Objective: 1. to compare the effects of compensatory strategies on the duration of attentive engagement during 10 min. walking, 2. to test associations between person’s cognitive function and the duration of attentive engagement during 10 min. walking in each compensatory strategy, and 3. to compare the effects of the compensatory strategies on gait during 10 min.

Background: People with Parkinson’s disease (PwP) can use compensatory strategies including cueing and cognitive movement strategies to improve their gait. However, it is not clear whether PwP can sustain their attention and engage in these strategies for prolonged periods, as in many cases is required in daily living.

Method: Eleven PwP walked for 10 minutes under 1) usual walking, 2) while using an external cue and 3) while using a cognitive movement strategy. Attention and gait outcomes were extracted from a single-channel EEG and accelerometer recordings, respectively. Cognitive function was assessed using computerized neuropsychological battery. Main outcome measures: 1. the % of Brain Engagement Index (BEI) signals within the attentive engagement range (0.3-0.7) and 2. Gait speed, cadence, swing time, and stride length.3) BEI data were divided into two-minute blocks and analyzed using mixed-model repeated-measures ANOVA. Gait parameters were compared by repeated measures ANOVA.

Results: Significant time and time X condition effects were found in the BEI analysis (F_(4,167) = 5.1, p < .001; F_(9,167) = 3.26, p = .001). Post-hoc analysis showed that in the cognitive-movement strategy condition, but not in the baseline and external-cues conditions, the % of BEI signals within the attentive engagement range decreased after two minutes of walking, and this decrease persisted until walking ended. Global cognitive and information processing scores were significantly associated with the % of BEI signal within the attentive engagement range in the cognitive-movement strategy condition only. Significant condition effects were found for all gait parameters.

Conclusion: Cognitive-movement strategy has positive effects on gait but it may impose a higher attentional load that results in a decline in attentive engagement, relative to walking with external cues.  Furthermore, persons with higher cognitive function maintain attentive engagement during prolonged walking.  Cognitive movement strategies’ depend on the availability of cognitive and attentional resources.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/attending-to-compensatory-strategies-during-prolonged-walking-in-parkinson-disease-a-pilot-study/