Physiotherapy - Theses
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ItemPeople with Parkinson's disease should avoid performing dual-tasks while walking: myth or reality?( 2009)Traditionally, people with Parkinson’s disease (PD) are advised to avoid performing dual-tasks while walking. Rehabilitation programs also emphasise the need to train walking under single-task conditions to improve gait and reduce risk for falls. There are findings that people with PD can walk faster and with longer strides while performing a secondary motor or cognitive task, when cued by a metronome or visual floor stripes. There are also findings that people with PD can walk faster and with longer strides while performing a secondary motor task simply by prioritising their attention to take big steps. Using attention is a convenient strategy favoured by people with PD to manage their gait difficulties. This thesis examined the immediate and training effects of two attention-priority strategies on dual-cognitive task walking in people with mild to moderate PD. Two groups of participants received 30 minutes of training to prioritise attention to take big steps while performing serial three subtractions (gait-priority strategy) or to divide their attention between taking big steps and the cognitive task (equal-priority strategy). Control groups received no training. Measures of gait hypo-bradykinesia (stride length and gait velocity), stride variability (Coefficient of variation [CV] of stride length and CV of stride time) and cognitive task performance (accurate enumeration rate) were assessed at baseline, during training, immediately after training and 30 minutes after training. Both attention-priority strategies improved stride length and gait velocity during training. The improvement was retained for at least 30 minutes after training. Both strategies have no effect on CVs of stride length, stride time and accurate enumeration rate. Many daily routines require our ability to overcome single-, dual- and multi-task demands while walking. Rehabilitation strategies should encompass real life demands in order to minimise functional impairments, activity limitations and participation restrictions, as recommended by the World Health Organisation. Putting together the findings of this thesis and the evidence provided by previous studies, it is concluded that traditional recommendations need qualification. Avoiding dual-tasks during walking or gait retraining in people with mild to moderate PD may not be necessary. Gait-priority and equal-priority strategies can be used as compensatory strategies to improve gait during dual-tasks. The two strategies can also be used in training programs for walking rehabilitation.