Influence of dual task and freezing of
gait on obstacle crossing behaviour of
patients with Parkinson’s disease
Pieruccini-Faria
1Sun
1,2
F. , Almeida
1
Q. ,
Jones
2
J.A.
Life Movement Disorders Research & Rehabilitation Centre & Department of Kinesiology, Wilfrid Laurier University; 2 Department of
Psychology - Cognitive Neuroscience, Wilfrid Laurier University
HYPOTHESIS
KEY FINDINGS
Crossing parameters of PDFOG will be the most
affected by dual task
Dual task does not
influence crossing
parameters in PD. Foot
positioning was only
affected in PD-FOG as a
result of planning deficits
PURPOSE
To investigate the influence
of a dual task and FOG on
obstacle crossing in PD
patients
Background
• Freezing of gait (FOG) is an incapacitating phenomenon that drastically reduces mobility and commonly leads to falls in patients with
Parkinson’s disease (PD) [1]
• Obstacle crossing demands greater amount of postural control and cognitive allocation compared to free gait [2]
• Cognitive flexibility is one of the major cognitive deficits among PD patients manifesting FOG episodes [3] and can affect obstacle
crossing performance[2]
• Thus it is important to evaluate whether increased cognitive demand can influence gait control of PD-FOG during obstacle crossing
Methods
•
Dual task involved mentally counting
assigned numbers in a sound track, in
three conditions: NC = Not counting; C1
= monitoring one number; C2 =
monitoring two numbers, while walking
towards and stepping over an obstacle
• Obstacle set at 15% of participant’s height
(~25cm).
• A mixed RM ANOVA 3x3 (Group x Dual
task)
• Step wise regression analysis were also
applied
Table 1 – Patients demographics
Table 2 – Crossing parameters
(standard deviations) per group
Lead foot horizontal distance
before obstacle (cm)
85.9
(19.5)
38.7(8.2)
36.0(8.9)
32.4(7.5)
35.1(5.0)
38.6(7.4)
42.0(5.4)
18.5(5.9)
16.4(3.5)
19.0(6.1)
17.1(7.3)
16.1(6.1)
21.7(7.8)
Crossing step length (cm)
73.8(10.3)
73.9(9.7)
74.7(10.0)
Crossing step width (cm)
32.2(8.6)
31.7(7.9)
29.5 (8.3)
Crossing velocity (cm/s)
60.4(20.3)
63.7(24.5)
77.1
(17.0)
Trail foot horizontal distance
before obstacle (cm)
Lead foot horizontal beyond
obstacle(cm)
Lead foot vertical
clearance(cm)
Trail foot vertical clearance(cm)
**
45
%
35
25
20
PD-FOG
PD-NonFOG
Groups
•
Crossing parameters were not affected
by a dual task in any of the groups
obstacles
• The TMT B-A score was the only
predictor of the Lead foot position after
crossing the obstacle in PD-FOG
• Since PD-FOG had an abnormal
positioning beyond the obstacle, an
impaired capacity to maintain or adjust
their motor plan may be suggested
Success rate
Lead foot horizontal distance
beyond obstacle
30
.0001
.340
Controls
98.9
(16.8)
40
.236
mean
90.3
(18.2)
CONTROL
P
S
value
8M/6F
74.7(8.2)
.202
Sex
Age(years)
UPDRSIII(total)
37.3(5.1) 33.1(10.7)
NA
FOG-Q (Item
3)
3.2(0.8)a 0.38(0.7)
0
3MS
92.6(6.7) 90.7(14.0) 95.9(3.9)
267.8
TMT B-A(s) (53.9)a,b 119.7(30.5)c 66.8(11.9)
PDNonFOG
PD-FOG
cm
PDPD-FOG NonFOG
14M
10M/3F
73.6(7.7) 69.6(6.1)
Discussion
Results
*
*
105
100
95
90
85
80
75
70
65
60
*
PD-FOG
‡
PD-nonFOG
CONTROLS
NC
C1
C2
DUAL TASK COMPLEXITY
Controls
.001
Statistical difference at p<0.05: a) PD-FOG x PD-nonFOG; b) PD-FOG x
Controls; c) PD-Non-FOG x Controls; TMT: Trail making test; FOG-Q:
Freezing of gait questionnaire; 3MS; Mini Mental 3MS
Crossing velocity
80
obstacle
Conclusion
75
*
A dual task does not influence crossing
parameters in any PD patients. However,
the abnormal shorter foot positioning in PDFOG after obstacle crossing might be
related to deficits regarding motor planning
resources.
cm/s
70
65
Key References
60
55
50
45
40
NC
C1
C2
DUAL TASK COMPLEXITY
Figure 1 – Depiction of the region where crossing
parameters were analyzed.
Difference between groups: *p<0.05;**p<0.01
Difference between conditions: ‡ p<0.05
Acknowledgments:
The authors would like to thanks
MSc Kaylena Ehgoetz Martens and
Wendy Spiegelberg for patients
recruitment and help during
data collections
[1] Bloem et al (2005) Falls and freezing of gait in Parkinson's disease:
a review of two interconnected, episodic phenomena. Movement
Disorders
[2] Siu et al. (2009) Attentional mechanisms contributing to balance
constraints during gait: the effects of balance impairments. Brain
Research
[3] Naismith (2009) The specific contributions of set-shifting to freezing
of gait in Parkinson's disease. Movement Disorders