The effects of STN-DBS on the dual task gait performance in patients with Parkinson's disease

• Main Authors: Ting-Chun Kuo, 郭亭君
• Other Authors: Shwn-Jen Lee
• Format: Others
• Language: en_US
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/4b2qzw

碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 97 === Background and Purpose: Subthalamic nucleus deep brain stimulation (STN-DBS) was proposed to modulate the circuitry of basal ganglia and frontal cortex, and this circuitry plays important role in motor and attentional control. With the dual task methodology and manipulation of STN-DBS stimulation and L-dopa on and off, we tested the hypothesis that there were effects of STN-DBS on both executive and motor systems and there were interaction effects with the combination of STN-DBS and L-dopa on both control systems during gait. Methods: Six patients with advanced PD and receiving STN-DBS surgery participated in this study. The gait analysis was conducted with the VICON 370 system at four sessions: (1) off L-dopa and off STN-DBS (off m/off s); (2) off L-dopa and on STN-DBS (off m/on s); (3) on L-dopa and on STN-DBS (on m/on s); (4) on L-dopa and off STN-DBS (on m/off s). In each session, subjects performed five walking conditions with randomized procedure of one secondary task: (1) walked at a preferred speed (BP) (2) walked while subtracting digits (a cognitive secondary task, C1); (3) walked while memorizing digits (a cognitive secondary task, C2); (4) walked while performing finger opposition (a motor secondary task, M1); or (5) walked while performing hand clasping (a motor secondary task, M2). Friedman’s test and Wilcoxon signed-rank test were used for statistical analysis. Results: Off m/on s significantly (p<0.05) increased speed, stride length and maximum knee excursion range when compared with off m/off s session in all of the walking task conditions. Stride length and maximum knee and ankle excursion range were significantly (p<0.05) increased when compared sessions off m/on s with on m/off s in C2, M1 and M2 tasks. The additive L-dopa significantly (p<0.05) increased speed in C1 and C2 tasks when compared sessions on m/on s with off m/on s. The additive STN-DBS significantly (p<0.05) increased speed, stride length and maximum knee excursion range in C2, M1 and M2 tasks when compared sessions on m/on s with on m/off s. The dual-task induced significant deteriorations of gait at off m/off s session than sessions off m/on s, on m/on s and on m/off s, especially in C1 and M2 task. Hypothesis regarding the effects of STN-DBS and interaction effects from the combination of STN-DBS and L-dopa on executive and motor systems of locomotor control were supported. Conclusions: STN-DBS not only improved gait performance, but also decreased attentional demands during gait in subjects with advanced PD.