A Case-Controlled Pilot Study on Rhythmic Auditory Stimulation-Assisted Gait Training and Conventional Physiotherapy in Patients With Parkinson's Disease Submitted to Deep Brain Stimulation

Antonino Naro, Loris Pignolo, Chiara Sorbera, Desiree Latella, Luana Billeri, Alfredo Manuli, Simona Portaro, Daniele Bruschetta, Rocco Salvatore Calabrò, Antonino Naro, Loris Pignolo, Chiara Sorbera, Desiree Latella, Luana Billeri, Alfredo Manuli, Simona Portaro, Daniele Bruschetta, Rocco Salvatore Calabrò

Abstract

Deep brain stimulation (DBS) is indicated when motor disturbances in patients with idiopathic Parkinson's disease (PD) are refractory to current treatment options and significantly impair quality of life. However, post-DBS rehabilitation is essential, with particular regard to gait. Rhythmic auditory stimulation (RAS)-assisted treadmill gait rehabilitation within conventional physiotherapy program plays a major role in gait recovery. We explored the effects of a monthly RAS-assisted treadmill training within a conventional physiotherapy program on gait performance and gait-related EEG dynamics (while walking on the RAS-aided treadmill) in PD patients with (n = 10) and without DBS (n = 10). Patients with DBS achieved superior results than those without DBS concerning gait velocity, overall motor performance, and the timed velocity and self-confidence in balance, sit-to-stand (and vice versa) and walking, whereas both groups improved in dynamic and static balance, overall cognitive performance, and the fear of falling. The difference in motor outcomes between the two groups was paralleled by a stronger remodulation of gait cycle-related beta oscillations in patients with DBS as compared to those without DBS. Our work suggests that RAS-assisted gait training plus conventional physiotherapy is a useful strategy to improve gait performance in PD patients with and without DBS. Interestingly, patients with DBS may benefit more from this approach owing to a more focused and dynamic re-configuration of sensorimotor network beta oscillations related to gait secondary to the association between RAS-treadmill, conventional physiotherapy, and DBS. Actually, the coupling of these approaches may help restoring a residually altered beta-band response profile despite DBS intervention, thus better tailoring the gait rehabilitation of these PD patients.

Keywords: beta oscillations; deep brain stimulation (DBS); idiopathic Parkinson's disease (iPD); rhythmic auditory stimulation (RAS); treadmill gait training.

Copyright © 2020 Naro, Pignolo, Sorbera, Latella, Billeri, Manuli, Portaro, Bruschetta and Calabrò.

Figures

Figure 1
Figure 1
The Event–Related Spectral Perturbation (ERSP) plots relative to the full gait cycle showing the average changes in spectral power during the gait cycle for the different electrode groups (brain areas). The horizontal axis is the percentage of gait cycle (as we performed a time–warping analysis) referred to the heel strikes (HS) and the toe offs (TO). *denotes post-pre significant changes (p < 0.001), #between-group post-pre significant differences (p < 0.001).
Figure 2
Figure 2
Correlation plot between beta power pre-post percent changes within motor programming ROI and pre-post percent improvement in 10-meter walking test (10 MWT).

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