Objective: To investigate the combined effects of visual and auditory cues on gait initiation and to investigate the correlation between the clinical rates of gait disturbances and the parameters of gait initiation in sound-triggered gait initiation in Parkinson’s disease (PD).

Background: Gait disturbance is one of cardinal symptoms in Parkinson’s disease (PD) which significantly degrades the quality of life. Cues of various modality can resolve freezing of gait and are adopted for rehabilitation of walking in PD.

Methods: We studied 8 PD patients with gait disturbances (2 men and 3 women, aged 50-72 years) and 8 age-matched normal controls (NC). The general gait disturbance and freezing of gait (FOG) were rated by UPDRS Part III, item 29 and Part II, item 14, respectively. The subjects stood on a line and were instructed to take three steps after a Go signal (a short beep of 100msec duration), which followed a vocal warning. They were instructed to "walk normally" without hurrying to take the initial step. The gait initiation time and the initial step length were measured using an ultrasonic device. The following conditions were compared: 1) Go signal, 2) Go signal + beep (> 2 sec duration), 3) Go signal + LED line 15cm in front of the toes and 4) Go signal + beep + LED line. A beep and an LED line appeared simultaneously with a Go signal, and the subjects were asked not to step on the LED line.

Results: Under the Go signal condition, the gait initiation time was longer in the PD group than in the NC group, but the difference was not significant. The initial step length was significantly smaller in the PD group than in the NC group. The gait initiation time did not change under the beeping condition, but it became shorter with an LED line. The initial step length also became longer with an LED line, but it did not change with the beeping sound. There was a tendency toward a negative correlation between the initial step length and the clinical rates of gait disturbances and FOG.

Conclusions: The gait initiation time was delayed and the initial step length was smaller in patients with PD than in normal subjects on sound-triggered gait initiation. The step initiation became easier when visual cueing was superimposed, but not when auditory cueing was enforced. Initial step length is one of the markers reflecting the severity of general gait disturbances and FOG in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/combined-effects-of-visual-and-auditory-cues-on-gait-initiation-in-parkinsons-disease/