was assessed using peaks in the trajectories of thigh sagittal plane segmental angles.
  
  
  RESULTS
  Walking with RSC resulted in lower stride frequencies, and thus larger step lengths (p-values <0.05), regardless of walking speed. The presence of visual flow did not impair the use of RSC, as evidenced by the lack of differences between conditions 3 and 4 (p>0.05).
  
  
  CONCLUSIONS
  Rhythmic somatosensory cueing may be a viable alternative for auditory cueing and is robust to changes in walking speed and visual distractors.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center (VUmc), Dienst Fysiotherapie, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. e.vanwegen@vumc.nl
authors.forename: E
authors.initials: E
authors.lastname: van Wegen
authors.forename: C
authors.initials: C
authors.lastname: de Goede
authors.forename: I
authors.initials: I
authors.lastname: Lim
authors.forename: M
authors.initials: M
authors.lastname: Rietberg
authors.forename: A
authors.initials: A
authors.lastname: Nieuwboer
authors.forename: A
authors.initials: A
authors.lastname: Willems
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: L
authors.initials: L
authors.lastname: Rochester
authors.forename: V
authors.initials: V
authors.lastname: Hetherington
authors.forename: H
authors.initials: H
authors.lastname: Berendse
authors.forename: J
authors.initials: J
authors.lastname: Zijlmans
authors.forename: E
authors.initials: E
authors.lastname: Wolters
authors.forename: G
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000368:Aged; D003463:Cues; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology*; D010507:Periodicity; D011597:Psychomotor Performance / Q000502:physiology*