Dual Task Turning in Place: A Reliable, Valid, and Responsive Outcome Measure of Freezing of Gait

Context The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. Objective To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. Design Descriptive laboratory study. Setting Sports injury-prevention center. Patients or Other Participants Uninjured and healthy athletes between the ages of 9 and 18 years. Intervention(s) Tandem gait measures repeated 3 times across the period of approximately 1 month. Main Outcome Measure(s) Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. Results Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single-task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r = .627; dual-task r = 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. Conclusions Tandem gait outcome measures demonstrated high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time.

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The efficacy of cognitive-cycling dual-task training in patients with early-stage Parkinson’s disease: A pilot study

Neurorehabilitation ◽

10.3233/nre-203090 ◽

2020 ◽

Vol 47 (4) ◽

pp. 415-426

Author(s):

Hsiu-Chen Chang ◽

Chiung-Chu Chen ◽

Yi-Hsin Weng ◽

Wei-Da Chiou ◽

Ya-Ju Chang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Performance ◽

Dual Task ◽

Rating Scale ◽

Early Stage ◽

Freezing Of Gait ◽

Timed Up And Go ◽

Gait Performance ◽

The Mean

BACKGROUND: Recent studies have suggested that cognitive-motor dual-task (DT) training might improve gait performance, locomotion automaticity, balance, and cognition in patients with Parkinson’s disease (PD). OBJECTIVE: We aimed to investigate the efficacy of cognitive-cycling DT training in patients with early-stage PD. METHODS: Participants were scheduled to perform cognitive tasks simultaneously with the cycling training twice per week for eight weeks for a total of 16 sessions during their on-states. Clinical assessments were conducted using the unified Parkinson’s disease rating scale (UPDRS), modified Hoehn and Yahr stage, Timed Up and Go (TUG) test, gait and cognitive performances under dual-task paradigm, the new freezing of gait questionnaire, Schwab and England Activities of Daily Living scale, 39-item Parkinson’s disease questionnaire, and cognitive performance. RESULTS: Thirteen eligible patients were enrolled in the study. The mean age was 60.64±5.32 years, and the mean disease duration was 7.02±3.23 years. Twelve PD patients completed 16 serial cognitive-cycling sessions for two months. After 16 sessions of training (T2), the UPDRS III scores improved significantly in both the off- and on-states, and TUG were significantly less than those at pretraining (T0). During both the single-task and the DT situations, gait performance and spatial memory cognitive performance significantly improved from T0 to T2. CONCLUSION: The present study demonstrated that cognitive-cycling DT training improves the motor functions, gait and cognitive performances of PD patients.

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The impact of turning and dual task on freezing of gait in Parkinson's disease

Gait & Posture ◽

10.1016/j.gaitpost.2018.07.105 ◽

2018 ◽

Vol 66 ◽

pp. S3-S4

Author(s):

M. Bertoli ◽

A. Cereatti ◽

U. Della Croce ◽

M. Mancini

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Freezing Of Gait ◽

The Impact

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Dual Motor-Cognitive Virtual Reality Training Impacts Dual-Task Performance in Freezing of Gait

IEEE Journal of Biomedical and Health Informatics ◽

10.1109/jbhi.2015.2479625 ◽

2015 ◽

Vol 19 (6) ◽

pp. 1855-1861 ◽

Cited By ~ 37

Author(s):

Isabelle Killane ◽

Conor Fearon ◽

Louise Newman ◽

Conor McDonnell ◽

Saskia M. Waechter ◽

...

Keyword(s):

Virtual Reality ◽

Task Performance ◽

Dual Task ◽

Freezing Of Gait ◽

Virtual Reality Training ◽

Dual Task Performance

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A Comparative Study of Objective Outcome Measures Used in Clinical Trials of Freezing of Gait

10.21203/rs.3.rs-153836/v1 ◽

2021 ◽

Author(s):

Gonzalo Revuelta ◽

Aaron Embry ◽

Jordan Elm ◽

Shonna Jenkins ◽

Philip Lee ◽

...

Keyword(s):

Clinical Trials ◽

Dual Task ◽

Stride Length ◽

Rating Scale ◽

Freezing Of Gait ◽

Control Group ◽

Surrogate Markers ◽

Pd Control ◽

Roc Curve Analysis ◽

Dopaminergic Drugs

Abstract Background: Freezing of gait (FOG) is notoriously difficult to quantify, leading to multiple metrics utilized as outcomes for clinical trials. The instrumented timed up a go and the many parameters that can be derived from it are commonly used as objective markers of gait severity in FOG trials, however it is unknown if they represent FOG severity. Objective: To determine the specificity and responsiveness of objective surrogate markers of FOG severity commonly utilized in FOG studies. Methods: Markers compared included: velocity, step/stride length, step/stride length variability, TUG, and turn duration. Data was collected in four conditions (ON and OFF dopaminergic drugs, with and without a dual task). Unified Parkinson’s Disease rating scale (UPDRS) was administered in the ON and OFF states. Results: 33 subjects were recruited (17 PD subjects without FOG (PD-control), and 16 subjects with PD and dopa-responsive FOG PD-FOG). The UPDRS motor scores were: 24.9 for the PD-control group in the ON state, 24.8 for the FOG group in the ON state, 42.4 for the FOG group in the OFF state. Significant mean differences between the ON and OFF conditions were observed with all surrogate markers (p<0.01). However, only dual task turn duration and step variability showed trends toward significance when comparing PD-control and ON-FOG (p=0.08). Test-retest reliability was high (ICC >0.90) for all markers except standard deviations. Step length variability was the only marker to show an area under the ROC curve analysis >0.70 comparing ON-FOG vs. PD-control. Conclusions: Multiple candidate surrogate markers for FOG severity showed responsiveness to levodopa challenge, however, most were not specific for FOG severity.

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Levodopa Responsiveness Subtypes of Freezing of Gait: Results Using a Levodopa Challenge

10.1101/667071 ◽

2019 ◽

Author(s):

J. Lucas McKay ◽

Felicia C. Goldstein ◽

Barbara Sommerfeld ◽

Douglas Bernhard ◽

Sahyli Perez Parra ◽

...

Keyword(s):

Interaction Effect ◽

Mixed Models ◽

Outcome Measure ◽

Freezing Of Gait ◽

Timed Up And Go ◽

Significant Group ◽

Main Outcome Measure ◽

Clinical Exam ◽

Threshold Levels ◽

Distinct Subtype

AbstractObjectiveTo demonstrate that levodopa-unresponsive freezing of gait (ONOFF-FOG), which is a disabling untreatable feature of Parkinson’s disease (PD), is distinct from responsive/OFF only FOG (OFF-FOG) and potentially has a distinct pathophysiology.MethodsFifty-five PD patients completed levodopa challenges after >12 hours OFF with supratherapeutic doses to classify them as NOFOG, OFF-FOG or ONOFF-FOG. Serum levodopa levels ensured threshold levels were met. An “ON” response was defined as ≥20% improvement in MDS-UPDRS-III score. Main outcome measure was MDS-UPDRS-III based on clinical exam, timed-up-and-go tests and 360° turns.Results45 patients exhibited an “ON” response to the challenge. Levodopa-equivalent-dose was 142±56% of patients’ typical morning doses. Patients could be classified as: 19 ONOFF-FOG, 11 OFF-FOG, 15 NOFOG. The ONOFF-FOG group exhibited significantly higher NFOG-Q, MDS-UPDRS-II/III scores compared to the OFF-FOG group. MDS-UPDRS-III total varied significantly across medication response states (P<0.01) and groups (P=0.03). Among MDS-UPDRS-III subdomains, significant effects of group (highest in ONOFF-FOG group) were identified for measures of lower extremities and gait. Linear mixed models revealed a highly significant association between serum levodopa level and MDS-UPDRS-III score that did not vary across the groups. There was a highly significant group interaction effect on the association between serum levodopa level with MDS-UPDRS-III item 11 “Freezing of Gait” (P<0.001).ConclusionsONOFF-FOG is a distinct subtype of FOG in PD, as opposed to OFF-FOG. This is an important step in demonstrating that FOG is not a single entity and, in turn, could lead to better understanding of pathophysiology and development of effective therapies.

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Dual task interference on postural sway, postural transitions and gait in people with Parkinson’s disease and freezing of gait

Gait & Posture ◽

10.1016/j.gaitpost.2017.05.006 ◽

2017 ◽

Vol 56 ◽

pp. 76-81 ◽

Cited By ~ 49

Author(s):

Ana Claudia de Souza Fortaleza ◽

Martina Mancini ◽

Patty Carlson-Kuhta ◽

Laurie A. King ◽

John G. Nutt ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Postural Sway ◽

Freezing Of Gait ◽

Task Interference ◽

Dual Task Interference

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Cognitively Challenging Agility Boot Camp Program for Freezing of Gait in Parkinson Disease

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320909331 ◽

2020 ◽

Vol 34 (5) ◽

pp. 417-427 ◽

Cited By ~ 2

Author(s):

Laurie A. King ◽

Martina Mancini ◽

Katrijn Smulders ◽

Graham Harker ◽

Jodi A. Lapidus ◽

...

Keyword(s):

Executive Function ◽

Functional Connectivity ◽

Parkinson Disease ◽

Dual Task ◽

Freezing Of Gait ◽

Exercise Program ◽

Dropout Rate ◽

Boot Camp ◽

Effect Sizes ◽

Dual Task Cost

Introduction. It is well documented that freezing of gait (FoG) episodes occur in situations that are mentally challenging, such as dual tasks, consistent with less automatic control of gait in people with Parkinson disease (PD) and FoG. However, most physical rehabilitation does not include such challenges. The purpose was to determine (1) feasibility of a cognitively challenging Agility Boot Camp–Cognitive (ABC-C) program and (2) effects of this intervention on FoG, dual-task cost, balance, executive function, and functional connectivity. Methods. A total of 46 people with PD and FoG enrolled in this randomized crossover trial. Each participant had 6 weeks of ABC-C and Education interventions. Outcome measures were the following: FoG, perceived and objective measures; dual-task cost on gait; balance; executive function; and right supplementary motor area (SMA)–pedunculopontine nucleus (PPN) functional connectivity. Effect sizes were calculated. Results. ABC-C had high compliance (90%), with a 24% dropout rate. Improvements after exercise, revealed by moderate and large effect sizes, were observed for subject perception of FoG after exercise, dual-task cost on gait speed, balance, cognition (Scales for Outcomes in Parkinson’s disease–Cognition), and SMA-PPN connectivity. Conclusions. The ABC-C for people with PD and FoG is a feasible exercise program that has potential to improve FoG, balance, dual-task cost, executive function, and brain connectivity. The study provided effect sizes to help design future studies with more participants and longer duration to fully determine the potential to improve FoG.

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Executive Control of Walking in People With Parkinson’s Disease With Freezing of Gait

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320969940 ◽

2020 ◽

Vol 34 (12) ◽

pp. 1138-1149

Author(s):

Rodrigo Vitorio ◽

Samuel Stuart ◽

Martina Mancini

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Executive Control ◽

Dual Task ◽

Near Infrared ◽

Inertial Sensors ◽

Cognitive Task ◽

Freezing Of Gait ◽

Functional Near Infrared Spectroscopy ◽

Indirect Measures

Background Walking abnormalities in people with Parkinson’s disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. Objective To investigate the influence of FoG status on automaticity of walking in people with PD. Methods Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD−FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. Results PD+FoG had greater PFC activation during both single and dual-task walking than PD−FoG ( P = .031). There were no differences in gait between PD−FoG and PD+FoG. Both groups decreased gait speed ( P = .029) and stride length ( P < .001) during dual-task walking compared with single-task walking. Conclusions These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.

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Dealing with the Heterogeneous Presentations of Freezing of Gait: How Reliable are the Freezing Index and Heart Rate for Freezing Detection?

10.21203/rs.3.rs-735366/v1 ◽

2021 ◽

Author(s):

Helena Cockx ◽

Jorik Nonnekes ◽

Bastiaan Bloem ◽

Richard van Wezel ◽

Ian Cameron ◽

...

Keyword(s):

Parkinson’S Disease ◽

Heart Rate ◽

Parkinson's Disease ◽

Dual Task ◽

Freezing Of Gait ◽

Heart Rate Change ◽

Rate Change ◽

Motion Sensors ◽

Normal Gait ◽

Fog Detection

Abstract Background: Freezing of gait (FOG) is an unpredictable gait arrest that hampers the lives of 40% of people with Parkinson’s disease. Because the symptom is heterogeneous in phenotypical presentation (it can present as trembling, shuffling, or akinesia) and manifests during various circumstances (it can be triggered by e.g. turning, passing doors, and dual-tasking), it is particularly difficult to detect with motion sensors. The freezing index (FI) is one of the most frequently used accelerometer-based methods for FOG detection. However, it might not adequately distinguish FOG from voluntary stops, certainly for the akinetic type of FOG. Interestingly, a previous study showed that heart rate signals could distinguish FOG from stopping and turning movements. This study aimed to investigate for which phenotypes and evoking circumstances the FI and heart rate might provide reliable signals for FOG detection.Methods: Sixteen people with Parkinson’s disease and daily freezing completed a gait trajectory designed to provoke FOG including turns, narrow passages, starting, and stopping, with and without a cognitive or motor dual-task. We compared the FI and heart rate of 406 FOG events to baseline levels, and to stopping and normal gait events (i.e. turns and narrow passages without FOG) using mixed-effects models. We specifically evaluated the influence of different types of FOG (trembling vs akinesia) and triggering situations (turning vs narrow passages; no dual-task vs cognitive dual-task vs motor dual-task) on both outcome measures. Results: The FI increased significantly for trembling FOG, but not for akinetic FOG. Furthermore, the index increased similarly during stopping and was therefore not significantly different from FOG. In contrast, heart rate change during FOG was for all types and during all triggering situations statistically different from stopping, but not from normal gait events. Conclusion: The FI has issues to distinguish FOG from voluntary stopping, especially of the akinetic type. In contrast, the clear distinction in heart rate change between FOG and voluntary stops, which was independent of the heterogeneous presentation of FOG, might provide a solution for this issue. Therefore, we suggest that combining a heart rate monitor with a motion sensor may be promising for future FOG detection.

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