A training approach to improve stepping automaticity while dual-tasking in Parkinson's disease: A prospective pilot study.
BACKGROUND
Deficits in motor movement automaticity in Parkinson's disease (PD), especially during multitasking, are early and consistent hallmarks of cognitive function decline, which increases fall risk and reduces quality of life. This study aimed to test the feasibility and potential efficacy of a wearable sensor-enabled technological platform designed for an in-home music-contingent stepping-in-place (SIP) training program to improve step automaticity during dual-tasking (DT).


METHODS
This was a 4-week prospective intervention pilot study. The intervention uses a sensor system and algorithm that runs off the iPod Touch which calculates step height (SH) in real-time. These measurements were then used to trigger auditory (treatment group, music; control group, radio podcast) playback in real-time through wireless headphones upon maintenance of repeated large amplitude stepping. With small steps or shuffling, auditory playback stops, thus allowing participants to use anticipatory motor control to regain positive feedback. Eleven participants were recruited from an ongoing trial (Trial Number: ISRCTN06023392). Fear of falling (FES-I), general cognitive functioning (MoCA), self-reported freezing of gait (FOG-Q), and DT step automaticity were evaluated.


RESULTS
While we found no significant effect of training on FES-I, MoCA, or FOG-Q, we did observe a significant group (music vs podcast) by training interaction in DT step automaticity (P<0.01).


CONCLUSIONS
Wearable device technology can be used to enable musically-contingent SIP training to increase motor automaticity for people living with PD. The training approach described here can be implemented at home to meet the growing demand for self-management of symptoms by patients.
Division of Translational Neuroscience, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Taylor
T
Chomiak
Alexander
A
Watts
Nicole
N
Meyer
Fernando V
FV
Pereira
Bin
B
Hu
D000368:Aged; D000465:Algorithms; D001288:Attention; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009146:Music; D010300:Parkinson Disease / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011446:Prospective Studies; D011597:Psychomotor Performance; D000068997:Smartphone; D016138:Walking