Project Summary/Abstract
Walking automaticity, the ability of the nervous system to successfully coordinate movement with minimal use
of executive resources, is a critical functional skill for independent mobility in daily life, and may be improved by
medication and/or appropriate rehabilitation-based intervention. This ability is compromised, even in early
stages of Parkinson's disease (PD). PD is responsible for major mobility disabilities and cognitive dysfunction
and a worse quality of life than most other chronic neurological diseases, and it imposes a heavy burden on
the health care system. Aim I will investigate the relation between cognitive function and walking automaticity
in subjects with PD and age-matched healthy control subjects by measuring brain activity in different parts of
the cerebral cortex while walking and turning. Levodopa, the most common pharmacological treatment in PD,
improves certain aspects of gait, but it may worsen or not change other aspects, such as balance. The effects
of levodopa on gait automaticity are not well understood. Aim II will characterize the changes in cortical activity
during walking due to usual levodopa intake in people with PD.
Cueing is often being used in rehabilitation. More recently, due to the increasingly user-friendly wireless
technology, personalized, closed-loop cueing devices are now being developed as an improvement over fixed
cueing methods (such us walking to the pace of a metronome or stepping over lines placed on the floor).
Recently, we showed that step-synchronized tactile feedback improved gait automaticity in PD; however, it is
not known which brain mechanisms are associated with learning of this tactile-feedback technique, nor if
benefits transfer to mobility during daily-living. Our objective is to investigate the effects of step-synchronized,
tactile cueing on gait automaticity measured in the laboratory; this is Aim III, a clinical trial. In addition, Aim III
will explore the feasibility of using the cueing system at home for one week.
This project will characterize the cortical correlates of gait automaticity, the changes in gait automaticity with
dopamine replacement and cueing in people with PD, and how these changes translate to improvement in gait
and turning. In
with
survivors.
ultimately
addition, personalized cueing-based rehabilitation could be effective for many other populations
gait disturbances, such as peripheral neuropathy, multiple sclerosis, traumatic brain injury, and cancer
There are minima l risks associated with this technology and the benefits could be significant in
improving walking and reducing falls in various populations.Furthermore, by understanding more
about the brain mechanisms associated with walking automaticity and motor learning through cueing, we will
be able to open a new route for innovative, more tailored, rehabilitation interventions.