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Walking deficits and altered brain capacity have been proved to be two of the main contributing factors in dual-task walking deficits in patients with Parkinson's disease (PD). In the past, patients with PD were usually suggested not to walk in dual-task conditions in order to concentrate on their walking performance better. However, since dual-task walking is really common in daily-life, this limitation usually lead to a decrease in quality of life for PD patients. In previous studies, effects of using attentional strategies in dual-task walking training remain unclear, while suitable attentional strategies and corresponded neuroplasticity for patients with and without freezing of gait have not been well discussed, either. Accordingly, this study is aimed to identify (1) whether internal or external attentional strategies is more ideal for PD patients with and without freezing of gait in dual-task walking training, and (2) changes in brain activity after receiving dual-task walking training with different attentional strategies in patients with or without freezing of gait. Our hypothesis are (1) patients with or without freezing of gait will react differently in dual-gait training with different attentional strategies, and (2) changes in brain activities will be different according to different attentional strategies given in the training.
The hypothesis will be tested by gait performance, suprapostural tasks performance, relative power spectrum of EEG, and scales including MDS-UPDRS, ABC, BBS, and TUG.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PD patients with freezing of gait, internal strategies | Experimental | Participants in this group will include PD patients with freezing of gait. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance. |
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| PD patients with freezing of gait, external strategies | Experimental | Participants in this group will include PD patients with freezing of gait. During dual-task walking training, external attentional strategies will be given, aiming to improve their gait performance. |
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| PD patients without freezing of gait, internal strategies | Experimental | Participants in this group will include PD patients without freezing of gait. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance. |
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| PD patients without freezing of gait, external strategies | Experimental | Participants in this group will include PD patients without freezing of gait. During dual-task walking training, external attentional strategies will be given, aiming to improve their gait performance. |
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| Healthy elders, internal strategies |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dual-task walking training | Behavioral | Participants will be instructed to perform both motor and cognitive dual-task walking during exercise training. For example, for motor dual-task walking, the participants may be instructed to throw and catch a ball while walking. As for cognitive dual-task walking, the participants may be instructed to name animals or perform calculation while walking. |
| Measure | Description | Time Frame |
|---|---|---|
| Gait velocity from GAITRite | gait performance | 60 minutes |
| Cadence from GAITRite | gait performance | 60 minutes |
| Mean step length from GAITRite | gait performance | 60 minutes |
| Step-to-step variability from GAITRite | gait performance | 60 minutes |
| Amplitude from a triaxial accelerometer, X axes | motor suprapostural task performance | 25 minutes |
| Amplitude from a triaxial accelerometer, Y axes | motor suprapostural task performance | 25 minutes |
| Amplitude from a triaxial accelerometer, Z axes | motor suprapostural task performance | 25 minutes |
| Correct rate on working memory task | cognitive suprapostural task performance | 25 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| EEG relative power in the delta band | brain activity under single, motor dual-task, and cognitive dual-task walking conditions | 60 minutes |
| EEG relative power in the theta band | brain activity under single, motor dual-task, and cognitive dual-task walking conditions |
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Inclusion Criteria:
for PD patients:
for healthy elders:
Exclusion Criteria:
for PD patients:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| School and Graduate Institute of Physical Therapy, National Taiwan University | Taipei | 100 | Taiwan |
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| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| Experimental |
Participants in this group will include healthy elders. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance. |
|
| Healthy elders, external strategies | Experimental | Participants in this group will include healthy elders. During dual-task walking training, internal attentional strategies will be given, aiming to improve their gait performance. |
|
|
| 60 minutes |
| EEG relative power in the alpha band | brain activity under single, motor dual-task, and cognitive dual-task walking conditions | 60 minutes |
| EEG relative power in the beta band | brain activity under single, motor dual-task, and cognitive dual-task walking conditions | 60 minutes |
| EEG relative power in the low gamma band | brain activity under single, motor dual-task, and cognitive dual-task walking conditions | 60 minutes |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |