The Effects of a Secondary Task on Forward and Backward Walking in Parkinson's Disease

Neurorehabilitation and neural repair (Impact Factor: 3.98). 09/2009; 24(1). DOI: 10.1177/1545968309341061
Source: PubMed


BACKGROUND: People with Parkinson's disease (PD) often fall while multitasking or walking backward, unavoidable activities in daily living. Dual tasks involving cognitive demand during gait and unfamiliar motor skills, such as backward walking, could identify those with fall risk, but dual tasking while walking backward has not been examined in those with PD, those who experience freezing of gait (FOG), or healthy older controls. METHODS: . A total of 78 people with PD (mean age = 65.1 +/-9.5 years; female, 28%) and 74 age-matched and sex-matched controls (mean age = 65.0 +/-10.0 years; female, 23%) participated. A computerized walkway measured gait velocity, stride length, swing percent, stance percent, cadence, heel to heel base of support, functional ambulation profile, and gait asymmetry during forward and backward walking with and without a secondary cognitive task. RESULTS: . Direction and task effects on walking performance were similar between healthy controls and those with PD. However, those with PD were more affected than controls, and freezers were more affected than nonfreezers, by backward walking and dual tasking. Walking backward seemed to affect gait more than dual tasking in those with PD,although the subset of freezers appeared particularly affected by both challenges. CONCLUSION: . People with PD are impaired while performing complex motor and mental tasks simultaneously,which may put them at risk for falling. Those with FOG are more adversely affected by both motor and mental challenges than those without. Evaluation of backward walking while performing a secondary task might be an effective clinical tool to identify locomotor difficulties.

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Available from: Madeleine E Hackney,
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    • "For instance, there is evidence that the concurrent performance of a cognitive task results in differential worsening of walk performance in those with clinically isolated syndrome [5] and persons with MS [6] compared with healthy controls. Additionally, research in persons with Parkinson's disease has utilized backwards walking with and without added cognitive tasks as a method to perturb walking function [7] [8]. This pilot study examined the effect of walking direction and simultaneous cognitive task on spatiotemporal gait parameters in persons with MS compared to healthy controls. "
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    ABSTRACT: Declines in walking performance are commonly seen when undergoing a concurrent cognitive task in persons with multiple sclerosis (MS). The purpose of this study was to determine the effect of walking direction and simultaneous cognitive task on the spatiotemporal gait parameters in persons with MS compared to healthy controls. Ten persons with MS (Median EDSS, 3.0) and ten healthy controls took part in this pilot study. Participants performed 4 walking trials at their self-selected comfortable pace. These trials included forward walking, forward walking with a cognitive task, backward walking, and backward walking with a cognitive task. Walking performance was indexed with measures of velocity, cadence, and stride length for each testing condition. The MS group walked slower with significantly reduced stride length compared to the control group. The novel observation of this investigation was that walking differences between persons with MS and healthy controls were greater during backward walking, and this effect was further highlighted during backward walking with added cognitive test. This raises the possibility that backward walking tests could be an effective way to examine walking difficulties in individuals with MS with relatively minimal walking impairment.
    10/2013; 2013:859323. DOI:10.1155/2013/859323
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    • "Motor learning mechanism is important to re-educate impaired musculoskeletal function [18]. Hackney and Earhart [17] demonstrated that backward direction generally more impacted to people with Parkinson disease (PD) than a secondary cognitive task, i.e. mental arithmetic task, during walking. "
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    ABSTRACT: Backward walking (BW) is a recently emerging exercise. However, limited studies exist regarding the motion analysis of BW compared with that of forward walking (FW). The present study identified the mechanisms of BW through kinetic analysis and focused on BW time-reversed data. A three-dimensional motion capture system was used to acquire the joint movements and to calculate the joint moments and the powers during walking. Ground reaction force curves were acquired from force plates. Each participant performed 10 FW trials and 40 BW trials with bare feet. All data were analyzed using paired t-tests (p<0.05) to verify the significant differences between FW and BW. In BW, since the progress is in the direction in which the person cannot see, the walker's speed is generally decreased compared to FW. As a result, the stride characteristics for each respective activity showed significant differences. The characteristics of angular displacement in all joints were almost identical in FW and time-reversed BW. However, selected crucial points of joint angles were significantly different. The moment pattern of the ankle joint was very similar in FW and time-reversed BW. In the knee and the hip joint, the joint moment pattern of time-reversed BW was simpler than FW. The joint power patterns of the ankle, the knee and the hip were different in FW and BW. An original finding of this study was that the main propulsion and shock absorption joint during BW is the ankle joint. The knee and hip joint did not generate propulsion power.
    Gait & posture 03/2013; 38(4). DOI:10.1016/j.gaitpost.2013.02.014 · 2.75 Impact Factor
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    • "The general assumption is that, if gait parameters are hampered under dual task conditions (a secondary cognitive task), execution of the behavior is no longer automatic (Hallett, 2008). Indeed, previous studies focusing on the execution of automaticity demonstrated that gait is affected under dual task conditions in PD (O'Shea et al., 2002; Hausdorff et al., 2003), and even more in FOG (Hackney and Earhart, 2010; Spildooren et al., 2010). "
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    ABSTRACT: Recent studies emphasize a key role of controlled operations, such as set-shifting and inhibition, in the occurrence of freezing of gait (FOG) in Parkinson's disease (PD). However, FOG can also be characterized as a de-automatization disorder, showing impairments in both the execution and acquisition of automaticity. The observed deficits in automaticity and executive functioning indicate that both processes are malfunctioning in freezers. Therefore, to explain FOG from a cognitive-based perspective, we present a model describing the pathways involved in automatic and controlled processes prior to a FOG episode. Crucially, we focus on disturbances in automaticity and control, regulated by the frontostriatal circuitry. In complex situations, non-freezing PD patients may compensate for deficits in automaticity by switching to increased cognitive control. However, as both automatic and controlled processes are more severely impaired in freezers, this hampers cognitive compensation in FOG, resulting in a potential breakdown. Future directions for cognitive rehabilitation are proposed, based on the cognitive model we put forward.
    Frontiers in Human Neuroscience 11/2012; 6:356. DOI:10.3389/fnhum.2012.00356 · 3.63 Impact Factor
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