title: The possible price of auditory cueing: influence on obstacle avoidance in Parkinson's disease.
abstract: BACKGROUND
  Under carefully controlled conditions, rhythmic auditory cueing can improve gait in patients with Parkinson's disease (PD). In complex environments, attention paid to cueing might adversely affect gait, for example when a simultaneous task-such as avoiding obstacles-has to be executed. We primarily examined whether concurrent auditory cueing interferes with an obstacle avoidance task in patients with PD. The secondary aim was to study differences between patients with and without freezing of gait.
  
  
  METHODS
  Nineteen patients with PD (8 with freezing) were examined on a treadmill in 4 conditions: normal walking; walking with auditory cueing; walking with an obstacle avoidance task; and walking with auditory cueing and obstacle avoidance. Outcome measures included kinematic gait parameters and obstacle crossing parameters.
  
  
  RESULTS
  Auditory cueing improved gait in PD, without negative effects on concurrent obstacle avoidance. Additionally, freezers avoided obstacles less efficiently than non-freezers.
  
  
  CONCLUSIONS
  PD patients are able to successfully execute an obstacle avoidance task, when auditory cueing is administered simultaneously. The different obstacle avoidance behavior in freezers may contribute to their higher fall risk.
authors.affiliation: Department of Neurology and Parkinson Centre Nijmegen, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Wandana
authors.initials: W
authors.lastname: Nanhoe-Mahabier
authors.forename: Arnaud
authors.initials: A
authors.lastname: Delval
authors.forename: Anke H
authors.initials: AH
authors.lastname: Snijders
authors.forename: Vivian
authors.initials: V
authors.lastname: Weerdesteyn
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Overeem
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods*; D000368:Aged; D015982:Bias; D003463:Cues; D005080:Exercise Test; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D011597:Psychomotor Performance / Q000502:physiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology