WALK core method : rhythmic auditory stimulation
Stimulation of the cerebello-thalamo-cortical axis
The primary auditory cortex interacts with two major pathways of motion processing and timing management: the BGTC pathway (basal ganglia - thalamus - motor cortex) and the CTC pathway (cerebellum - thalamus - motor cortex). Hyperactivations of this CTC pathway are reported both in the initiation of movement in patients with Parkinson's disease but also during finger tapping exercises.
This pathway thus appears as a major pathway in sensorimotor dialogues and in the initiation of gait synchronized to an external signal.
Many studies have proven the efficacy of this method in gait rehabilitation for Parkinson's disease patient and its benefits on the improvement of classic spatio-temporal walking parameters such as speed or stride length.
In Bryant's study, which involved about 20 Parkinson's patients, there was an improvement in stride speed and stride length in a single test. These effects are accentuated by daily training and persist during the test without stimulation after one week of practice. Among the people surveyed, 75% are interested in using a device delivering RAS on a daily basis to support them in their walking.
Nieuwboer & al. also studied the impact of the administration of sound cues at home over 6 weeks of training on 153 patients with Parkinson's disease. As previously demonstrated, there was an increase in the speed and stride length of the patients. Motor skills are slightly increased with an improvement in posture and walking score and balance tests (4.2%). Improvement in balance and patient confidence may result in a decreased risk of falling.
Gait speed
Stride
length
Step
regularity
Cadence
+15 - 25%
+20 - 30%
+ 40%
+10 - 15%
Clinical evaluation of WALK device
44 patients with Parkinson's disease answered two self-administered questionnaires, at D0 (before use) and D7 (after use of WALK). The items used are based on standardized questionnaires:
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UDPRS[9], in particular item 2.12 for walking and balance and item 2.13 for freezing
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PDQ-39[10], in particular the following items:
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Item 1 - Leisure
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Item 2 - Tasks of daily life
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Item 6 - Autonomy
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Item 10 - Outdoor activities
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Item 26 - Self-confidence
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The ergonomics of the device, the occurrence of adverse effects and the device's duration of use were also measured through these questionnaires.
An average improvement of 19% in the walking and balance score was observed.
57% of patients reported that the device helped them to reduce their motor symptoms.
After a week using the WALK device, a 17% significant decrease in the freezing of gait (FOG) score is observed. Among the patients surveyed, 43% stated that the device helped them reduce the occurrence and the severity of their FOG episodes.
By analysing 5 aspects of patients' quality of life (leisure activities, daily tasks, independence, outdoor activities, self-confidence) before and after using the device, we can see a significant 18% score improvement.
During this first week, 69% of patients used the WALK for more than an 1 hour a day, and 42% for more than 3 hours a day.
Conclusion
This first study highlights the positive impact of the WALK medical device over a one-week period, particularly on patients' motor skills and quality of life. This device is suitable for self-administred use. Future interventional clinical studies will determine the device's immediate impact on patients' walking parameters (speed, stride length) after home training over a one-month period. A follow-up will be carried out in order to estimate the system's long-term effects (> 6 months).
References
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Coull, Jt, et Ac Nobre. « Dissociating Explicit Timing from Temporal Expectation with FMRI ». Current Opinion in Neurobiology 18, no 2 (avril 2008): 137 44.
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Wu, Tao, Liang Wang, Mark Hallett, Yi Chen, Kuncheng Li, et Piu Chan. « Effective Connectivity of Brain Networks during Self-Initiated Movement in Parkinson’s Disease ». NeuroImage 55, no 1 (1 mars 2011): 204 15.
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Lewis, M. M., C. G. Slagle, A. B. Smith, Y. Truong, P. Bai, M. J. McKeown, R. B. Mailman, A. Belger, et X. Huang. « Task Specific Influences of Parkinson’s Disease on the Striato-Thalamo-Cortical and Cerebello-Thalamo-Cortical Motor Circuitries ». Neuroscience 147, no 1 (15 juin 2007): 224 35.
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McIntosh, G. C., Brown, S. H., Rice, R. R., & Thaut, M. H. (1997). Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 62(1), 22–6.
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Ghai, Shashank, Ishan Ghai, Gerd Schmitz, and Alfred O. Effenberg. “Effect of Rhythmic Auditory Cueing on Parkinsonian Gait: A Systematic Review and Meta-Analysis.” Scientific Reports 8, no. 1 (January 11, 2018): 506.
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Howe, T. E., B. Lövgreen, F. W. J. Cody, V. J. Ashton, et J. A. Oldham. « Auditory Cues Can Modify the Gait of Persons with Early-Stage Parkinson’s Disease: A Method for Enhancing Parkinsonian Walking Performance? » Clinical Rehabilitation 17, no 4 (juillet 2003): 363‑67.
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Bryant, M. S., D. H. Rintala, E. C. Lai, et E. J. Protas. « An Evaluation of Self-Administration of Auditory Cueing to Improve Gait in People with Parkinson’s Disease ». Clinical Rehabilitation 23, no 12 (Decembre 2009): 1078 85.
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Nieuwboer, A, G Kwakkel, L Rochester, D Jones, E van Wegen, A M Willems, F Chavret, V Hetherington, K Baker, et I Lim. « Cueing training in the home improves gait‐related mobility in Parkinson’s disease: the RESCUE trial ». Journal of Neurology, Neurosurgery, and Psychiatry 78, no 2 (février 2007): 134‑40.