Improvements in temporal and postural aspects of gait vary following single- and multi-modal training in individuals with Parkinson's disease

• Published in: Parkinsonism & related disorders Vol. 64; pp. 280 - 285
• Main Authors: Rosenfeldt, Anson B., Penko, Amanda L., Streicher, Matthew C., Zimmerman, Nicole M., Koop, Mandy Miller, Alberts, Jay L.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2019
• Subjects: Aged; Cognition; Cognitive Dysfunction - etiology; Cognitive Dysfunction - physiopathology; Cognitive Dysfunction - rehabilitation; Cognitive Remediation - methods; Dual task; Executive Function - physiology; Exercise Therapy - methods; Female; Gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - physiopathology; Gait Disorders, Neurologic - rehabilitation; Humans; Male; Middle Aged; Neurological Rehabilitation - methods; Outcome and Process Assessment, Health Care; Parkinson Disease - complications; Parkinson Disease - physiopathology; Parkinson Disease - rehabilitation; Parkinson's disease; Postural Balance - physiology; Psychomotor Performance - physiology; Single task; Cognition; Parkinson's disease; Single task; Gait; Dual task
• ISSN: 1353-8020; 1873-5126
• DOI: 10.1016/j.parkreldis.2019.05.021

Gait deteriorates under dual task conditions in individuals with Parkinson's disease (PD). Therapeutic interventions have the potential to improve dual task performance, although it remains unclear how training affects gait performance under varying cognitive domains. The primary aim of this trial was to determine the effect of an 8-week single- or multi-modal gait and cognitive training intervention on dual task performance across cognitive domains in individuals with PD.
Twenty individuals with PD completed a 24-session single-modal training (SMT, n = 10) or multi-modal training (MMT, n = 10). The SMT group performed gait and cognitive training sequentially; the MMT group performed gait and cognitive training simultaneously. Gait was analyzed using motion capture analysis during simultaneous performance of six untrained cognitive tasks.
Both SMT and MMT resulted in significant improvements in MDS-UPDRS III scores and gait performance. Improvements in arm swing were more prevalent in the less affected extremity, while improvements in the more affected upper extremity favored the MMT group. Temporal aspects of gait (velocity, step length) improved under all dual task conditions, while postural aspects of gait (step width, arm swing) varied by cognitive task.
Both SMT and MMT were effective in improving motor and dual task performance in PD. Improvements in upper extremity gait variables in the MMT group may indicate that the complexity of the training is be beneficial in PD. The different responses in temporal and postural aspects of gait highlights the need for clinicians to train multiple cognitive domains during behavioral therapy.
•Single-, multi-modal training improve dual task performance in Parkinson's disease.•Multi-modal training had a greater impact on arm swing improvements.•Gait velocity and step length improved across all cognitive domains.•Step length and arm swing improvements varied by cognitive task.•Upper and lower extremity improvements followed different patterns of improvement.