A randomised controlled trial evaluating the effect of an individual auditory cueing device on freezing and gait speed in people with Parkinson's disease

BackgroundParkinson's disease is a progressive neurological disorder resulting from a degeneration of dopamine producing cells in the substantia nigra. Clinical symptoms typically affect gait pattern and motor performance. Evidence suggests that the use of individual auditory cueing devices may be used effectively for the management of gait and freezing in people with Parkinson's disease. The primary aim of the randomised controlled trial is to evaluate the effect of an individual auditory cueing device on freezing and gait speed in people with Parkinson's disease.MethodsA prospective multi-centre randomised cross over design trial will be conducted. Forty-seven subjects will be randomised into either Group A or Group B, each with a control and intervention phase. Baseline measurements will be recorded using the Freezing of Gait Questionnaire as the primary outcome measure and 3 secondary outcome measures, the 10 m Walk Test, Timed "Up & Go" Test and the Modified Falls Efficacy Scale. Assessments are taken 3-times over a 3-week period. A follow-up assessment will be completed after three months. A secondary aim of the study is to evaluate the impact of such a device on the quality of life of people with Parkinson's disease using a qualitative methodology.ConclusionThe Apple iPod-Shuffle™ and similar devices provide a cost effective and an innovative platform for integration of individual auditory cueing devices into clinical, social and home environments and are shown to have immediate effect on gait, with improvements in walking speed, stride length and freezing. It is evident that individual auditory cueing devices are of benefit to people with Parkinson's disease and the aim of this randomised controlled trial is to maximise the benefits by allowing the individual to use devices in both a clinical and social setting, with minimal disruption to their daily routine.Trial registrationThe protocol for this study is registered with the US NIH Clinical Trials Registry (NCT00727467).

[1]  Yoshikuni Mizuno,et al.  Music therapy in parkinson's disease: Improvement of parkinsonian gait and depression with rhythmic auditory stimulation , 2006 .

[2]  Nir Giladi,et al.  Gait festination in Parkinson's disease. , 2001, Parkinsonism & related disorders.

[3]  Tonya Toole,et al.  Training with Verbal Instructional Cues Results in Near‐term Improvement of Gait in People with Parkinson Disease , 2005, Journal of neurologic physical therapy : JNPT.

[4]  Jeffrey M. Hausdorff,et al.  The power of cueing to circumvent dopamine deficits: A review of physical therapy treatment of gait disturbances in Parkinson's disease , 2002, Movement disorders : official journal of the Movement Disorder Society.

[5]  G. Kwakkel,et al.  Effects of external rhythmical cueing on gait in patients with Parkinson's disease: a systematic review , 2005, Clinical rehabilitation.

[6]  K Desloovere,et al.  Abnormalities of the spatiotemporal characteristics of gait at the onset of freezing in Parkinson's disease , 2001, Movement disorders : official journal of the Movement Disorder Society.

[7]  Matthew B. Miles,et al.  Qualitative Data Analysis: An Expanded Sourcebook , 1994 .

[8]  Colleen G Canning,et al.  The effect of directing attention during walking under dual-task conditions in Parkinson's disease. , 2005, Parkinsonism & related disorders.

[9]  M. Morris,et al.  The biomechanics and motor control of gait in Parkinson disease. , 2001, Clinical biomechanics.

[10]  O. Blin,et al.  Quantitative analysis of gait in Parkinson patients: increased variability of stride length , 1990, Journal of the Neurological Sciences.

[11]  A. Nieuwboer,et al.  The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson's disease. , 2007, Archives of physical medicine and rehabilitation.

[12]  M. Thaut,et al.  Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson's disease. , 1997, Journal of neurology, neurosurgery, and psychiatry.

[13]  Lynn Rochester,et al.  The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson's disease. , 2005, Archives of physical medicine and rehabilitation.

[14]  J. Summers,et al.  Stride length regulation in Parkinson's disease. Normalization strategies and underlying mechanisms. , 1996, Brain : a journal of neurology.

[15]  M. Rogers,et al.  Disorders of posture, balance, and gait in Parkinson's disease. , 1996, Clinics in geriatric medicine.

[16]  J. Summers,et al.  The pathogenesis of gait hypokinesia in Parkinson's disease. , 1994, Brain : a journal of neurology.

[17]  J. Chandler,et al.  Reliability of impairment and physical performance measures for persons with Parkinson's disease. , 1997, Physical therapy.

[18]  Parkinson's disease and parkinsonism in the elderly , 2000 .

[19]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[20]  Becky G. Farley,et al.  Training BIG to move faster: the application of the speed–amplitude relation as a rehabilitation strategy for people with Parkinson’s disease , 2005, Experimental Brain Research.

[21]  Nir Giladi,et al.  Construction of freezing of gait questionnaire for patients with Parkinsonism. , 2000, Parkinsonism & related disorders.

[22]  Donna Lockett,et al.  Development and validation of a modified falls-efficacy scale , 2008, Disability and rehabilitation. Assistive technology.

[23]  A. Shumway-cook,et al.  Predicting the probability for falls in community-dwelling older adults. , 1997, Physical therapy.

[24]  R. Freedland,et al.  The effects of pulsed auditory stimulation on various gait measurements in persons with Parkinson's Disease. , 2002, NeuroRehabilitation.

[25]  G. Kwakkel,et al.  Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial , 2007, Journal of Neurology, Neurosurgery & Psychiatry.

[26]  C. Marsden,et al.  Slowness of movement in Parkinson's disease , 1989, Movement disorders : official journal of the Movement Disorder Society.

[27]  中田 力.  Integrated human brain science : theory, method, application (music) , 2000 .

[28]  G. Kwakkel,et al.  Efficacy of a physical therapy program in patients with Parkinson's disease: a randomized controlled trial. , 2005, Archives of physical medicine and rehabilitation.

[29]  P. Teitelbaum,et al.  Verbal instructional sets to normalise the temporal and spatial gait variables in Parkinson’s disease , 1998, Journal of neurology, neurosurgery, and psychiatry.

[30]  Nir Giladi,et al.  Motor blocks in Parkinson's disease , 1992, Neurology.

[31]  Michel Panisset,et al.  Freezing of gait in Parkinson's disease. , 2004, Neurologic clinics.

[32]  Yasuyuki Okuma,et al.  Freezing of gait in Parkinson’s disease , 2006, Journal of neurology.

[33]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[34]  S Fahn,et al.  Freezing of gait in PD , 2001, Neurology.

[35]  M. Morris,et al.  Reliability of measurements obtained with the Timed "Up & Go" test in people with Parkinson disease. , 2001, Physical therapy.

[36]  S. Gibson,et al.  Fear of falling revisited. , 1996, Archives of physical medicine and rehabilitation.

[37]  A. Gentile,et al.  Instructional Cues and Parkinsonian Gait: A Pilot Study , 2003 .

[38]  J. M. Brault,et al.  Rhythmic auditory stimulation in gait training for Parkinson's disease patients , 1996, Movement disorders : official journal of the Movement Disorder Society.

[39]  M. Woollacott,et al.  Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. , 2000, Physical therapy.

[40]  K Desloovere,et al.  The use of rhythmic auditory cues to influence gait in patients with Parkinson's disease, the differential effect for freezers and non-freezers, an explorative study , 2006, Disability and rehabilitation.