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Investigating Therapies for Freezing of Gait

maanantai 24. huhtikuuta 2017 päivittänyt: Rebecca Chow, Sun Life Financial Movement Disorders Research and Rehabilitation Centre

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

Freezing of gait (FOG) is arguably one of the most debilitating motor symptoms experienced by individuals with Parkinson's disease (PD). FOG may be caused by an overload of cognitive, limbic, and sensorimotor system activity in the basal ganglia. Therefore, the purpose of this study is to evaluate cognitive, limbic, and sensorimotor therapies in individuals with FOG. Participants in this study will undergo all three types of treatments in a randomized counterbalanced order. Each treatment will occur in 1 hour sessions, twice weekly for a period of 4 weeks.

Tutkimuksen yleiskatsaus

Tila

Tuntematon

Ehdot

Interventio / Hoito

Yksityiskohtainen kuvaus

Freezing of gait (FOG) is arguably one of the most debilitating motor symptoms experienced by individuals with Parkinson's disease (PD), and negatively impacts quality of life (Walton et al., 2015). Furthermore, advanced FOG does not respond well to treatments commonly used in Parkinson's disease (Nutt et al., 2011), therefore warranting the use of adjunct treatment options. The development of potential treatment strategies for FOG should focus on the underlying mechanism. The cross-talk model of FOG proposes that FOG may be caused by an overload of cognitive, limbic, and sensorimotor system activity in the basal ganglia, resulting in a depletion of dopaminergic resources, leading to FOG (Lewis & Barker, 2009). Hence, based on the cross-talk model, treatments targeting the cognitive, sensorimotor and limbic systems independently may lead to a reduction in FOG episodes. Previous studies have demonstrated the efficacy of therapies targeting these domains in PD and healthy individuals, however, these have yet to be explored in FOG. Therefore, the purpose of this study is to evaluate cognitive, sensorimotor, and limbic therapies in individuals with FOG.

This study will employ a within-subjects design, in which participants will undergo all three treatments in a randomized counterbalanced order. Sessions for each type of treatment will occur for 1 hour, twice weekly for a period of 4 weeks. Participants will also undergo pre- and post-test assessments prior to and following each 4-week treatment period. The cognitive training will utilize the "Smartbrain Pro" computer software, which has previously demonstrated efficacy in individuals with Parkinson's disease (Paris et al., 2011). The sensorimotor training group will participate in proprioceptive training of the upper and lower limbs. This training will entail a target matching task, in which participants will produce active and self-defined movements while blindfolded (i.e. without visual feedback). The limbic training group will undergo cognitive behavioural therapy (CBT) focusing solely on anxiety symptoms.

Opintotyyppi

Interventio

Ilmoittautuminen (Todellinen)

17

Vaihe

  • Ei sovellettavissa

Yhteystiedot ja paikat

Tässä osiossa on tutkimuksen suorittajien yhteystiedot ja tiedot siitä, missä tämä tutkimus suoritetaan.

Opiskelupaikat

  • Kanada
    • Ontario
      • Waterloo, Ontario, Kanada, N2L 3C5
        • Sun Life Financial Movement Disorders Research and Rehabilitation Centre

Osallistumiskriteerit

Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.

Kelpoisuusvaatimukset

Opintokelpoiset iät

  • Lapsi
  • Aikuinen
  • Vanhempi Aikuinen

Hyväksyy terveitä vapaaehtoisia

Ei

Sukupuolet, jotka voivat opiskella

Kaikki

Kuvaus

Inclusion Criteria:

  • Either gender
  • Diagnosed with idiopathic PD by a Neurologist
  • Self-reported FOG with the use of UPDRS-II (Question 14)
  • Confirmation of present FOG by a movement disorder specialist
  • Able to walk 10 meters, unassisted
  • Able to understand English instructions

Exclusion Criteria:

  • A neurological disease other than PD
  • Peripheral neuropathy
  • Clinically diagnosed with dementia

Opintosuunnitelma

Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.

Miten tutkimus on suunniteltu?

Suunnittelun yksityiskohdat

  • Ensisijainen käyttötarkoitus: Hoito
  • Jako: Satunnaistettu
  • Inventiomalli: Crossover-tehtävä
  • Naamiointi: Yksittäinen

Aseet ja interventiot

Osallistujaryhmä / Arm
Interventio / Hoito
Kokeellinen: Cognitive Training
Participants will independently complete cognitive exercises on the "Smartbrain Pro" computer software. These exercises aim to train different aspects of executive function. The difficulty level of each exercise will increase relative to each participant's progress. Sessions will last for one hour, occurring twice weekly for a period of 4 weeks.
Käyttäytyminen: Cognitive Training
Training the cognitive domain may be accomplished by training various cognitive and executive functions with guided practice focusing on specific skills (e.g. visuospatial processing, executive function, memory, language, and attention). Cognitive training has been demonstrated to be efficacious in several studies in individuals with PD. Given the potential cognitive contribution to FOG episodes, this type of therapy may alleviate FOG by potentially improving upon planning, set-shifting, and/or response inhibition.
Kokeellinen: Cognitive Behavioural Therapy
Participants will undergo one-on-one sessions of cognitive-behavioural therapy (CBT) working with a therapist to establish an individualized CBT plan which will focus on symptoms of anxiety. Participants will complete a total of eight one-hour sessions over 4 weeks.
Käyttäytyminen: Cognitive Behavioural Therapy
CBT has been demonstrated to be effective in the remediation of anxiety in individuals with PD. This may be beneficial to individuals experiencing FOG, given the evidence that anxiety may provoke FOG. During periods of elevated anxiety (e.g. walking in a threatening environment), freezers will be able to more efficiently process this limbic load resulting in greater resources available for movement control.
Kokeellinen: Proprioceptive Training
Participants will complete one-on-one sessions a target matching proprioceptive training protocol using their upper and lower limbs. For the upper limb target-reaching task, participants will be seated in front of a surface marked with ten targets. They will first visualize a specified target, then blindfolded and asked to reach towards that target with the blindfold on. The blindfold will then be removed allowing participants to view their performance relative to the target. This task will be repeated for the remaining targets on both sides and for both upper and lower limbs. Participants will complete a total of eight one-hour sessions over 4 weeks.
Käyttäytyminen: Proprioceptive Training
Currently, studies investigating proprioceptive training as a treatment in PD are limited. However, this type of training has potential by improving proprioceptive processing. It would be expected that due to this training, when sensorimotor processing is challenged during locomotion (e.g. by removing visual feedback and preventing compensation of proprioception deficits), freezers would experience less decrements to gait due to an enhanced ability to process sensorimotor demands.

Mitä tutkimuksessa mitataan?

Ensisijaiset tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Gait Assessment
Aikaikkuna: Change from Baseline at 4 weeks of first treatment phase
Participants will walk approximately 9.75 metres for 12 trials. Recording of kinematic data will be done with eight Optotrak® cameras (Northern Digital, NDI, Waterloo, Ontario). Spatiotemporal gait parameters will be analyzed from this assessment.
Change from Baseline at 4 weeks of first treatment phase
Gait Assessment
Aikaikkuna: Change from Baseline at 4 weeks of second treatment phase
Participants will walk approximately 9.75 metres for 12 trials. Recording of kinematic data will be done with eight Optotrak® cameras (Northern Digital, NDI, Waterloo, Ontario). Spatiotemporal gait parameters will be analyzed from this assessment.
Change from Baseline at 4 weeks of second treatment phase
Gait Assessment
Aikaikkuna: Change from Baseline at 4 weeks of third treatment phase
Participants will walk approximately 9.75 metres for 12 trials. Recording of kinematic data will be done with eight Optotrak® cameras (Northern Digital, NDI, Waterloo, Ontario). Spatiotemporal gait parameters will be analyzed from this assessment.
Change from Baseline at 4 weeks of third treatment phase

Toissijaiset tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Stroop Test
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of first treatment phase
This test assesses inhibitory control and will be administered in a paper-based format.
Pre-intervention and Post-intervention at week 4 of first treatment phase
Trail-making test
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of first treatment phase
This will also be administered in a paper-based format. This test will assess visuospatial function and set-shifting ability.
Pre-intervention and Post-intervention at week 4 of first treatment phase
Stroop Test
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of second treatment phase
This test assesses inhibitory control and will be administered in a paper-based format.
Pre-intervention and Post-intervention at week 4 of second treatment phase
Trail-making test
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of second treatment phase
This will also be administered in a paper-based format. This test will assess visuospatial function and set-shifting ability.
Pre-intervention and Post-intervention at week 4 of second treatment phase
Stroop Test
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of third treatment phase
This test assesses inhibitory control and will be administered in a paper-based format.
Pre-intervention and Post-intervention at week 4 of third treatment phase
Trail-making test
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of third treatment phase
This will also be administered in a paper-based format. This test will assess visuospatial function and set-shifting ability.
Pre-intervention and Post-intervention at week 4 of third treatment phase
Passive Joint Angle Matching
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of first treatment phase
This task will be assessed in order to evaluate proprioceptive functioning.
Pre-intervention and Post-intervention at week 4 of first treatment phase
Passive Joint Angle Matching
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of second treatment phase
This task will be assessed in order to evaluate proprioceptive functioning.
Pre-intervention and Post-intervention at week 4 of second treatment phase
Passive Joint Angle Matching
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of third treatment phase
This task will be assessed in order to evaluate proprioceptive functioning.
Pre-intervention and Post-intervention at week 4 of third treatment phase
Parkinson Anxiety Scale
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of first treatment phase
The Parkinson Anxiety Scale (PAS), which is a self-report questionnaire used to assess anxiety levels, will be administered to participants. This tool has demonstrated good concurrent validity in individuals with PD against other existing anxiety scales (Leentjens et al., 2014).
Pre-intervention and Post-intervention at week 4 of first treatment phase
Parkinson Anxiety Scale
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of second treatment phase
The Parkinson Anxiety Scale (PAS), which is a self-report questionnaire used to assess anxiety levels, will be administered to participants. This tool has demonstrated good concurrent validity in individuals with PD against other existing anxiety scales (Leentjens et al., 2014).
Pre-intervention and Post-intervention at week 4 of second treatment phase
Parkinson Anxiety Scale
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of third treatment phase
The Parkinson Anxiety Scale (PAS), which is a self-report questionnaire used to assess anxiety levels, will be administered to participants. This tool has demonstrated good concurrent validity in individuals with PD against other existing anxiety scales (Leentjens et al., 2014).
Pre-intervention and Post-intervention at week 4 of third treatment phase
Unified Parkinson's disease Rating Scale Motor Subsection (UPDRS-III)
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of first treatment phase
A clinician administered assessment which evaluates individuals' motor symptom severity
Pre-intervention and Post-intervention at week 4 of first treatment phase
Unified Parkinson's disease Rating Scale Motor Subsection (UPDRS-III)
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of second treatment phase
A clinician administered assessment which evaluates individuals' motor symptom severity
Pre-intervention and Post-intervention at week 4 of second treatment phase
Unified Parkinson's disease Rating Scale Motor Subsection (UPDRS-III)
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of third treatment phase
A clinician administered assessment which evaluates individuals' motor symptom severity
Pre-intervention and Post-intervention at week 4 of third treatment phase
New Freezing of Gait Questionnaire (NFOGQ)
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of first treatment phase
Participants will be asked to complete the New Freezing of Gait Questionnaire (NFOGQ) questionnaire developed by Nieuwboer and colleagues (2009). This provides a self-reported measure of frequency and duration of FOG episodes. This tool has been validated and proven to be highly reliable in individuals with PD, as well as assessing treatment interventions for FOG.
Pre-intervention and Post-intervention at week 4 of first treatment phase
New Freezing of Gait Questionnaire (NFOGQ)
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of second treatment phase
Participants will be asked to complete the New Freezing of Gait Questionnaire (NFOGQ) questionnaire developed by Nieuwboer and colleagues (2009). This provides a self-reported measure of frequency and duration of FOG episodes. This tool has been validated and proven to be highly reliable in individuals with PD, as well as assessing treatment interventions for FOG.
Pre-intervention and Post-intervention at week 4 of second treatment phase
New Freezing of Gait Questionnaire (NFOGQ)
Aikaikkuna: Pre-intervention and Post-intervention at week 4 of third treatment phase
Participants will be asked to complete the New Freezing of Gait Questionnaire (NFOGQ) questionnaire developed by Nieuwboer and colleagues (2009). This provides a self-reported measure of frequency and duration of FOG episodes. This tool has been validated and proven to be highly reliable in individuals with PD, as well as assessing treatment interventions for FOG.
Pre-intervention and Post-intervention at week 4 of third treatment phase

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Sponsori

Sun Life Financial Movement Disorders Research and Rehabilitation Centre

Tutkijat

  • Päätutkija: Rebecca Chow, BSc, Sun Life Financial Movement Disorders Research and Rehabilitation Centre

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