Robot-assisted gait training with auditory and visual cues in Parkinson's disease: A randomized controlled trial - 12/05/22
Highlights |
• | Comparison of the effects of gait-training strategies for Parkinson's disease. |
• | Robot-assisted gait training and treadmill training were randomly allocated. |
• | Gait speed on the 10-m walk test did not vary between the groups. |
• | Cognitive dual-task interference showed a training-related group difference. |
• | The neural mechanisms of gait improvement differed by training strategy. |
Abstract |
Background |
Robot-assisted gait training (RAGT) may have beneficial effects on Parkinson's disease (PD); however, the evidence to date is inconsistent.
Objectives |
This study compared the effects of RAGT and treadmill training (TT) on gait speed, dual-task gait performance, and changes in resting-state brain functional connectivity in individuals with PD.
Methods |
In this prospective, single-center, randomized controlled trial with a parallel two-group design, 44 participants were randomly allocated to undergo 12 sessions (3 times per week for 4 weeks) of RAGT or TT. The primary outcome was gait speed on the 10-m walk test (10mWT) under comfortable walking conditions. Secondary outcomes included dual-task interference on gait speed, balance, disability scores, fear of falling, freezing of gait, and brain functional connectivity changes. All clinical outcomes were measured before (T0), immediately after (T1), and 1 month after treatment (T2).
Results |
The mean (SD) age of the participants was 68.1 (8.1) years, and mean disease duration 108.0 (61.5) months. The groups did not significantly differ on the 10mWT (T0-T1, p = 0.726, Cohen's d = 0.133; T0-T2, p = 0.778, Cohen's d = 0.121). We observed a significant time-by-group interaction (F = 3.236, p = 0.045) for cognitive dual-task interference, controlling for confounders. After treatment, coupling was decreased to a greater extent with RAGT than TT between the visual and dorsal attention networks (p = 0.015), between bilateral fronto-parietal networks (p = 0.043), and between auditory and medial temporal networks (p = 0.018). Improvement in cognitive dual-task interference was positively correlated with enhanced visual and medial temporal network coupling overall (r = 0.386, p = 0.029) and with TT (r = 0.545, p = 0.024) but not RAGT (r = 0.151, p = 0.590).
Conclusions |
RAGT was not superior to intensity-matched TT on improving gait functions in individuals with PD but may be beneficial in improving gait ability under cognitive dual-task conditions. The therapeutic mechanism and key functional connectivity changes associated with improvement may differ between treatment strategies.
ClinicalTrials.gov |
#NCT03490578
Le texte complet de cet article est disponible en PDF.Keywords : Parkinson's disease, Robot-assisted gait training, Cognitive dual-task interference, Independent component analysis, Resting-state functional MRI, Functional-network connectivity
Plan
Vol 65 - N° 3
Article 101620- mai 2022 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.