title: Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation.
abstract: People with Parkinson disease (PD) who show freezing of gait also have dysfunction in cognitive domains that interact with mobility. Specifically, freezing of gait is associated with executive dysfunction involving response inhibition, divided attention or switching attention, and visuospatial function. The neural control impairments leading to freezing of gait have recently been attributed to higher-level, executive and attentional cortical processes involved in coordinating posture and gait rather than to lower-level, sensorimotor impairments. To date, rehabilitation for freezing of gait primarily has focused on compensatory mobility training to overcome freezing events, such as sensory cueing and voluntary step planning. Recently, a few interventions have focused on restitutive, rather than compensatory, therapy. Given the documented impairments in executive function specific to patients with PD who freeze and increasing evidence of overlap between cognitive and motor function, incorporating cognitive challenges with mobility training may have important benefits for patients with freezing of gait. Thus, a novel theoretical framework is proposed for exercise interventions that jointly address both the specific cognitive and mobility challenges of people with PD who freeze.
authors.affiliation: D.S. Peterson, PhD, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon, and Department of Neurology, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (USA). petedani@ohsu.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Peterson
authors.affiliation: L.A. King, PT, PhD, Veterans Affairs Portland Health Care System (VAPORHCS) and Department of Neurology, School of Medicine, Oregon Health and Science University.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: King
authors.affiliation: R.G. Cohen, PhD, Department of Psychology and Communication Studies, University of Idaho, Moscow, Idaho.
authors.forename: Rajal G
authors.initials: RG
authors.lastname: Cohen
authors.affiliation: F.B. Horak, PT, PhD, Veterans Affairs Portland Health Care System (VAPORHCS) and Department of Neurology, School of Medicine, Oregon Health and Science University.
authors.forename: Fay B
authors.initials: FB
authors.lastname: Horak
mesh_terms: D001288:Attention; D015928:Cognitive Behavioral Therapy; D060825:Cognitive Dysfunction / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D056344:Executive Function; D005081:Exercise Therapy; D005684:Gait; D006801:Humans; D008960:Models, Psychological; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*