Action Observation Plus Sonification. A Novel Therapeutic Protocol for Parkinson’s Patient with Freezing of Gait

Abstract

Freezing of gait (FoG) is a disabling symptom associated with falls, with little or no responsiveness to pharmacological treatment. Current protocols used for rehabilitation are based on the use of external sensory cues. However, cued strategies might generate an important dependence on the environment. Teaching motor strategies without cues [i.e., action observation (AO) plus Sonification] could represent an alternative/innovative approach to rehabilitation that matters most on appropriate allocation of attention and lightening cognitive load. We aimed to test the effects of a novel experimental protocol to treat patients with Parkinson’s disease (PD) and FoG, using functional, and clinical scales. The experimental protocol was based on AO plus Sonification. 12 patients were treated with 8 motor gestures. They watched eight videos showing an actor performing the same eight gestures, and then tried to repeat each gesture. Each video was composed by images and sounds of the gestures. By means of the Sonification technique, the sounds of gestures were obtained by transforming kinematic data (velocity) recorded during gesture execution, into pitch variations. The same 8 motor gestures were also used in a second group of 10 patients; which were treated with a standard protocol based on a common sensory stimulation method. All patients were tested with functional and clinical scales before, after, at 1 month, and 3 months after the treatment. Data showed that the experimental protocol have positive effects on functional and clinical tests. In comparison with the baseline evaluations, significant performance improvements were seen in the NFOG questionnaire, and the UPDRS (parts II and III). Importantly, all these improvements were consistently observed at the end, 1 month, and 3 months after treatment. No improvement effects were found in the group of patients treated with the standard protocol. These data suggest that a multisensory approach based on AO plus Sonification, with the two stimuli semantically related, could help PD patients with FoG to relearn gait movements, to reduce freezing episodes, and that these effects could be prolonged over time.

Auditory Proprioceptive Integration: Effects of Real-Time Kinematic Auditory Feedback on Knee Proprioception

“…Moreover, changes in movement patterns associated with subliminal changes in frequency can also have practical implications. For instance, enhancement in breathing (Murgia et al, 2016 ), music learning (Hol, 2011 ; Lahav et al, 2013 ), arm reaching (Maulucci and Eckhouse, 2001 ; Schmitz et al, 2014 ; Scholz et al, 2016 ), gait (Maulucci and Eckhouse, 2011 ; Zhang et al, 2013 ; Mezzarobba et al, 2017 ), sports (Eriksson and Bresin, 2010 ; Sigrist et al, 2013 ), performance with real-time auditory feedback has been demonstrated in a few studies. Here, subliminal modulation in frequency during training can be introduced to enhance variability in movement patterns, which further can lead to a dynamic learning pattern (Stein et al, 2014 ).…”

“…The perception of additional real-time acoustic feedback driven by dynamic or kinematic movement parameters obviously supports sensory/perceptual-motor representations (Effenberg, 2005 ; Schmitz et al, 2013 ) by enhancing cross-modal stimulation (Scholz et al, 2015 ; Ghez et al, 2017 ), multisensory integration (Schmitz et al, 2013 ; Effenberg et al, 2016 ), internal motor simulation (Schmitz and Effenberg, 2017 ), and neural plasticity (Altenmüller et al, 2009 ; Ghai et al, 2017c ). Literature indicates strong associations between auditory and motor areas for enhancing the performance in music (Lahav et al, 2013 ), breathing (Murgia et al, 2016 ), writing (Effenberg et al, 2015 ; Danna and Velay, 2017 ), sports (Sigrist et al, 2013 , 2015 ; Effenberg et al, 2016 ), and rehabilitation (Altenmüller et al, 2009 ; Murgia et al, 2015 ; Pau et al, 2016 ; Scholz et al, 2016 ; Ghai et al, 2017c ; Mezzarobba et al, 2017 ). Strong auditory motor couplings have also been confirmed in neuroimaging studies, where enhanced activation in cortical and sub-cortical structures associated with biological motion perception were reported (Scheef et al, 2009 ; Schmitz et al, 2013 ).…”

Efficacy and Characteristics of the Stimuli of Action Observation Therapy in Subjects With Parkinson's Disease: A Systematic Review

“…Studies included participants with a disease duration of at least 5 years and without dementia (Mini-Mental Status Examination > 24). Four studies included patients with freezing of gait, with an incidence of at least one episode in a week and a duration of at least 2 s for each episode (17,(27)(28)(29). Finally, in addition to a PD control group, two studies provided a sample of healthy controls matched for age and sex with patients (18,27).…”

“…During observation, participants were asked to keep their attention on movement details without performing any kind of movement. Only one study, after observation of each video-clip, asked patients to imitate the observed actions while they were still watching the same video (28). Other four studies asked patients to imitate the observed tasks after observation (17,20,27,29), whereas the remaining two studies delivered AOT without imitation (18,19).…”

Neural Basis of Action Observation and Understanding From First- and Third-Person Perspectives: An fMRI Study

“…Action observation has been proposed to provide an alternative and innovative approach to rehabilitation ( Mezzarobba et al, 2017 ; Scott et al, 2018 ), and a deeper understanding of the effects of body side, posture, and perspective is crucial for identifying the most effective conditions for stimulation of the motor system during action observation.…”