Visuomotor control of walking in Parkinson’s disease: Exploring possible links between conscious movement processing and freezing of gait

Hardeman, Lotte E. S.; Kal, Elmar; Young, William R.; Kamp, John van der; Ellmers, Toby J.

doi:10.1016/j.bbr.2020.112837

Cited by 12 publications

(5 citation statements)

References 76 publications

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“…For instance, in FGA item 6, the AOPT-E group exhibited a remarkable shift in focus, reducing fixations on the ground before stepping over an obstacle and instead directing attention towards the obstacle itself and the surrounding terrain. This shift indicates improved balance and expanded visual awareness during walking, echoing recent findings that people with PD and FOG tend to concentrate more on immediate steps [59]. Furthermore, our study surpasses prior research revealing that people with PD exhibit fewer relevant fixations during regular walking but increase their focus on task-relevant elements during obstacle negotiation [60].…”

Section: Plos Onesupporting

confidence: 82%

Effects of activity-oriented physiotherapy with and without eye movement training on dynamic balance, functional mobility, and eye movements in patients with Parkinson’s disease: An assessor-blinded randomised controlled pilot trial

Mildner,

Hotz,

Kübler

et al. 2024

PLoS ONE

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Objectives To describe changes in balance, walking speed, functional mobility, and eye movements following an activity-oriented physiotherapy (AOPT) or its combination with eye movement training (AOPT-E) in patients with Parkinson’s disease (PD). To explore the feasibility of a full-scale randomised controlled trial (RCT). Methods Using an assessor-blinded pilot RCT, 25 patients with PD were allocated to either AOPT or AOPT-E. Supervised interventions were performed 30 minutes, 4x/weekly, for 4 weeks, alongside inpatient rehabilitation. Outcomes were assessed at baseline and post-intervention, including dynamic balance, walking speed, functional and dual-task mobility, ability to safely balance, health-related quality of life (HRQoL), depression, and eye movements (number/duration of fixations) using a mobile eye tracker. Freezing of gait (FOG), and falls-related self-efficacy were assessed at baseline, post-intervention, and 4-week follow-up. Effect sizes of 0.10 were considered weak, 0.30 moderate, and ≥0.50 strong. Feasibility was assessed using predefined criteria: recruitment, retention and adherence rates, adverse events, falls, and post-intervention acceptability using qualitative interviews. Results Improvements were observed in dynamic balance (effect size r = 0.216–0.427), walking speed (r = 0.165), functional and dual-task mobility (r = 0.306–0.413), ability to safely balance (r = 0.247), HRQoL (r = 0.024–0.650), and depression (r = 0.403). Falls-related self-efficacy (r = 0.621) and FOG (r = 0.248) showed varied improvements, partly sustained at follow-up. Eye movement improvements were observed after AOPT-E only. Feasibility analysis revealed that recruitment was below target, with less than two patients recruited per month due to COVID-19 restrictions. Feasibility targets were met, with a retention rate of 96% (95% confidence interval [CI]: 77.68–99.79) and a 98.18% (95% CI: 96.12–99.20) adherence rate, exceeding the targets of 80% and 75%, respectively. One adverse event unrelated to the study intervention confirmed intervention safety, and interview data indicated high intervention acceptability. Conclusions AOPT-E and AOPT appeared to be effective in patients with PD. Feasibility of a larger RCT was confirmed and is needed to validate results.

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Section: Plos Onesupporting

confidence: 82%

Effects of activity-oriented physiotherapy with and without eye movement training on dynamic balance, functional mobility, and eye movements in patients with Parkinson’s disease: An assessor-blinded randomised controlled pilot trial

Mildner,

Hotz,

Kübler

et al. 2024

PLoS ONE

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“…The high influence of clutter on doorway freezing suggests that attentional processes play an additional role as a causal mechanism for doorway freezing. A previous study investigated visual search behavior in freezers when walking toward a doorway in a cluttered environment ( 21 ). They found that freezing episodes were related to a prolonged eye fixation toward the obstacles while focusing on the walkway seemed to prevent freezing from manifesting.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, to explore whether doorway freezing indeed relates to dysfunctional visuomotor processing as mainly hypothesized in literature, or whether disturbed attentional processes due to cognitive or affective distractors also play a role. Therefore, we added a questionnaire inquiring about various types of mental processes occurring during doorway passing (the Gait-Specific Attention Profile, G-SAP) ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

The effect of doorway characteristics on freezing of gait in Parkinson’s disease

Cockx,

Lemmen,

van Wezel

et al. 2023

Front. Neurol.

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BackgroundFreezing of gait is a debilitating symptom in Parkinson’s disease, during which a sudden motor block prevents someone from moving forward. Remarkably, doorways can provoke freezing. Most research has focused on the influence of doorway width, and little is known about other doorway characteristics influencing doorway freezing.ObjectiveFirstly, to provide guidelines on how to design doorways for people with freezing. Secondly, to compare people with doorway freezing to people without doorway freezing, and to explore the underlying mechanisms of doorway freezing.MethodsWe designed a web-based, structured survey consisting of two parts. Part I (n = 171 responders), open to people with Parkinson’s disease with freezing in general, aimed to compare people with doorway freezing to people without doorway freezing. We explored underlying processes related to doorway freezing with the Gait-Specific Attention Profile (G-SAP), inquiring about conscious movement processes occurring during doorway passing. Part II (n = 60), open for people experiencing weekly doorway freezing episodes, inquired about the influence of specific doorway characteristics on freezing.ResultsPeople with doorway freezing (69% of Part I) had higher freezing severity, longer disease duration, and scored higher on all sub scores of the G-SAP (indicating heightened motor, attentional, and emotional thoughts when passing through doorways) than people without doorway freezing. The main categories provoking doorway freezing were: dimensions of the door and surroundings, clutter around the door, lighting conditions, and automatic doors.ConclusionWe provide recommendations on how to maximally avoid freezing in a practical setting. Furthermore, we suggest that doorways trigger freezing based on visuomotor, attentional, and emotional processes.

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“…The high influence of clutter on doorway freezing suggests that attentional processes play an additional role as a causal mechanism for doorway freezing. A previous study investigated visual search behavior in freezers when walking toward a doorway in a cluttered environment [19]. They found that freezing episodes were related to a prolonged eye fixation towards the obstacles while focusing on the walkway seemed to prevent freezing from manifesting.…”

Section: Cluttermentioning

confidence: 99%

“…Second, we explored whether doorway freezing indeed relates to dysfunctional visuomotor processing as hypothesized, or whether disturbed attentional processes due to cognitive or affective distractors also play a role. We, therefore, added the Gait-Specific Attention Profile (G-SAP) [18,19] to our survey, which is a questionnaire designed to assess conscious mental processes occurring during gait. We adapted this questionnaire to inquire about mental processes specifically when walking through doorways.…”

Section: Introductionmentioning

confidence: 99%

The influence of doorway characteristics on freezing of gait

Cockx,

Lemmen,

van Wezel

et al. 2023

Preprint

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BACKGROUND: Freezing of gait is a debilitating symptom in Parkinson’s disease, during which a sudden motor block prevents someone from moving forward. Remarkably, doorways can provoke freezing. Most research has focused on the influence of doorway width, and little is known about other doorway characteristics influencing doorway freezing.OBJECTIVES: Firstly, to provide guidelines on how to design spaces for people with freezing. Secondly, to explore the underlying mechanisms of doorway freezing.METHODS: We designed a web-based, structured survey consisting of two parts. Part I (n = 171 responders), open to people with Parkinson’s disease with freezing in general, aimed to compare people with doorway freezing to people without doorway freezing. We explored underlying processes related to doorway freezing with the Gait-Specific Attention Profile (G-SAP), inquiring about conscious movement processes occurring during doorway passing, with sub scores for motor, attentional, and emotional aspects of movement processes. Part II (n = 60), open for people experiencing weekly doorway freezing episodes, inquired about the influence of specific doorway characteristics on freezing.RESULTS: People with doorway freezing (69 % of Part I) had higher freezing severity, longer disease duration, and scored higher on all sub scores of the G-SAP than people without doorway freezing. The main categories provoking doorway freezing were: dimensions of the door and surroundings, clutter around the door, lighting conditions, and automatic doors.CONCLUSIONS: We provide recommendations on how to maximally avoid freezing in a practical setting. Furthermore, we suggest that doorways trigger freezing based on visuomotor, attentional, and emotional processes.

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Visuomotor control of walking in Parkinson’s disease: Exploring possible links between conscious movement processing and freezing of gait

Cited by 12 publications

References 76 publications

Effects of activity-oriented physiotherapy with and without eye movement training on dynamic balance, functional mobility, and eye movements in patients with Parkinson’s disease: An assessor-blinded randomised controlled pilot trial

Effects of activity-oriented physiotherapy with and without eye movement training on dynamic balance, functional mobility, and eye movements in patients with Parkinson’s disease: An assessor-blinded randomised controlled pilot trial

The effect of doorway characteristics on freezing of gait in Parkinson’s disease

The influence of doorway characteristics on freezing of gait

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