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Synchronizing Finger Taps to Regular Beats Improves Gait of Parkinson’s Patients, Study Suggests

gait, finger tapping, Parkinson's

Parkinson’s disease patients improved their gait after undergoing training in which they tapped their fingers in synchrony to regular bets set at a faster pace than their walking speed, a study has found.

The research, “Rhythmic priming across effector systems: A randomized controlled trial with Parkinson’s disease patients,” appeared in the journal Human Movement Science.

Clinical studies have shown that rhythmic auditory stimulation (RAS), using rhythm and music, significantly improved gait and upper extremity function for stroke, Parkinson’s disease, traumatic brain injury, and other conditions.

Auditory stimuli have been used in the motor rehabilitation of patients with Parkinson’s disease, who increased their walking speed, stride length, and stability after RAS training, an approach that uses rhythmic cues to improve motor function.

It is still unclear whether short-term RAS of arm or finger movements also improves gait, although studies have suggested that rhythmic arm movements while walking enable arm-leg coordination to improve gait.

Therefore, researchers at the University of Toronto and Colorado State University decided to investigate whether RAS training of arm or finger movements would modulate gait speed in 37 patients with idiopathic (of unknown cause) Parkinson’s disease.

A group of 11 patients (with seven men, a mean age of 68.4 years, and disease duration of 4.8 years) underwent a four-minute training — three one-minute blocks separated by 30 seconds — in which arm or finger movements were performed in synchrony to beats (using a metronome) set to a 20% faster pace than their pre-training walking speed. The patients used the index finger of the least affected hand for tapping. Auditory stimuli were delivered with a speaker placed one meter away from the participant.

A separate group of 14 participants (with six men, a mean age of 64.2 years, and disease duration of 7.7 years) was asked to swing both arms in an alternating manner in synchrony with the metronome. Both finger-tapping and arm swing tasks were performed with participants seated in an armless chair.

The 12 patients in the control group — with four men, a mean age of 67.3 years, and disease duration of 11.7 years — did not receive any training.

All participants were on Parkinson’s medication and had a Hoehn & Yahr (H&Y) scale score of one or two, which indicates that their balance was not impaired.

Gait assessments pre- and post-training required walking on a 14-meter flat walkway at the participant’s preferred walking speed with no auditory cueing.

The results revealed a significant 9.5% increase in gait velocity after the finger-tapping training, from an average of 69.75 meters/min before training to 76.03 meters/min post-training. No differences were seen in the arm-swing and control groups.

Patients who underwent finger-tapping training also showed an 8% increase in gait cadence, or the number of steps per minute — from 109.25 to 117.5 — unlike those in the other groups. No post-training differences in stride length were seen in any group.

“The present study supports the hypothesis that rhythmic priming is possible across effector systems by demonstrating that (RAS) training of finger movements had immediate effects on gait velocity and cadence of patients with Parkinson’s,” the researchers wrote.

“The present findings have direct implications for motor rehabilitation and extend the current application of rhythmic-based interventions,” they added.

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Treadmill Incline Training Improves Walking Speed of Parkinson’s Patients, Study Finds

treadmill incline training

Eight weeks of training on a treadmill with continuously varying surface inclines improved gait disturbances, particularly walking speed, in Parkinson’s disease patients, researchers report.

Their finding were published in the study, “Exploring gait adaptations to perturbed and conventional treadmill training in Parkinson’s disease: Time-course, sustainability, and transfer,” in the journal Human Movement Science.

As the disease progresses, Parkinson’s patients experience an increase in gait difficulties and balance problems, lowering their mobility and quality of life.

In addition, studies have shown that Parkinson’s patients take shorter and slower steps, and have high stride-to-stride variability.

Because some gait disturbances are drug-resistant, nonpharmacological treatment options are needed to improve these patients’ quality of life.

“Improved stride length and stride-to-stride variability have been demonstrated following several weeks of treadmill practice for both, overground and treadmill walking, respectively,” the authors wrote.

Researchers had recently demonstrated that eight weeks of treadmill therapy with additional postural perturbations (i.e., varying surface inclines) improved overground gait speed and dynamic balance control in Parkinson’s patients.

Now the same team at Friedrich-Alexander University Erlangen-Nürnberg has analyzed spatiotemporal gait adaptations to treadmill training — with and without an incline — both on and off the machine.

They used data from a randomized controlled Phase 1 trial (NCT01856244) aimed at investigating the effectiveness of a sensorimotor treadmill intervention to improve walking and balance abilities in people in the early stages of Parkinson’s disease.

Sensorimotor treadmill training was conducted on a special machine that challenged the participants through small oscillations, simulating walking on natural, uneven surfaces. This intervention was compared with conventional treadmill training without surface perturbations.

Thirty-eight Parkinson’s patients were randomly assigned to 40 minutes of treadmill training two times per week for eight weeks. Of these patients, 18 performed treadmill training with continuously varying surface inclines, while the other 20 walked on the treadmill without surface perturbations.

Patients were assessed every week during training protocol (prior to the training sessions), within one week after the intervention, and at a three-month follow-up.

Gait variability significantly decreased in both training groups. Nonetheless, longer stride length and time, stance time, and swing time were significantly improved only in the treadmill incline training group.

For reference, one gait cycle consists of two phases: stance, or the period of time that the foot is on the ground, and swing, meaning the period of time that the foot is off the ground moving forward.

Researchers then investigated the sustainability of gait changes over three months.

At the three-month follow-up, there were significant changes between the groups in stance and swing time, which were due to a much higher variability in the conventional treadmill training group. Statistical comparisons within the groups revealed no significant changes in the treadmill incline training group.

Additional statistical analysis also showed decreased step length asymmetry in the conventional treadmill training group.

The team then assessed the extent of transfer effects to overground gait in both training regimes.

“When considering the entire sample, significant changes in overground gait parameters at [week 8] were observed only for stance- and swing time, with a significantly decreased stance time … and a corresponding increase in swing time,” they wrote. However, these findings were statistically significant only in the treadmill incline training regime.

“[Parkinson’s disease] patients demonstrated marked gait adaptations to the eight-week treadmill intervention, which were partially retained after three months follow-up,” they noted.

Treadmill training with small oscillations seemed to reduce gait disturbances, but the transfer of such changes to overground walking was limited in most evaluated variables.

Further research is still necessary to corroborate these findings.

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