title: Auditory cueing in Parkinson's patients with freezing of gait. What matters most: Action-relevance or cue-continuity?
abstract: Gait disturbances are a common feature of Parkinson's disease, one of the most severe being freezing of gait. Sensory cueing is a common method used to facilitate stepping in people with Parkinson's. Recent work has shown that, compared to walking to a metronome, Parkinson's patients without freezing of gait (nFOG) showed reduced gait variability when imitating recorded sounds of footsteps made on gravel. However, it is not known if these benefits are realised through the continuity of the acoustic information or the action-relevance. Furthermore, no study has examined if these benefits extend to PD with freezing of gait. We prepared four different auditory cues (varying in action-relevance and acoustic continuity) and asked 19 Parkinson's patients (10 nFOG, 9 with freezing of gait (FOG)) to step in place to each cue. Results showed a superiority of action-relevant cues (regardless of cue-continuity) for inducing reductions in Step coefficient of variation (CV). Acoustic continuity was associated with a significant reduction in Swing CV. Neither cue-continuity nor action-relevance was independently sufficient to increase the time spent stepping before freezing. However, combining both attributes in the same cue did yield significant improvements. This study demonstrates the potential of using action-sounds as sensory cues for Parkinson's patients with freezing of gait. We suggest that the improvements shown might be considered audio-motor 'priming' (i.e., listening to the sounds of footsteps will engage sensorimotor circuitry relevant to the production of that same action, thus effectively bypassing the defective basal ganglia).
authors.affiliation: Department of Clinical Sciences, Brunel University, London, UK. Electronic address: will.young@brunel.ac.uk.
authors.forename: William R
authors.initials: WR
authors.lastname: Young
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, CA, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Shreve
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, CA, USA.
authors.forename: Emma Jane
authors.initials: EJ
authors.lastname: Quinn
authors.affiliation: School of Psychology, Queen's University Belfast, Belfast, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Craig
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, CA, USA; Department of Neurosurgery, Stanford University, CA, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Bronte-Stewart
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods*; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001307:Auditory Perception; D001696:Biomechanical Phenomena; D001835:Body Weight; D015331:Cohort Studies; D003463:Cues; D005528:Foot / Q000503:physiopathology; D020233:Gait Disorders, Neurologic / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology* / Q000534:rehabilitation*; D016138:Walking / Q000502:physiology
chemical_list: D000978:Antiparkinson Agents
keywords: Audio-motor priming; Auditory observation; Freezing of gait; Imitation; Parkinson's; Sensory cueing