Rehabilitation in Parkinson's disease

Our medical device makes a proven rehabilitation method accessible to everyone thanks to new technologies.

This neurological rehabilitation method consists in establishing an artificial rhythm by using external rhythmic sound stimulation. The close relationship between the auditory system and the motor system can explain the beneficial effects observed during an RAS.

 

Neurological mechanisms 

Cerebello-thalamo-cortical pathway

 

Auditory information could also influence two major pathways for movement processing and timing management: the BGTC pathway (basal ganglia - thalamus - motor cortex) and the CTC pathway (cerebellum - thalamus - motor cortex). Hyperactivations of CTC pathway are described both in the initiation of movement in patients with Parkinson's disease and in finger tapping exercises. This path therefore appears as a major path in sensorimotor loop and in the developping a pace synchronized on an external signal.

 

Many studies have demonstrated the effectiveness of this technique in Parkinson's disease and its benefits in improving conventional spatio-temporal walking parameters such as speed or stride length

In Bryant's study, which includes about twenty Parkinson's patients, improvements in speed and stride length were observed in acute testing. These effects are enhanced by daily training and persist after one week of practice during the unstimulated test. Among the people surveyed, 75% are interested in using a device that delivers the RAS on a daily basis to support them in their journey.

 

Nieuwboer's study also studied the impact of administering sound cues at home over 6 weeks of training on 153 patients with Parkinson's disease[8]. As previously demonstrated, there is an increase in patients' speed and stride length. Motor skills are slightly enhanced with an improvement in posture, walking score (4.2%) and balance tests. The risk of falling was also measured, as improving patient's mobility through auditory stimulation could increase his risk of falling. However, the obtained results do not show an increase in falls in treated patients instead showing that improvement of the patient's balance and confidence could reduce risk of falling.

Gait speed

Stride 

length

Step

regularity

Cadence

Assessment of the WALK device on walking, freezing and quality of life of Parkinson's disease patients

Assessment of the WALK device on walking, freezing and quality of life of Parkinson's disease patients

Assessment of the WALK device on walking, freezing and quality of life of Parkinson's disease patients

Assessment of the WALK device on walking, freezing and quality of life of Parkinson's disease patients

Assessment of the WALK device on walking, freezing and quality of life of Parkinson's disease patients

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:

  • UDPRS[9], in particular item 2.12 for walking and balance and item 2.13 for freezing

  • PDQ-39[10], in particular the following items:

    • Item 1 - Leisure

    • Item 2 - Tasks of daily life

    • Item 6 - Autonomy

    • Item 10 - Outdoor activities  

    • Item 26 - Self-confidence

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 

  • Coull, Jt, et Ac Nobre. « Dissociating Explicit Timing from Temporal Expectation with FMRI ». Current Opinion in Neurobiology 18, no 2 (avril 2008): 137 44.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

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