A new approach toward gait training in patients with Parkinson’s Disease

Carvalho, Lívia Pinheiro; Mate, Kedar; Cinar, Eda; Abou-Sharkh, Ahmed; Lafontaine, Anne‐Louise; Mayo, Nancy E.

doi:10.1016/j.gaitpost.2020.06.031

Cited by 13 publications

(11 citation statements)

References 33 publications

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“…29 There have also been researches quantifying the long-term effects of a short-term intervention that uses external cues given by a sensor. 32 This study was performed on a small sample size which might be a limitation in its effectiveness. The duration of the research is 4 weeks which is a long time and as there is less motivation in Parkinson's patients this might lead to decreased patient compliance.…”

Section: Resultsmentioning

confidence: 99%

Comparison of effect of rhythmic auditory cueing versus rhythmic visual cueing on gait abnormalities with gait parameters in Parkinson’s patients

Naik¹,

Paldhikar²

2022

IJN

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: Parkinson’s patients benefit from multisensory cues, therefore it is vital to determine which sensory cue is more effective on gait.A Case-Control study design with a correlational technique wherein the evaluation of the relationship of the variables between two different groups was performed (baseline & post-intervention). The study consisted of 14 individuals with Group A (n=7) & Group B (n=7) using Random allocation by Chit Method. Group A (Rhythmic Auditory Cueing) with the help of metronomic cues given based on the subject’s initial cadence and progressed by 10% each week and Group B (Rhythmic Visual Cueing) with colorful stripes on the ground, the placement of which was changed each week. The duration of the study was 4 weeks (3 times each week), wherein the patients were made to walk on a 10m pathway. The outcome measures used were the crude method of gait analysis and the 10m Walk Test (at baseline and post-intervention). We conclude that both the group had improvements in their Spatio-temporal gait parameters, however, Group A had better results. The clinical study takes us to the conclusion that the intervention of Rhythmic auditory cueing proves to be more effective in improving the patient’s stride length, cadence, and, step-width thus helping in improving the patient's walking pattern.

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Section: Resultsmentioning

confidence: 99%

Comparison of effect of rhythmic auditory cueing versus rhythmic visual cueing on gait abnormalities with gait parameters in Parkinson’s patients

Naik¹,

Paldhikar²

2022

IJN

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“…Thus, auditory AF provides a fresh perspective to the learner in terms of feedback and improves overall learning by reducing subjective workload [ 5 ]. This was recently demonstrated by Carvalho et al who incorporated auditory AF in a new strategy employed by physical therapists to mitigate Parkinson’s disease (PD) gait symptoms by “placing the heel first when stepping” [ 2 ]. PD is a neurodegenerative disorder that affects around 1% of the old age population, and approximately 20% of these patients have gait disturbances.…”

Section: Reviewmentioning

confidence: 99%

“…The work of Carvalho et al was based on the “auditory alarm” variant of auditory AF, which produces sound without tone modulation when the movement variable exceeds the allocated threshold. For instance, the alarm rings when it senses unequal activity or loading of the weakened limb as compared with its normal counterpart [ 2 ].…”

Section: Reviewmentioning

confidence: 99%

“…In motor learning, feedback is movement-related information that is “fed back” to the learner before, during (concurrent), and after (terminal) an attempt to perform a task to enable modifications for the next action. In the field of sports, feedback is given by coaches to athletes to perform better, and in rehabilitation, therapists use it in patients who lost motor functions due to diseases [ 1 , 2 ]. Feedback information can be intrinsic (sensory), if it comes from movement production within the body, and/or extrinsic (augmented), if it is provided by sources outside the body and supplements intrinsic feedback [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Augmented Feedback on Motor Learning: A Systematic Review

Moinuddin¹,

Goel²,

Sethi³

2021

Cureus

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In motor learning, augmented feedback (AF) is the information provided by sources outside the body and encompasses visual feedback, auditory feedback, and multimodal augmented feedback. This review aims to examine the most recent evidence on these different modality types in healthy and diseased populations and athletes. The reporting of this review was guided by the standards of the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)” statement with the aim to examine the most recent evidence on these feedback types in healthy and diseased populations and athletes. The literature search for this review has been limited to electronic journals with the search engines ISI Web of Knowledge, OvidSP EMBASE, and PubMed databases. This review considers visual feedback as the cornerstone of all augmented feedback types by citing its superiority in learning complex skills by medical students and balance maintenance by older adults. The review also deciphers the role of auditory augmented feedback in encumbering already burdened visual connections in the rehabilitation of patients with Parkinson’s disease (PD) and prosthetic limbs and further argues why the multimodal feedback model seems to be the most efficient way to offer feedback in learning motor tasks by alluding to multifaceted “skill training communication model” in the prevention of sports injuries such as anterior cruciate ligament tears. Multimodal augmented feedback seems to be the most effective and appropriate way to give feedback during motor learning in healthy and diseased populations and athletes as its stimuli are perceived faster and tend to be retained longer compared with the unimodal stimuli of auditory and visual feedback mechanisms.

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“…In two proof-of-concept studies of 6 people with PD[22] and 6 pre-frail seniors[23] receiving 5 training sessions with Heel2Toe TM over 2 weeks, every person made at least one clinically meaningful change on one gait parameter after training. The potential mechanism of action is a dopamine-driven reward and feedback loop.…”

Section: Introductionmentioning

confidence: 99%

Real-time Auditory Feedback for Improving Gait and Walking in People with Parkinson’s Disease: A Pilot and Feasibility Trial

Mayo,

Mate,

Fellows

et al. 2024

Preprint

Self Cite

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BackgroundTechnology is poised to bridge the gap between demand for therapies to improve gait in people with Parkinson’s and available resources. A wearable sensor, Heel2ToeTM, a small device that attaches to the side of the shoe and gives a sound each time the person starts their step with a strong heel strike has been developed and pre-tested by a team at McGill University. The objective of this study was to estimate feasibility and efficacy potential of the Heel2ToeTMsensor in changing walking capacity and gait pattern in people with Parkinson’s.MethodsA pilot study was carried out involving 27 people with Parkinson’s randomized 2:1 to train with the Heel2Toe[TM] sensor and or to train with recommendations from a gait-related workbook.ResultsA total of 21 completed the 3-month evaluation, 14 trained with the Heel2Toe[TM] sensor and 7 trained with the workbook. Thirteen of 14 people in the Heel2Toe group improved over measurement error on the primary outcome, the Six Minute Walk Test, (mean change 66.4 m.) and 0 of the 7 in the Workbook group (mean change –19.4 m.): 4 of 14 in the Heel2Toe group made reliable change and 0 of 7 in the Workbook group. Improvements in walking distance were accompanied by improvements in gait quality. 40% of participants in the intervention group were strongly satisfied with their technology experience and an additional 37% were satisfied.ConclusionsDespite some technological difficulties, feasibility and efficacy potential of the Heel2Toe sensor in improving gait in people with Parkinson’s was supported.Key messages regarding feasibility1)What uncertainties existed regarding the feasibility?The Heel2Toe sensor had been used in clinical research as an assessment tool and in two small proof-of-concept studies with short-term supervised use to detect change and get user feedback on their experience. There was a need to test the sensor for home use and include a control group as perhaps the attention and exercise recommendations could alone have benefit. Therefore, we designed this pilot and feasibility study.2)What are the key feasibility findings?Dropouts from the trial were mainly related to the COVID situation. There were no adverse events in either group. Challenges with using the Heel2Toe sensor related to functionality of the app which were addressed immediately; hardware challenges were addressed in revisions including ease of charging and Bluetooth connectivity; there were challenges for people to use the smart-phone app optimally. Our current revision has removed need for the smartphone. The results also showed that people were able to use the sensor on their own at home with some technical support (average 22 minutes per person) which diminished over time and that, despite technical challenges, the majority of people were satisfied with their experience with the technology, some very much so. There was a strong response in the Heel2Toe group and a near nil response in the control group demonstrating efficacy potential.3)What are the implications of the feasibility findings for the design of the main study?The main study will use the revised version of the Heel2Toe sensor which has eliminated the challenges with connectivity and smartphone skills. Using the 6MWT as the outcome and based on conservative estimates of effect size (0.5), a sample size of 64 per group would be supported. This sample size would also be sufficient for estimating effects on other explanatory and downstream outcomes. Participants would keep the sensor after the study.

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A new approach toward gait training in patients with Parkinson’s Disease

Cited by 13 publications

References 33 publications

Comparison of effect of rhythmic auditory cueing versus rhythmic visual cueing on gait abnormalities with gait parameters in Parkinson’s patients

Comparison of effect of rhythmic auditory cueing versus rhythmic visual cueing on gait abnormalities with gait parameters in Parkinson’s patients

The Role of Augmented Feedback on Motor Learning: A Systematic Review

Real-time Auditory Feedback for Improving Gait and Walking in People with Parkinson’s Disease: A Pilot and Feasibility Trial

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