Effects of cognitive task on gait initiation in Parkinson disease: Evidence of motor prioritization?

Abstract

Abstract-While much is known about the effects of dual tasking on cyclical and continuous motor performance (e.g., locomotion), there is a paucity of information on the effect of dual tasking on the initiation of movement. Therefore, the purpose of this study was to investigate the effect of a concurrent cognitive task on gait initiation in three groups: patients with Parkinson disease, healthy older adults, and healthy young adults. We examined the anticipatory postural adjustment displacements and velocities during single-task gait initiation as well as two dual-task conditions: (1) 0-back + gait initiation and (2) 2-back + gait initiation. The Parkinson disease group exhibited less anticipatory postural adjustment displacement and velocity than their aged-matched healthy peers and young adults during the single-and dual-task gait initiation settings (p < 0.05). Of interest was the finding of no additional effect on anticipatory postural adjustment displacement or velocity of gait initiation during the dual-task conditions in any group, including the Parkinson disease group. More traditionally studied gait/balance dual-task paradigms have demonstrated both motor and cognitive decline. Therefore, our results may suggest a prioritization of more "intentional" movement task (e.g., gait initiation) while dual tasking in Parkinson disease.

The Influence of a Cognitive Task on the Postural Phase of Gait Initiation in Parkinson’s Disease: An Electromyographic-Based Analysis

“…The TA is the main muscle to propel the body forward in the postural phase of the GI (Elble et al, 1994), but its activity is usually impaired in individuals with PD (Gantchev et al, 1996) as it tends to become weaker as the disease progresses (Crenna, Frigo, Giovannini, & Piccolo, 1990). This TA impairment can explain the longer duration of the mediolateral CoP displacement in individuals with PD compared to controls, in fact the lower backward displacement tends to increase the lateral displacement in order to release the swing limb (Carpinella et al, 2007;Nocera et al, 2013;Yiou et al, 2012) and tends to be lower in the dual-task condition relatively to the single-task condition. The dual-task condition involves the execution of two tasks simultaneously: one being the main task, with a greater focus of attention on it, and the other is the secondary task (V. E. Nocera et al, 2013;Vanshika & Ravi, 2012).…”

“…This TA impairment can explain the longer duration of the mediolateral CoP displacement in individuals with PD compared to controls, in fact the lower backward displacement tends to increase the lateral displacement in order to release the swing limb (Carpinella et al, 2007;Nocera et al, 2013;Yiou et al, 2012) and tends to be lower in the dual-task condition relatively to the single-task condition. The dual-task condition involves the execution of two tasks simultaneously: one being the main task, with a greater focus of attention on it, and the other is the secondary task (V. E. Nocera et al, 2013;Vanshika & Ravi, 2012). Biomechanical studies of postural stability have demonstrated that in the dual-task condition, subjects with Parkinson's disease (PD) exhibit impaired postural control (Nocera et al, 2013;Yogev-Seligmann et al, 2010).…”

“…The dual-task condition involves the execution of two tasks simultaneously: one being the main task, with a greater focus of attention on it, and the other is the secondary task (V. E. Nocera et al, 2013;Vanshika & Ravi, 2012). Biomechanical studies of postural stability have demonstrated that in the dual-task condition, subjects with Parkinson's disease (PD) exhibit impaired postural control (Nocera et al, 2013;Yogev-Seligmann et al, 2010). In addition, some authors have suggested that the dual-task condition restricts their anticipatory postural adjustments (APAs) in order to focus on the cognitive task without losing balance (Nocera et al, 2013;Yogev-Seligmann et al, 2010); however, in our study the difference found between the conditions was not significant.…”

“…The confirmation of this hypothesis may be usefully for rehabilitation by establishing strategies to reduce the impact of the disease on the individuals' postural control. Based on previous studies (Nocera et al, 2013;Yogev-Seligmann et al, 2010), it can be hypothesised that the EMG activities of the SOL and TA muscles would be reduced (lower magnitude and later activation) in individuals with PD relative to controls, and that these EMG activities would also have a lower magnitude and later activation in the dual-task condition compared to the single-task condition for PD subjects, albeit without differences in terms of activation patterns. Therefore, the aim of this study was to compare the postural phase strategies during gait initiation in single-and dual-task conditions in controls and individuals with PD (Modified Hoehn and Yahr scale < 3).…”

“…This indicates that the expected change of cortical to subcortical areas during the switch from controlled processing to automatic processing does not occur in individuals with PD (Pringsheim, Jette, Frolkis, & Steeves, 2014). Biomechanical studies of postural stability during GI and walking have clearly demonstrated that the execution of dual-task has a significant effect on postural control among individuals with PD (Nocera, Roemmich, Elrod, Altmann, & Hass, 2013; "The Influence of a Cognitive Task on the Postural Phase of Gait Initiation in Parkinson's Disease: An Electromyographic Based Analysis" by Fernandes A, Sousa AS, Rocha N, Tavares JM Motor Control © 2016 Human Kinetics, Inc. Yogev-Seligmann et al, 2010). Nevertheless, these studies have accessed the postural control strategies based on kinematic variables which hamper the reasoning about the implications of neural impairment of PD in motor control dysfunctions during the GI.…”