Investigating Therapies for Freezing of Gait Targeting the Cognitive, Limbic, and Sensorimotor Domains

Rebecca Chow, Bryan P Tripp, Daniel Rzondzinski, Quincy J Almeida, Rebecca Chow, Bryan P Tripp, Daniel Rzondzinski, Quincy J Almeida

Abstract

Background: Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson's disease (PD), but treatments are extremely limited due to our poor understanding of the underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively.

Objective: To investigate whether these 3 treatments could improve functional outcomes of FOG.

Methods: In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged.

Results: FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions.

Conclusions: The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).

Keywords: Parkinson’s disease; anxiety; cognitive function; freezing of gait; proprioception.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Total frequency (A) and duration (B) of freezing of gait (FOG) episodes in all gait assessment conditions at pre and post cognitive training, proprioceptive training, and cognitive behavioral therapy (CBT) interventions. Post hoc Wilcoxon signed-rank tests also showed certain statistically significant pairwise differences (P < .05), marked with *, **, a, and b. However, these comparisons were across different test conditions, so they are not clinically meaningful. None of the pre-post differences in individual test conditions was significant.

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