The JFK BIG study: the impact of LSVT BIG® on dual task walking and mobility in persons with Parkinson's disease

Sara Isaacson, Ashley O'Brien, Jennifer D Lazaro, Arlen Ray, Gerard Fluet, Sara Isaacson, Ashley O'Brien, Jennifer D Lazaro, Arlen Ray, Gerard Fluet

Abstract

[Purpose] The aim of this study was to test the hypothesis that Lee Silverman Voice Treatment-BIG decreases the negative impact of hypokinesia on dual task performance in persons with Parkinson's disease. [Subjects and Methods] The records of 114 patients with Parkinson's admitted to outpatient rehabilitation at a suburban hospital were reviewed. Demographics and data for 8 outcome measures were extracted for subjects that completed 14 of 16 sessions of BIG. 93 of these subjects had records of pre and post-test Timed Up and Go, Timed Up and Go Motor, and Timed Up and Go Cognitive scores. Average age was 68.4 years (SD=10.6) and average disease duration was 4.9 years (SD=5.3). [Results] Subjects demonstrated statistically significant improvements for Timed Up and Go (3.3 SD=4.5), Timed Up and Go Motor (4.4 SD=5.8) and Timed Up and Go Cognitive (4.7 SD=5.4). Concurrent motor and cognitive performance remained stable. Dual task cost decreased at a statistically significant level for Timed Up and Go Cognitive (7% SD=31%) but not Motor (4% SD=32%). [Conclusion] These findings suggest that cueing strategies associated with LSVT BIG become internalized and decrease the negative impact of hypokinesia on mobility and cognitive performance while performing two tasks simultaneously in persons with Parkinson's.

Keywords: Dual task; LSVT BIG; Parkinson’s disease.

Figures

Fig. 1.
Fig. 1.
LSVT BIG intervention substantially decreased TUG MOTOR and TUG COG dual task cost in subjects that initially presented with DTC >10%. Note that 24 subjects improved their DTC score to within normal limits.
Fig. 2.
Fig. 2.
Dual task interference is reduced as a result of LSVT BIG intervention. Change scores are z-normalized to eliminate the impact of change score magnitude27).

References

    1. Janssens J, Malfroid K, Nyffeler T, et al. : Application of LSVT BIG intervention to address gait, balance, bed mobility, and dexterity in people with Parkinson disease: a case series. Phys Ther, 2014, 94: 1014–1023.
    1. Millage B, Vesey E, Finkelstein M, et al. : Effect on gait speed, balance, motor symptom rating, and quality of life in those with stage I Parkinson’s disease utilizing LSVT BIG®. Rehabil Res Pract, 2017, 2017: 9871070.
    1. Ebersbach G, Ebersbach A, Edler D, et al. : Comparing exercise in Parkinson’s disease—the Berlin LSVT®BIG study. Mov Disord, 2010, 25: 1902–1908.
    1. Morris ME, Iansek R, Matyas TA, et al. : Stride length regulation in Parkinson’s disease. Normalization strategies and underlying mechanisms. Brain, 1996, 119: 551–568.
    1. Brown LA, de Bruin N, Doan JB, et al. : Novel challenges to gait in Parkinson’s disease: the effect of concurrent music in single- and dual-task contexts. Arch Phys Med Rehabil, 2009, 90: 1578–1583.
    1. de Bruin N, Doan JB, Turnbull G, et al. : Walking with music is a safe and viable tool for gait training in Parkinson’s disease: the effect of a 13-week feasibility study on single and dual task walking. Parkinsons Dis, 2010, 2010: 483530.
    1. Allen NE, Schwarzel AK, Canning CG: Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis, 2013, 2013: 906274.
    1. Kelly VE, Eusterbrock AJ, Shumway-Cook A: A review of dual-task walking deficits in people with Parkinson’s disease: motor and cognitive contributions, mechanisms, and clinical implications. Parkinsons Dis, 2012, 2012: 918719.
    1. Farley BG, Koshland GF: Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res, 2005, 167: 462–467.
    1. Ebersbach G, Grust U, Ebersbach A, et al. : Amplitude-oriented exercise in Parkinson’s disease: a randomized study comparing LSVT-BIG and a short training protocol. J Neural Transm (Vienna), 2015, 122: 253–256.
    1. LSVT BIG Training and Certification Manual LSVT Global Tuscon AZ, 2016.
    1. Fox C, Ebersbach G, Ramig L, et al. : LSVT LOUD and LSVT BIG: behavioral treatment programs for speech and body movement in Parkinson disease. Parkinsons Dis, 2012, 2012: 391946.
    1. Fisher BE, Petzinger GM, Nixon K, et al. : Exercise-induced behavioral recovery and neuroplasticity in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse basal ganglia. J Neurosci Res, 2004, 77: 378–390.
    1. Taub E: Harnessing brain plasticity through behavioral techniques to produce new treatments in neurorehabilitation. Am Psychol, 2004, 59: 692–704.
    1. Kelly VE, Eusterbrock AJ, Shumway-Cook A: The effects of instructions on dual-task walking and cognitive task performance in people with Parkinson’s disease. Parkinsons Dis, 2012, 2012: 671261.
    1. Bloem BR, de Vries NM, Ebersbach G: Nonpharmacological treatments for patients with Parkinson’s disease. Mov Disord, 2015, 30: 1504–1520.
    1. Baker K, Rochester L, Nieuwboer A: The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson’s disease. Arch Phys Med Rehabil, 2007, 88: 1593–1600.
    1. Mak MK, Yu L, Hui-Chan CW: The immediate effect of a novel audio-visual cueing strategy (simulated traffic lights) on dual-task walking in people with Parkinson’s disease. Eur J Phys Rehabil Med, 2013, 49: 153–159.
    1. Mirelman A, Maidan I, Herman T, et al. : Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson’s disease? J Gerontol A Biol Sci Med Sci, 2011, 66: 234–240.
    1. O’Shea S, Morris ME, Iansek R: Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks. Phys Ther, 2002, 82: 888–897.
    1. Rochester L, Hetherington V, Jones D, et al. : The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease. Arch Phys Med Rehabil, 2005, 86: 999–1006.
    1. Huang SL, Hsieh CL, Wu RM, et al. : Minimal detectable change of the timed “up & go” test and the dynamic gait index in people with Parkinson disease. Phys Ther, 2011, 91: 114–121.
    1. Morris S, Morris ME, Iansek R: Reliability of measurements obtained with the Timed “Up & Go” test in people with Parkinson disease. Phys Ther, 2001, 81: 810–818.
    1. Steffen T, Seney M: Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther, 2008, 88: 733–746.
    1. Podsiadlo D, Richardson S: The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 1991, 39: 142–148.
    1. Hofheinz M, Mibs M: The prognostic validity of the Timed Up and Go Test with a dual task for predicting the risk of falls in the elderly. Gerontol Geriatr Med, 2016, 2: 2333721416637798.
    1. Nocera JR, Stegemöller EL, Malaty IA, et al. National Parkinson Foundation Quality Improvement Initiative Investigators: Using the Timed Up & Go test in a clinical setting to predict falling in Parkinson’s disease. Arch Phys Med Rehabil, 2013, 94: 1300–1305.
    1. Lundin-Olsson L, Nyberg L, Gustafson Y: Attention, frailty, and falls: the effect of a manual task on basic mobility. J Am Geriatr Soc, 1998, 46: 758–761.
    1. Maranhão-Filho PA, Maranhão ET, Lima MA, et al. : Rethinking the neurological examination II: dynamic balance assessment. Arq Neuropsiquiatr, 2011, 69: 959–963.
    1. Lima LC, Ansai JH, Andrade LP, et al. : The relationship between dual-task and cognitive performance among elderly participants who exercise regularly. Braz J Phys Ther, 2015, 19: 159–166.
    1. Barbosa JM, Prates BS, Concalves CF, et al. : Efeito da realizacao simultanea de tarefas cognitivas e motoras no desempenho functional de idosos da comunidade. Fisioter Pesqui, 2008, 15: 374–379.
    1. Shumway-Cook A, Brauer S, Woollacott M: Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther, 2000, 80: 896–903.
    1. Verhaeghen P, Cerella J: Aging, executive control, and attention: a review of meta-analyses. Neurosci Biobehav Rev, 2002, 26: 849–857.
    1. Plummer P, Eskes G: Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Front Hum Neurosci, 2015, 9: 225.
    1. Montero-Odasso M, Muir SW, Speechley M: Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Arch Phys Med Rehabil, 2012, 93: 293–299.
    1. Wajda DA, Motl RW, Sosnoff JJ: Dual task cost of walking is related to fall risk in persons with multiple sclerosis. J Neurol Sci, 2013, 335: 160–163.
    1. Ueno T, Sasaki M, Nishijima H, et al. : LSVT-BIG improves UPDRS III scores at 4 weeks in Parkinson’s disease patients with wearing off: a prospective, Open-Label study. Parkinsons Dis, 2017, 2017: 8130140.
    1. Dal Bello-Haas V, Klassen L, Sheppard MS, et al. : Psychometric properties of activity, self-efficacy, and quality-of-life measures in individuals with Parkinson disease. Physiother Can, 2011, 63: 47–57.
    1. Nieuwboer A, Kwakkel G, Rochester L, et al. : Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. J Neurol Neurosurg Psychiatry, 2007, 78: 134–140.
    1. Campbell CM, Rowse JL, Ciol MA, et al. : The effect of cognitive demand on Timed Up and Go performance in older adults with and without Parkinson disease. J Neurol Phys Ther, 2003, 27: 2–7.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe