| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 106 === Background: Parkinson’s disease (PD) is a common neurodegenerative disorder. Dysfunction of dopaminergic cells in basal ganglia leads to deficits in the automatic execution of movements such as gait disturbances. Auditory cues are often used in clinical setting and revealed benefits in ambulation. Moreover, the effects of cueing-based training on gait pattern might come from the accumulation of a series of neuroplasticity through serial motor training. However, current studies provided little information on the changes of neuroplasticity after the patients with PD carried out the cued-based training. Furthermore, it is still uncertain whether PD with or without freezing of gait (FOG) can achieve equal favorable effects from auditory cues.
Purpose: The present study is to investigate the effects of auditory-cued treadmill training for a single session on the neurophysiology and gait performance in patients with PD. Neurophysiology will be evaluated the cortical excitability through transcranial magnetic stimulation (TMS). The study will further explore whether any different effects of auditory cues between freezers and non-freezers.
Methods: This is a crossover study. Freezers (FOG, n=8), non-freezers (nFOG, n=9), and healthy subjects (control, n=9) were recruited in this study. Each subject randomly carried out training with two condition with at least one-week washout interval. Two conditions were 30-minutes of treadmill training with (AC condition) and without rhythmic auditory cues (NC condition). All subjects received the baseline and post-treatment assessments. Primary outcome measures included the cortical excitability and the secondary outcome measures included the gait performance in both comfortable and fast walking speed.
Statistical analysis: Repeated measure analysis of variance (RM-ANOVA) was used to determine differences of mean scores of the dependent variables between groups under two condition. The statistical significance was set at P<0.05.
Results: PD subjects compared to healthy subjects revealed lengthened CSP duration after training whether with or without auditory cues (p<0.001 and p=0.392, respectively). Significantly increased CSP duration in AC condition (p=0.032), but not in NC condition (p=0.257) for the FOG group was found. The nFOG group presented significantly lengthened CSP duration in both AC and NC condition (p=0.007 and p=0.008, respectively). Both PD and control groups reduced SICI(2ms), increased ICF(10ms), and ICF(12ms) after training whether with or without AC (p=0.003, p=0.009, and p=0.009, respectively), but the FOG and nFOG did not show significant differences in SICI and ICF after training. For the gait performance in comfortable speed, PD and control group showed increased speed (p=0.006) and stride length (p<0.001) after training whether with or without AC. Moreover, both the FOG and nFOG group increased stride length (p=0.002) after treadmill training whether with or without auditory cues. The step time CV in the FOG group presented a downward tendency after training, whereas the non-freezers presented an opposite picture.
Conclusion: One-session treadmill training whether with or without auditory cues played a major role in modulated cortical excitability, increased step length, and gait velocity in comfortable walking speed for patients with PD. The auditory cues with treadmill training enhanced the corticospinal inhibition in both freezers and non-freezers. However, this phenomenon cannot be found in freezers when they received treadmill training without cues.
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