Original article
The Effect of External Rhythmic Cues (Auditory and Visual) on Walking During a Functional Task in Homes of People With Parkinson’s Disease

Presented in part to the World Physical Therapy Conference, June 2003, Barcelona, Spain, and the First Scientific Conference of Association of Physiotherapists in Parkinson’s Disease Europe, July 2003, Southampton, UK.
https://doi.org/10.1016/j.apmr.2004.10.040Get rights and content

Abstract

Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems AM, Kwakkel G, Van Wegen E. The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease.

Objectives

To evaluate (1) the influence of rhythmic cues on gait interference during a functional activity and (2) the relationship of clinical symptoms to gait interference.

Design

Repeated-measures study.

Setting

Participants’ homes.

Participants

Twenty subjects with idiopathic Parkinson’s disease (PD) and a control group of 10 age-, sex-, and education-matched subjects.

Interventions

Subjects performed a simple functional task that included a walking component and a dual-motor task. The functional task was performed with and without external rhythmic (auditory and visual) cues.

Main outcome measures

Walking speed, mean step length, and step frequency were compared during trials of the tasks. In addition, tests of cognitive executive function (Hayling and Brixton tests), anxiety and depression (Hospital Anxiety and Depression Scale), and fatigue (Multidimensional Fatigue Inventory) were undertaken.

Results

The use of auditory cues during a dual task involving gait reduced the interference effect on the task; significant increases in step length were observed in PD subjects (P=.018), representing an increase of 19%.

Conclusions

External auditory cues may be useful in reducing interference and maintaining gait performance during more complicated functional activities. Clinical symptoms, such as depression and fatigue, could influence the ability to focus attention and may increase gait interference during the performance of complex tasks, with subsequent implications for functional walking and safety.

Section snippets

Participants

We studied 20 people with idiopathic PD (12 men, 8 women; mean age, 64.6±7.96y) and a control group of 10 healthy subjects matched for age, sex, and premorbid intelligence quotient (IQ) (6 men, 4 women; mean age 63.5±7.03y). PD subjects had a median disease severity score of 2.5 (minimum, 1.5; maximum, 4) on the Hoehn and Yahr Scale and a mean disease duration of 10±1.6 years. Ethics approval for the study was granted by the Newcastle and North Tyneside Health Authority Joint Ethics Committee,

Participant details

Subjects’ demographic and clinical details are shown in table 1. We used independent 2-tailed t tests to compare the PD and control groups. There were no significant differences in age, sex, or premorbid IQ. There was a significant difference in the MMSE scores, however, with all subjects scoring above 26, indicating the absence of dementia. PD subjects had significantly higher scores for the Hayling and Brixton tests and the fatigue and depression tests. Results of t tests are shown in table 1

Discussion

Use of auditory cues facilitated a significant increase in mean step length during a dual-motor task that was also substantial from a clinical perspective, representing a difference of 19%. There was also a trend toward an increase in walking speed during the dual-motor task with auditory cues. Visual rhythmic cues also resulted in a trend toward improved walking speed during a dual-motor task. Other clinical symptoms that could compete for attention were correlated with walking speed.

Conclusions

The present study provides some evidence that use of auditory rhythmic cues in the context of the home environment and during functional activities leads to improvements in walking speed and mean step length in subjects with PD. Subjects were able to integrate rhythmic cues into a functional task immediately. These results provide information about the influence of cue use during complex functional tasks that has not previously been described. The results support the utility of external

Acknowledgments

We thank David Burn, MD, and Richard Walker, MD, for their help and support recruiting subjects for the study.

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    Supported by the European Commission Framework V funding (grant no. QLRT-2001-00120).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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