Effects of Attentional Focus Strategy on Dual-task Walking Training in Patients With Parkinson's Disease

Not Applicable

Completed

• Conditions: Parkinson Disease; Dual-task Walking
• Interventions: Behavioral: Dual-task walking training

• Registration Number: NCT04364152
• Lead Sponsor: National Taiwan University Hospital

Brief Summary

Walking deficits and altered brain capacity have been proved to be two of the main contributing factors in dual-task walking deficits in patients with Parkinson's disease (PD). In the past, patients with PD were usually suggested not to walk in dual-task conditions in order to concentrate on their walking performance better. However, since dual-task walking is really common in daily-life, this limitation usually lead to a decrease in quality of life for PD patients. In previous studies, effects of using attentional strategies in dual-task walking training remain unclear, while suitable attentional strategies and corresponded neuroplasticity for patients with and without freezing of gait have not been well discussed, either. Accordingly, this study is aimed to identify (1) whether internal or external attentional strategies is more ideal for PD patients with and without freezing of gait in dual-task walking training, and (2) changes in brain activity after receiving dual-task walking training with different attentional strategies in patients with or without freezing of gait. Our hypothesis are (1) patients with or without freezing of gait will react differently in dual-gait training with different attentional strategies, and (2) changes in brain activities will be different according to different attentional strategies given in the training.

Detailed Description

The hypothesis will be tested by gait performance, suprapostural tasks performance, relative power spectrum of EEG, and scales including MDS-UPDRS, ABC, BBS, and TUG.

Study Timeline

• Study First Submitted: 2020-04-23
• Study First Submitted QC: 2020-04-23
• Study First Posted: 2020-04-27
• Study Start: 2020-08-06
• Primary Completion: 2021-08-01
• Status Verified: 2023-08
• Study Completion: 2023-08-01
• Last Update Submitted: 2023-09-05
• Last Update Posted: 2023-09-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

for PD patients:

• (1) a diagnosis of idiopathic PD by a neurologist expert in movement disorders (2) onset age > 40 years old, (3) presence of gait disorders or freezing of gait (points on 3.10 in MDS-UPDRS>=1 or points on item 3 in NFOG-Q >0) (4) able to walk independently without an assistance device at least for 20 meters (5) without obvious action or postural tremor, according to the score of 3.15 and 3.16 (action and postural tremor of hands) in MDS-UPDRS

for healthy elders:

• (1) without musculoskeletal of neurological diseases which may affect balance or walking performance (2) no medication that might influence their balance or cognition (3) MMSE> 26 points.

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Exclusion Criteria

for PD patients:

• (1) with other neurological or musculoskeletal disease that might affect balance or walking (2) have a Mini-Mental State Examination (MMSE) < 27 points (3) have a history of brain surgery (4) have to modulate their medication for duration of the experiment.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
PD patients without freezing of gait, external strategies	Dual-task walking training	Participants in this group will include PD patients without freezing of gait. During dual-task walking training, external attentional strategies will be given, aiming to improve their gait performance.
PD patients with freezing of gait, internal strategies	Dual-task walking training	Participants in this group will include PD patients with freezing of gait. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance.
PD patients with freezing of gait, external strategies	Dual-task walking training	Participants in this group will include PD patients with freezing of gait. During dual-task walking training, external attentional strategies will be given, aiming to improve their gait performance.
Healthy elders, internal strategies	Dual-task walking training	Participants in this group will include healthy elders. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance.
Healthy elders, external strategies	Dual-task walking training	Participants in this group will include healthy elders. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance.
PD patients without freezing of gait, internal strategies	Dual-task walking training	Participants in this group will include PD patients without freezing of gait. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance.

Primary Outcome Measures

Name	Time	Method
Mean step length from GAITRite	60 minutes	gait performance
Amplitude from a triaxial accelerometer, X axes	25 minutes	motor suprapostural task performance
Step-to-step variability from GAITRite	60 minutes	gait performance
Amplitude from a triaxial accelerometer, Y axes	25 minutes	motor suprapostural task performance
Gait velocity from GAITRite	60 minutes	gait performance
Cadence from GAITRite	60 minutes	gait performance
Correct rate on working memory task	25 minutes	cognitive suprapostural task performance
Amplitude from a triaxial accelerometer, Z axes	25 minutes	motor suprapostural task performance

Secondary Outcome Measures

Name	Time	Method
EEG relative power in the low gamma band	60 minutes	brain activity under single, motor dual-task, and cognitive dual-task walking conditions
EEG relative power in the delta band	60 minutes	brain activity under single, motor dual-task, and cognitive dual-task walking conditions
EEG relative power in the alpha band	60 minutes	brain activity under single, motor dual-task, and cognitive dual-task walking conditions
EEG relative power in the theta band	60 minutes	brain activity under single, motor dual-task, and cognitive dual-task walking conditions
EEG relative power in the beta band	60 minutes	brain activity under single, motor dual-task, and cognitive dual-task walking conditions

Trial Locations

Locations (1)

School and Graduate Institute of Physical Therapy, National Taiwan University; 🇨🇳 Taipei, Taiwan