Evaluation of Compensation Strategies for Gait Impairment in Patients With Parkinson Disease

Tosserams, Anouk; Keijsers, Noël L.W.; Kapelle, Willanka M.; Kessels, Roy P. C.; Weerdesteyn, Vivian; Bloem, Bastiaan R.; Nonnekes, Jorik

doi:10.1212/wnl.0000000000201159

Cited by 10 publications

(12 citation statements)

References 44 publications

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“…At the individual level, 71% of the participants responded to some form of cueing (> 10% relative reduction of percent time frozen). We found unique responders to each cueing modality which strengthens the previously described importance of an individually tailored, personalized approach when applying compensation strategies in PD [6].…”

Section: Discussionsupporting

confidence: 85%

“…This may suggest that only relatively few participants were responsive to cueing. It is known that the effect of external cueing varies greatly among people with PD and even depends on the context in which they are applied [ 6 ]. This is reflected by previous studies on tactile cueing; while most found beneficial effects [ 15 , 17 , 18 , 35 ], others did not find an effect at the group level, which is in line with our findings [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…It highly impairs mobility, causes falls and reduces the quality of life [2]. FOG improves only partially in response to pharmacological treatment; therefore, non-pharmacological treatments, such as external cueing, are a key complementary treatment modality [4][5][6]. External cues include rhythmic temporal or spatial stimuli that can help to initiate or to continue movements, such as gait [5,7].…”

Section: Introductionmentioning

confidence: 99%

“…Visual and auditory cueing effectively reduce FOG [ 8 – 11 ]. The response to cueing, however, varies greatly between people with PD [ 6 , 12 ]; indeed, not all persons with PD respond to cueing, and for some, gait may even worsen [ 4 ]. Although the exact working mechanism of various types of cueing remains unknown, this specific compensation strategy aims to shift the habitual (internally driven) motor control of a person with PD to a more goal-directed (externally driven) control.…”

Section: Introductionmentioning

confidence: 99%

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Good vibrations: tactile cueing for freezing of gait in Parkinson’s disease

Klaver

Vugt

Bloem³

et al. 2023

J Neurol

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Background Cueing strategies can alleviate freezing of gait (FOG) in people with Parkinson’s disease (PD). We evaluated tactile cueing delivered via vibrating socks, which has the benefit of not being noticeable to bystanders. Objective To evaluate the effect of tactile cueing compared to auditory cueing on FOG. Methods Thirty-one persons with PD with FOG performed gait tasks during both ON and OFF state. The effect of open loop and closed loop tactile cueing, as delivered by vibrating socks, was compared to an active control group (auditory cueing) and to a baseline condition (uncued gait). These four conditions were balanced between subjects. Gait tasks were videotaped and annotated for FOG by two experienced raters. Motion data were collected to analyze spatiotemporal gait parameters. Responders were defined as manifesting a relative reduction of > 10% in the percent time frozen compared to uncued gait. Results The average percent time frozen during uncued gait was 11.2% in ON and 21.5% in OFF state. None of the three tested cueing modalities affected the percentage of time frozen in either the ON (p = 0.20) or OFF state (p = 0.12). The number of FOG episodes and spatiotemporal gait parameters were also not affected. We found that 22 out of 31 subjects responded to cueing, the response to the three types of cueing was highly individual. Conclusions Cueing did not improve FOG at the group level; however, tactile as well as auditory cueing improved FOG in many individuals. This highlights the need for a personalized approach when using cueing to treat FOG.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Good vibrations: tactile cueing for freezing of gait in Parkinson’s disease

Klaver

Vugt

Bloem³

et al. 2023

J Neurol

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“…In conjunction, measuring the effect of applying these strategies on physiological markers of arousal (e.g., measured by skin conductance, heart rate, pupil diameter) would help establish the plausibility of our proposed neurobiological framework. Lastly, looking into specific patient characteristics that may be associated with the efficacy of either arousal-reducing (e.g., high levels of trait anxiety) or arousal-increasing strategies (e.g., high levels of apathy or anhedonia) will be essential to eventually work towards a more personalized approach to the use of these non-pharmacological strategies in clinical practice [ 74 ]. Indeed, a subgroup characterization of the present cohort revealed that women less frequently reported to have used strategies to increase arousal, which may be a reflection of the higher prevalence of anxiety among women with PD [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Modulating arousal to overcome gait impairments in Parkinson’s disease: how the noradrenergic system may act as a double-edged sword

Tosserams

Bloem

Martens

et al. 2023

Transl Neurodegener

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In stressful or anxiety-provoking situations, most people with Parkinson’s disease (PD) experience a general worsening of motor symptoms, including their gait impairments. However, a proportion of patients actually report benefits from experiencing—or even purposely inducing—stressful or high-arousal situations. Using data from a large-scale international survey study among 4324 people with PD and gait impairments within the online Fox Insight (USA) and ParkinsonNEXT (NL) cohorts, we demonstrate that individuals with PD deploy an array of mental state alteration strategies to cope with their gait impairment. Crucially, these strategies differ along an axis of arousal—some act to heighten, whereas others diminish, overall sympathetic tone. Together, our observations suggest that arousal may act as a double-edged sword for gait control in PD. We propose a theoretical, neurobiological framework to explain why heightened arousal can have detrimental effects on the occurrence and severity of gait impairments in some individuals, while alleviating them in others. Specifically, we postulate that this seemingly contradictory phenomenon is explained by the inherent features of the ascending arousal system: namely, that arousal is related to task performance by an inverted u-shaped curve (the so-called Yerkes and Dodson relationship). We propose that the noradrenergic locus coeruleus plays an important role in modulating PD symptom severity and expression, by regulating arousal and by mediating network-level functional integration across the brain. The ability of the locus coeruleus to facilitate dynamic ‘cross-talk’ between distinct, otherwise largely segregated brain regions may facilitate the necessary cerebral compensation for gait impairments in PD. In the presence of suboptimal arousal, compensatory networks may be too segregated to allow for adequate compensation. Conversely, with supraoptimal arousal, increased cross-talk between competing inputs of these complementary networks may emerge and become dysfunctional. Because the locus coeruleus degenerates with disease progression, finetuning of this delicate balance becomes increasingly difficult, heightening the need for mental strategies to self-modulate arousal and facilitate shifting from a sub- or supraoptimal state of arousal to improve gait performance. Recognition of this underlying mechanism emphasises the importance of PD-specific rehabilitation strategies to alleviate gait disability.

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