Multiple-task walking training in people with mild to moderate Parkinson's disease: a pilot study Does auditory rhythmical cueing improve gait in people with Parkinson's disease and cognitive impairment? A feasibility study. Training with Verbal Instructional Cues Results in Near‐term Improvement of Gait in People with Parkinson Disease Verbal Fluency Task Affects Gait in Parkinson's Disease with Motor Freezing The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson's disease.
Objective : To determine whether multiple-task training of walking is feasible and worthwhile in people with mild to moderate Parkinson 's disease . Design : Baseline-controlled pilot study with three-week baseline , training and retention phases . Setting : University research laboratory . Subjects : Five people aged 61 ±8 years with mild to moderate Parkinson 's disease ( Hoehn and Yahr stages II — III ) . Interventions : Multiple-task training was performed for 30 minutes once a week during the three-week training phase . Main measures : Participants were tested and trained during the ` on ' phase of medication . Feasibility of training was examined using 10 cm visual analogue scales to measure participant perception of mental fatigue , physical fatigue , difficulty , anxiety and confidence . Walking velocity , stride length and cadence under multiple-task conditions were measured . Results : Participants reported low levels of mental fatigue , physical fatigue , difficulty and anxiety as well as high levels of confidence associated with multiple-task training . No adverse effects of training were reported . Multiple-task walking velocity increased by 0.09 ± 0.06 m/s ( 95 % confidence interval ( CI ) 0.02 to 0.16 ) between the baseline and training phase and this increase was maintained in the retention phase . Conclusion : Multiple-task training is feasible in people with mild to moderate Parkinson 's disease . The data suggest sustained benefits on multiple-task walking velocity are possible . A r and omized controlled trial of multiple-task training efficacy is warranted Gait and balance problems result ing from Parkinson 's disease ( PD ) are more common in people with PD and dementia ( PDD ) , yet , it is unknown whether the benefits of cueing therapy for mobility generalize to them . We aim ed to determine the feasibility and effectiveness of auditory cues to improve gait in PD and cognitive impairment ( PD-CI ) . Nine participants with PD-CI walked with and without auditory cues using two different strategies : ( 1 ) Cue with temporal instruction to " step in time to the beat , " ( 2 ) Cue with spatiotemporal instruction to " take a big step in time to the beat . " Cues were delivered with a metronome at preferred stepping frequency while on medication during single and dual-task gait . Gait was assessed using GAITRite and walking speed , stride amplitude , step frequency , and variability ( CV% ) of step and double limb support time were measured . Data were analyzed in SPSS version 16 using fixed-effect linear mixed models . An adjusted , P value of 0.01 was considered significant . Participants were men , aged 74.89 ( + /-6.45 ) years with median MMSE of 22 ( range 20.5 - 25 ) and UPDRS III score of 44 ( 35.5 - 47.0 ) . Participants complied with testing and instructions . The cue that focused attention on both temporal and spatial parameters of gait significantly improved single and dual-task walking speed and stride amplitude . This study provides evidence for the potential of cueing to improve gait in PD-CI . Only individuals with mild CI were included , and the effect with increased CI and different types of dementia requires further evaluation Purpose To assess immediate and near-term effects of an instructional set on select gait parameters in people living with Parkinson disease ( PD ) . Subjects Five individuals with early stage PD participated in a within subject design in Part One . Eleven individuals with early stage PD were r and omly assigned to a treatment group ( n = 5 ) or a control group ( n = 6 ) in Part Two . Methods The treatment consisted of a 10-day training program of walking 1800 feet per day and with the instructions to “ take long steps . ” Testing occurred before treatment ( baseline ) , immediately after treatment , one week after treatment , and one month after treatment . Measurements of step length , velocity , and cadence were taken without the use of the instructional set . Results There was a significant increase in step length and velocity and a significant decrease in cadence between baseline and all post-test measures for part one . For part 2 , step length of the treatment group significantly increased between baseline and all 3 post-tests and there was a significant difference between the treatment group and control group at all post-tests for step length . Conclusions : The instructional set was effective in improving parameters of gait for at least 4 weeks . These data support the concept that people with Parkinson disease have a potential for motor learning We examined the effects of a simultaneous verbal fluency task on  walking in Parkinson 's disease ( PD ) patients with freezing of gait ( PD-F ) compared to nonfreezing patients ( PD-NF ) or control subjects ( C ) . Effects of antiparkinsonian medications on gait in PD-F were examined . PD-F patients exhibited a greater increase in the number of steps to complete the walk with verbal fluency , even when the effect of medication was taken into account ( mean increase ± SD ) : PD-F = 4.2 ± 4.6 , n = 10 ; PD-NF = 0.1 ± 1.6 , n = 9 ; C = 1.5 ± 1.5 , n = 19 ; P = .007 . Medications improved walking in PD-F patients by decreasing the number of steps , the time to walk , and freezing . PD-F patients may be more dependent on attention for walking OBJECTIVE To compare the effect of rhythmic auditory and attentional cues , and a combination of both cues on  gait  , in people with Parkinson 's disease ( PD ) during single and dual tasks . DESIGN A repeated- measures study requiring participants to perform single and dual-motor tasks under different cueing conditions . SETTING Human movement analysis laboratory . PARTICIPANTS Fifteen participants with idiopathic PD and a comparison group of 12 healthy participants . INTERVENTIONS Three cueing strategies were compared : a rhythmic auditory cue ( walking in time to a metronome beat ) , an attentional strategy ( asked to focus on taking big step ) , and a combination cue ( asked to walk in time to a metronome beat while taking big steps ) . MAIN OUTCOME MEASURES Walking speed , step amplitude , and step frequency . RESULTS Walking speed of PD participants improved significantly compared with noncued walking in the single- and dual-task condition with the attentional ( P<.001 , P=.037 ) and combination cue strategies ( P=.013 , P=.028 ) . Step amplitude also increased significantly with the attentional and combination cue strategies in single- ( P<.001 , P<.001 ) and dual-task ( P<.001 , P<.001 ) conditions . Step frequency was reduced significantly with the attentional strategy ( P=.042 ) in the single and dual tasks ( P<.001 ) and combination cue strategy ( P=.009 ) in the dual task . The rhythmic auditory cue alone did not alter significantly any parameter of gait in the single or dual tasks . CONCLUSIONS The attentional strategy and the combination of a rhythmic auditory cue with an attentional strategy were equally effective , and improved walking speed and step amplitude significantly during both single and dual tasks . The combination cue , however , may still be a useful alternative in situations of increased attentional dem and , or where problems exist with executive function
Objective : To collate and appraise empirical evidence relating to the effects of verbal instructions ( verbal comm and s given by another person ) on stride length , gait velocity and stride variability in people with Parkinson ’s disease .