Effects of dual-task interventions on gait performance of patients with Parkinson's Disease: A systematic review

Santos, Luís A. A.; Campos, Carlos; Bento, Teresa; Lattari, Eduardo; Nardi, Antônio Egidio; Rocha, Nuno Barbosa F.; Machado, Sérgio

doi:10.5935/MedicalExpress.2016.04.01

Brasil

Español English

REVIEW • MedicalExpress (São Paulo, online) 3 (4) • Jul-Aug 2016 • https://doi.org/10.5935/MedicalExpress.2016.04.01 copy

Effects of dual-task interventions on gait performance of patients with Parkinson's Disease: A systematic review

EFEITO DA DUPLA TAREFA NA MARCHA EM PACIENTES COM DOENÇA DE PARKINSON: UMA REVISÃO SISTEMÁTICA

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

Parkinson's disease is characterized by motor and non-motor symptoms that impair patients' gait performance, especially while performing dual/concurrent tasks. These deficits impair patients' daily function, because dual-tasking is a crucial ability in terms of everyday living. The aim of this study was to systematically review the effects of dual task interventions on gait performance of patients with Parkinson's disease.

METHOD:

Studies were retrieved from MEDLINE/PubMed, LILACS and SciELO. We used the PICOS strategy to determine eligibility criteria. The search strategy included an advanced search on the included databases, using the following search query: "Parkinson's Disease" AND "Double Task" OR "Concurrent Tasks" OR "Gait" AND "Walk". Study selection was carried out by two independent researchers and a third one was called when consensus was needed.

RESULTS:

A total of 188 articles were identified: 169 articles from Medline/PubMed, 10 articles in SciELO, 8 articles in LILACS and 1 item from manual searches. A total of 56 articles were analyzed regarding the eligibility and exclusion criteria based on full text. A final total of 7 studies were included in the systematic review.

CONCLUSION:

The different types of dual-task interventions reported (dance, sound stimuli, visual and somatosensory) were associated to improvements in several gait performance indicators of Parkinson's disease patients, including gait speed, stride time and length, cadence and step length. External stimuli seem to play a critical role on specific training effects on dual-task gait performance.

KEYWORDS:
Parkinson's disease; dual-task; gait

Study/ Year	Sample Size Age	PD Stage (H&Y)/PD Duration (years)	Medication	Treatment & Assessment Procedures	Type of DT	Measures	Main results
Romenets et al.²⁸28 Romenets SR, Anang J, Fereshtehnejad SM, Pelletier A, Postuma R. Tango for treatment of motor andnon-motor manifestations in Parkinson'sdisease: randomized control study. Complement Ther Med. 2015;23(2):175-84. http://dx.doi.org/10.1016/j.ctim.2015.01.015 http://dx.doi.org/10.1016/j.ctim.2015.01...	n = 33 TDG = 18 63.2 ± 9.9 CG = 15 64.3 ± 8.1	1 - 3 TDG 5.5 ± 4.4 CG 7.7 ± 4.6	ON	TDG: Tango Dance, 60’ group sessions, 2 times per week, during 12 weeks. CG: Daily home-based exercises.	Tango Dance	TUG (sec) DT-TUG score Walking with pivot turns	Significant group x time interaction (p = 0.042); TDG ↑ in comparison to CG. Significant group x time interaction (p = 0.012); TDG ↑ in comparison to CG. Non-significant trend group x time interaction (p = 0.066); TDG ↑ in comparison to CG.
Duncan & Earhart²⁵25 Duncan RP, Earhart GM. Controlled Trial of Community-Based Dancing to Modify Disease Progression in in Parkinson Disease. Neurorehabil Neural Repair. 2012;26(2):132-43. http://dx.doi.org/10.10.1177/1545968311421614 http://dx.doi.org/10.10.1177/15459683114...	n = 52 TDG = 26 69.3 ± 1.9 CG = 26 69.0 ± 1.5	TDG=1-4 5.8 ± 1.1 CG = 2-4 7.0 ± 1.0	ON during intervention OFF during assessments	TDG: Tango Dance, 60’ group sessions, 2 times per week, during 24 months. CG: No prescribed exercise. Assessment: Baseline, 3, 6 and 12 months.	Tango Dance	FoGQ Gait Speed 6MWT	Significant group x time interaction (p = 0.006); TDG maintained performance while CG ↓ after 12 months. Significant group x time interaction for forward walking (p = 0.04) and DT walking (p = 0.02); TDG ↑ in comparison to CG at 6 and 12 months. Significant interaction (p = 0.02); TDG maintained performance while CG ↓ after 12 months.
Duncan & Earhart²⁶26 Duncan RP, Earhart GM. Are the Effects of Community-Based Dance on Parkinson Disease Severity, Balance, and Functional Mobility Reduced with Time? A 2-Year Prospective Pilot Study. J Altern Complement Med. 2014; 20(10):757-63. http://dx.doi.org/10.10.1089/acm.2012.0774 http://dx.doi.org/10.10.1089/acm.2012.07...	n = 10 TDG = 5 69.6 ± 6.6 CG = 5 66 ± 11	TDG = 2-3 6.6 ± 7.5 CG = 2-2,5 11 ± 3.9	ON during intervention OFF during assessments	TDG: Tango Dance, 60’ group sessions, 2 times per week, during 24 months. CG: No prescribed exercise. Assessment: Baseline, 12 and 24 months.	Tango Dance	DT-TUG 6MWT	Significant group x time interaction (p = 0.048); TDG ↑ in comparison to CG, although there were no significant between group differences at any time point. Significant group x time interaction (p = 0.013); TDG maintained performance while CG ↓ after 24 months.
de Bruin et al.²⁹29 de Bruin N, Doan JB, Turnbull G, Suchowersky O, Bonfield S, Hu B, et al. Walking with music is a safe and viable tool for gait training in PD:The effect of a 13-week feasibility study on single and dual task walking. Parkinsons Dis. 2010;2010:483530. http://dx.doi.org/10.10.4061/2010/483530 http://dx.doi.org/10.10.4061/2010/483530...	n = 22 MG = 11 64.1 ± 4.2 CG = 11 67.0 ± 8.1	MG = 2-3 6.4 ± 4.2 CG = 2-2.5 4.5 ± 3.3	ON	MG: 30’ walking at a comfortable pace, while listening self-selected music, 3 times per week, during 13 weeks. Patients also performed their regular activities. CG: continued their usual routine during 13 weeks. Both groups reported daily activities and eventual falls. Assessment: 10 meter self-paced walked in 2 conditions - simple task (without any other task) and DT (while performing serial 3 subtractions).	Walking while Listening to Music	Gait Speed Cadence Stride Time	Significant ↑ in the MG (p = 0.002); Non-significant trend task x time interaction favoring the DT condition in the MG (p = 0.081); No changes or interaction in the CG. Significant ↑ in the MG (p = 0.007); Non-significant trend task x time interaction favoring the DT condition in the MG (p = 0.056); No changes or interaction in the CG. Significant ↑ in the MG (p = 0.019); Non-significant trend task x time interaction favoring the DT condition in the MG (p = 0.062); No changes or interaction in the CG.
Fok et al.³¹31 Fok P, Farrel M, McMeeken J. Prioritizing gait in dual-task conditions in people with Parkinson's. Hum Mov Sci. 2010;29(5):831-42. http://dx.doi.org/10.10.1016/j.humov.2010.06.005 http://dx.doi.org/10.10.1016/j.humov.201...	n = 12 TG = 6 66.8 ± 9.0 CG = 6 57.7 ± 12.3	TG = 2.5-3.5 4.2 ± 2.4 CG = 1.5-3.5 5.5 ± 3.8	ON	TG: DT walking training using gait prioritization, 30’ single session.Participants walked using big steps while performing a series of -3 subtractions. Subjects instructed to totally focus on big steps. CG: 30 minute sitting down reading magazine Assessment: Simple tasks (walking and subtractions alone) and DT (walking plus subtractions). Two trials in each condition at baseline, immediately after training and 30 minutes after (retention).	DT walking training (subtraction cognitive task)	Stride Length Gait Speed	Significant time x group x task interaction after training ( p = 0.03); TG ↑ in comparison to CG; Non-significant trend task x time interaction favoring the DT condition ( p = 0.08). Significant time x group x task interaction after training ( p = 0.03); TG ↑ in comparison to CG; Significant task x time interaction favoring the DT condition ( p = 0.001).
Fok et al.³²32 Fok P, Farrel M, McMeeken J. The effect of dividing attention between walking and auxiliary tasks in people with Parkinson's disease. Hum Mov Sci. 2012;31(1):236-46. http://dx.doi.org/10.10.1016/j.humov.2011.05.002 http://dx.doi.org/10.10.1016/j.humov.201...	n = 12 TG = 6 73 ± 12 CG = 6 66.3 ± 11.7	TG = 2.5 - 3 3.9 ± 2.4 CG = 2 - 3.5 3.5 ± 2.6	ON	TG: DT walking training using divided attention, 30’ single session. Participants walked using big steps while performing a series of -3 subtractions. Subjects instructed to divide their attention on both tasks. CG: 30 minute sitting down reading magazine. Assessment: Simple tasks (walking and subtractions alone) and DT (walking plus subtractions). Two trials in each condition at baseline, immediately after training and 30 minutes after (retention).	DT walking training (subtraction cognitive task)	Stride Length Gait Speed	Significant time x group interaction ( p = 0.001); TG ↑in comparison to CG; No significant time x group x task interaction. Significant time x group interaction ( p = 0.001); TG ↑in comparison to CG; No significant time x group x task interaction.
Rochester et al.³⁰30 Rochester L, Baker K, Hetherington V, Jones D, Willems AM, Kwakkel G, et al. Evidence for motor learning in Parkinson's disease: Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues. Brain Res. 2010;10(1319):103-11. http://dx.doi.org/10.10.1016/j.brainres.2010.01.001 http://dx.doi.org/10.10.1016/j.brainres....	n = 153 eERC = 7667.5 lERC = 77 69	eERC = 2.5 - 3 7 years lERC = 2.5 - 3 8 years	ON	Cross-Design ERC intervention Study ERC: External rhythmical cueing training, 30’ sessions, 3 times per week, during 3 weeks. Auditory, visual and somatosensory cues were used: -eERC started the intervention immediately (week 1); -lERC started the intervention at week 4. Assessment: DT, walking with a tray with 2 glasses of water; Simple Task, walking without tray. Assessment at baseline, after both training periods and 6 week follow-up.	External Rhythmical Cueing Training	Gait Speed Step length Cadence	↑ On Simple Task with visual (p = 0.03), auditory (p = 0.02) and somatosensory (p = 0.0004) cues. ↑ On DT with visual ↑ On DT with visual (p = 0.002), auditory (p = 0.03) and somatosensory (p = 0.0004) cues and non-cue (p = 0.04)., auditory (p = 0.03) and somatosensory (p = 0.0004) cues and non-cue (p = 0.04). ↑ On Simple Task with visual (p = 0.001), auditory (p = 0.005) and somatosensory (p = 0.002) cues and non-cue (p = 0.023). ↑ On DT with visual (p = 0.001), auditory (p = 0.01) and somatosensory (p = 0.0004) cues and non-cue (p = 0.004). ↑ On Simple Task without cue (p = 0.03). On DT with visual (p = 0.002), auditory (p = 0.03) and somatosensory (p = 0.0004) cues and non-cue (p = 0.04).

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