【論文摘要】Effects of Attentional Focus Strategies on Dual-task Walking Training in Parkinson's Disease With Freezing of Gait

【論文摘要】注意力聚焦策略對具凍凝步態巴金森患者於雙重作業行走訓練之影響

張靜琳(Ching-Lin Chang) ； 許晨星(Chen-Hsing Sheu) ； 吳瑞美(Ruey-Meei Wu) ； 黃正雅(Cheng-Ya Huang)

《物理治療》 46卷2期 (2021/06) Pp. 96-97

https://doi.org/10.6215/FJPT.202106.O03

摘要

Background and Purpose: Freezing of gait (FOG) is one kind of gait impairments specific to patients with Parkinson disease (PD), and it is often triggered in dual-task conditions. Attentional focus strategies include internal focus (IF) and external focus (EF). The IF strategy means that attention is focused on body movements, and the EF strategy means that attention is focused on movement effects. Most previous studies proposed that EF strategy led to better postural stability because it would enhance movement automaticity. However, how the attentional focus strategies influence dual-task walking training hasn't been investigated, especially in PD with FOG. Therefore, this study aimed to compare effects of IF and EF strategies on dual-task walking training in PD with FOG. Methods: Thirty-four PD patients with FOG were recruited in this study and randomized to the IF group or the EF group for 6-week dual-task walking training. During dual-task walking training, IF group was instructed to focus on their body movements, while EF group needed to focus on the effects of movements. Dual-task walking (e.g. walking and carrying a tray) performance were evaluated before the start of intervention (pre-test) and after the end of intervention (post-test) under both ON and OFF medication states. Besides, the numbers of FOG and fall were also recorded for 2 weeks before and after the training. Results: After the training, both IF and EF groups increased gait velocity and step length in dual-task walking under ON medication state. However, the EF group had higher cadence at posttest than the IF group. Under OFF medication state, only the IF group increased step length and decreased gait variability after the training. On the other hand, although both groups decreased the occurrence of FOG and fall, more percentage of participants in the IF group showed the improvement (FOG: p = 0.043; fall: p = 0.037). Conclusion: Both IF and EF strategies improved dual-task walking control in PD with FOG under ON medication state. However, only the IF strategy could transfer the training effects to OFF medication state. Clinical Relevance: Our results suggested that IF strategy was an effective learning strategy to improve dual-task walking control under both ON and OFF medication states, especially for PD with FOG. Furthermore, IF strategy could reduce the risk of falling due to decreased FOG and fall episodes in their daily life.