Compensatory movement strategies differentially affect attention allocation and gait parameters in persons with Parkinson’s disease

Abstract

Persons with Parkinson’s disease (PwP) are advised to use compensatory strategies such as external cues or cognitive movement strategies to overcome gait disturbances. It is suggested that external cues involve the processing of sensory stimulation, while cognitive-movement strategies use attention allocation. This study aimed to compare over time changes in attention allocation in PwP between prolonged walking with cognitive movement strategy and external cues; to compare the effect of cognitive movement strategies and external cues on gait parameters; and evaluate whether these changes depend on cognitive function. Eleven PwP participated in a single-group pilot study. Participants walked for 10 min under each of three conditions: natural walking, using external cuing, using a cognitive movement strategy. Attention and gait variables were extracted from a single-channel electroencephalogram and accelerometers recordings, respectively. Attention allocation was assessed by the% of Brain Engagement Index (BEI) signals within an attentive engagement range. Cognitive function was assessed using a neuropsychological battery. The walk was divided into 2-min time segments, and the results from each 2-min segment were used to determine the effects of time and condition. Associations between cognitive function and BEI signals were tested. Findings show that in the cognitive movement strategy condition, there was a reduction in the % of BEI signals within the attentive engagement range after the first 2 min of walking. Despite this reduction the BEI did not consistently differ from natural and metronome walking. Spatiotemporal gait variables were better in the cognitive movement strategy condition relative to the other conditions. Global cognitive and information processing scores were significantly associated with the BEI only when the cognitive movement strategy was applied. In conclusion, the study shows that a cognitive movement strategy has positive effects on gait variables but may impose a higher attentional load. Furthermore, when walking using a cognitive movement strategy, persons with higher cognitive function showed elevated attentive engagement. The findings support the idea that cognitive and attentional resources are required for cognitive movement strategies in PwP. Additionally, this study provides support for using single-channel EEG to explore mechanistic aspects of clinical interventions.

The development of a home-based technology to improve gait in people with Parkinson's disease: a feasibility study

“…It should be noted that the absence of a metronome effect on gait variables in the current study is contrary to previous studies and reviews that suggested that auditory cues increase gait speed and stride length [5,12,13] and reduce gait variability [44][45][46]. However, several studies reported that auditory cueing did not affect these parameters [47][48][49]. The increase in variability when the light stripes were used was previously explained by the different nature of the cues: Visual cues, which are spatial in nature, mainly seem to influence scaling and amplitude generation during walking, while temporal auditory cues tend to affect the timing of gait and interlimb coordination [5,6].…”

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“…Theta activity is associated with a variety of cognitive and attentional processes involving both frontal and posterior cortical regions, including the periodic sampling of unattended visual information and navigation of the sensory environment [ 76 ]. This supports the idea that the PD group requires considerable cognitive and attentional resources for processing environmental information [ 77 ]. Caviness et al hypothesised that the increase in theta power was related to the abnormal diffuse acetylcholine and monoamine pathway projection to broad neocortical areas and intrinsic cortical circuits in PD [ 78 ].…”

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“…This renders them less practical for ongoing real-time monitoring. More recently, algorithms have been developed to extract real-time markers of attentional processes from single channels, necessitating short measurement times, at the scale of seconds [56,57,58,59 ▪ ,60 ▪ ,61,62 ▪ ,63,64,65 ▪ ,66,67].…”