Article

OBJECTIVE: To examine the effects of cue timing, across 3 sensory modalities, on
anticipatory postural adjustments (APAs) during gait initiation in people with
Parkinson disease (PD). DESIGN: Observational study. SETTING: Biomechanics
research laboratory. PARTICIPANTS: Individuals with idiopathic PD (N=25; 11 with
freezing of gait [FOG]) were studied in the off-medication state (12-h overnight
withdrawal). INTERVENTIONS: Gait initiation was tested without cueing
(self-initiated) and with 3 cue timing protocols: fixed delay (3s), random delay
(4-12s), and countdown (3-2-1-go, 1-s intervals) across 3 sensory modalities
(acoustic, visual, and vibrotactile). MAIN OUTCOME MEASURES: The incidence and
spatiotemporal characteristics of APAs during gait initiation were analyzed,
including vertical ground reaction forces and center of pressure. RESULTS: All
cue timings and modalities increased the incidence and amplitude of APAs compared
with self-initiated stepping. Acoustic and visual cues, but not vibrotactile
stimulation, improved the timing of APAs. Fixed delay or countdown timing
protocols were more effective at decreasing APA durations than random delay cues.
Cue-evoked improvements in APA timing, but not amplitude, correlated with the
level of impairment during self-initiated gait. Cues did not improve the late
push-off phase in the FOG group. CONCLUSIONS: External cueing improves gait
initiation in PD regardless of cue timing, modality, or clinical phenotype (with
and without FOG). Acoustic or visual cueing with predictive timing provided the
greatest improvements in gait initiation; therefore, these protocols may provide
the best outcomes when applied by caregivers or devices.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS