| Objective:Parkinson’s disease(PD)is a common neurodegenerative disease,mainly occurring in middle-aged and elderly people over 65 years old.Gait disorder is one of the typical clinical features and a common cause of disability and injury.It is manifested by slow gait speed,short stride length,shuffling gait,and frozen of gait(FOG)as the disease progresses.Daily activities that require walking while performing another cognitive or motor tasks are called dual tasks.Patients with Parkinson’s disease experience gait changes during dual-task activities,including decreased gait speed,prolonged double support phase,and increased gait variability,which increase the risk of falls and affect quality of life.Therefore,the purpose of this study was to:(1)To explore the effects of different tasks on the gait of patients with Parkinson’s disease and healthy elderly people,to screen and evaluate the main gait parameters of dual-task gait abnormality,and to preliminarily determine the relationship between changes in gait parameters and cognitive resource needs;(2)To investigate the effects of different task activities on the prefrontal activity and gait of Parkinson’s disease patients with and without frozen of gait,and to determine the relationship between the changes of gait parameters and the activation of prefrontal cortex(PFC);(3)To compare the intervention effects of 12-week Wuqinxi and stretching training on the gait,motor function and cognitive function of Parkinson’s disease patients in different tasks.Methods:This study was divided into three experiments to investigate the effect of exercise intervention on the gait of Parkinson’s patients during different tasks.Part 1: A cross-sectional study was conducted to explore the effects of different tasks on the gait of patients with Parkinson’s disease and healthy elderly people.Twenty patients with Parkinson’s disease and 20 healthy elderly people were required to perform 5 tasks,walk at a normal speed,and obstacle negotiation,counting backward,serial-3 subtraction and answer the questions.The PKMAS electronic walkway and matching software were used to collect and analyze gait parameters,compare the characteristics of gait parameters of subjects in different tasks,screen and evaluate related gait parameters with abnormal dual-task gait,and judge the relationship between changes in gait parameters and cognitive demands.Part 2: Recruit 12 PD patients with freezing of gait(FOG)and 12 PD patients without freezing of gait(N-FOG),using gait assessment like part 1,and analyzed dual task cost(DTC)when completed five tasks.At the same time,functional near-infrared spectroscopy(f NIRS)was used to measure the changes of oxygenated hemoglobin(Hb O2)in prefrontal cortex of the brain while walking,and to determine the relationship between the changes of gait parameters and the activation of prefrontal cortex.Part 3: Forty patients with PD were recruited and randomly assigned to the Wuqinxi group and the stretching group,with20 people in each group,training two sessions for a week,60 minutes each time for a total of 12 weeks.Before and after training,the data of gait parameters during the five tasks,motor function and cognitive function were collected.To compare the effects of two kinds of exercise on gait during the five tasks in patients with PD,as well as the intervention effect on balance,mobility,cognitive function and mood and quality of life.Results:(1)The gait speed(cm/s)(90.33±8.39 vs 107.23±12.08),stride length(cm)(84.95±19.21 vs 111.96±11.85)and stride width(cm)(7.60±2.62 vs 9.32±3.29)in PD patients were significantly decreased in single task walking(P<0.05).The double support time(0.37±0.12 vs 0.27±0.05)and double support %(32.95±7.28 vs 25.30±2.84)in patients with PD were higher than those in healthy elderly patients(P<0.05).However,there was no significant difference between the two groups in the stride length variability and the variation of dual support time variability.Patients with PD had lower gait speed(cm/s)(55.77±17.72 vs 84.24±16.42,55.49±16.77 vs 76.63±18.67,52.99±16.21 vs 73.33±16.76)and stride length(69.55±19.65 vs 96.98±7.78,68.45±17.79 vs 93.54±9.04,66.23±18.07 vs 90.16±8.75)than the healthy elderly(P<0.05)in counting backward,subtraction and answering question.Double support time(sec)(0.51±0.20 vs 0.38±0.15,0.53±0.21 vs 0.43±0.18,0.53±0.16 vs 0.38±0.07)and double support %(38.91±9.19 vs 29.35±3.36,40.51±9.14 vs 30.17±3.83,40.90±8.43 vs 30.65±3.53)were significantly higher than those of healthy elderly(P<0.05).(2)Gait speed(cm/s)(73.50±24.29→50.69±23.66)and the stride length(cm)(84.86±20.48→65.73±23.51)decreased,and the double support % increased(34.18±9.09→43.21±15.12)in FOG group compared with N-FOG group.There were significant differences in the DTC of counting backward,subtraction and answering question(P<0.05).In FOG group,DTC gait speed(%)(-31.78±25.76,-32.61±23.74),DTC stride length(%)(-23.84±18.95,-24.91±16.46)and DTC double support%(26.10±25.48,22.04±21.35)significantly increased in counting backward and subtraction compare with these parameters(-28.77±28.49,-21.80±18.99,20.84±21.79)in answering questions.In N-FOG group,the DTC speed(%)(-20.20±14.07)in subtraction was higher than that in counting backward(-15.77±17.35)and answering question(-18.93±28.91).The DTC speed(%)and DTC double support(%)(-16.93±20.17)in answering question.27.29±43.40)was higher than these parameters in counting backward(-10.38±11.73,13.69±12.89)and the subtraction(-13.83±9.88,14.16±16.64).The activation of PFC in counting backward and subtraction were higher than in the other tasks(P<0.05),while the activation of PFC in counting backward was increased in the N-FOG group(P<0.05).(3)After 12 weeks of exercise intervention,in Wuqinxu group,the gait speed(cm/s)increased(91.03±9.34→97.42±10.85)and stride lenghth(cm)increased(101.92±11.57→107.78±10.57)in single task,and the double support % in obstacle negotiation decreased(26.19±4.59→24.15±3.60),and the stride length(cm)in subtraction increased(77.69±13.03→82.73±10.39).In the stretching group,thedouble support % in the single task decreased(33.27±7.79→31.36±8.19),the gait speed across obstacles increased(74.14±24.52→78.53±23.96),and the stride variability of the counting backward decreased(18.71±12.37→15.75±11.53).In the Wuqinxi group,the balance function of PD patientsincreased(20.05±7.18→ 24.52±4.20),mobility increased(11.43±3.48→10.05±2.01),cognitive score(28.90±1.67→29.00±1.14),mood score decreased(12.28±9.05→8.39±5.87)and quality of life score decreased(30.00±17.24→22.37±15.88).The results showed that Wuqinxi could improve balance function,mobility,cognitive function,mood and quality of life.Conclusion:(1)The changes of gait speed,stride length,cadence,double support time and double support %in performing subtraction calculation,counting backwards and answering questions in patients with mild to moderate Parkinson’s disease were greater than those in healthy elderly people,which could be used as the main parameters to evaluate the abnormality of dual-task gait,and the changes of gait parameters may be related to cognitive demands.(2)Patients with mild to moderate Parkinson’s disease with FOG had slower gait speed,shorter stride length,and longer double support % during dual-task walking.The DTC of gait parameters in counting backward,subtraction and answering questions increased significantly.The activity of the prefrontal cortex should be activated to obtain cognitive resources to compensate for the decline in walking function.(3)Wuqinxi can improve gait speed and stride length in single task and stride length in dual task,reduce the double suppor%t,and improve motor function,cognitive funciton,mood and quality of life in patients with mild to moderate Parkinson’s disease.Stretch training can reduce the double support% in a single task and stride length variability in a dual task.Therefore,intervention methods should be selected according to characteristics of gait parameters. |
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