title: Parkinsonian gait improves with bilateral subthalamic nucleus deep brain stimulation during cognitive multi-tasking.
abstract: Gait impairment in Parkinson's disease reduces mobility and increases fall risk, particularly during cognitive multi-tasking. Studies suggest that bilateral subthalamic deep brain stimulation, a common surgical therapy, degrades motor performance under cognitive dual-task conditions, compared to unilateral stimulation.
  
  
  
  To measure the impact of bilateral versus unilateral subthalamic deep brain stimulation on walking kinematics with and without cognitive dual-tasking.
  
  
  
  Gait kinematics of seventeen patients with advanced Parkinson's disease who had undergone bilateral subthalamic deep brain stimulation were examined off medication under three stimulation states (bilateral, unilateral left, unilateral right) with and without a cognitive challenge, using an instrumented walkway system.
  
  
  
  Consistent with earlier studies, gait performance declined for all six measured parameters under cognitive dual-task conditions, independent of stimulation state. However, bilateral stimulation produced greater improvements in step length and double-limb support time than unilateral stimulation, and achieved similar performance for other gait parameters.
  
  
  
  Contrary to expectations from earlier studies of dual-task motor performance, bilateral subthalamic deep brain stimulation may assist in maintaining temporal and spatial gait performance under cognitive dual-task conditions.
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Chenji
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Wright
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kelvin L
authors.initials: KL
authors.lastname: Chou
authors.affiliation: Deparment of Psychology, University of Michigan, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Rachael D
authors.initials: RD
authors.lastname: Seidler
authors.affiliation: Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: pgpatil@med.umich.edu.
authors.forename: Parag G
authors.initials: PG
authors.lastname: Patil
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications* / Q000628:therapy; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: Cognitive impairment; Deep brain stimulation; Dual-task; Gait; Parkinson's disease