Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues
Identifieur interne : 002415 ( Main/Corpus ); précédent : 002414; suivant : 002416Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues
Auteurs : Lynn Rochester ; Katherine Baker ; Alice Nieuwboer ; David BurnSource :
- Movement Disorders [ 0885-3185 ] ; 2011-02-15.
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- KwdEn :
Abstract
Background:: Independence of certain gait characteristics from dopamine replacement therapies highlights its complex pathophysiology in Parkinson's disease (PD). We explored the effect of two different cue strategies on gait characteristics in relation to their response to dopaminergic medications. Patients and Methods:: Fifty people with PD (age 69.22 ± 6.6 years) were studied. Participants walked with and without cues presented in a randomized order. Cue strategies were: (1) internal cue (attention to increase step length) and (2) external cue (auditory cue with instruction to take large step to the beat). Testing was carried out two times at home (on and off medication). Gait was measured using a Stride Analyzer (B&L Engineering). Gait outcomes were walking speed, stride length, step frequency, and coefficient of variation (CV) of stride time and double limb support duration (DLS). Results:: Walking speed, stride length, and stride time CV improved on dopaminergic medications, whereas step frequency and DLS CV did not. Internal and external cues increased stride time and walking speed (on and off dopaminergic medications). Only the external cue significantly improved stride time CV and DLS CV, whereas the internal cue had no effect (on and off dopaminergic medications). Conclusions:: Internal and external cues selectively modify gait characteristics in relation to the type of gait disturbance and its dopa‐responsiveness. Although internal (attention) and external cues target dopaminergic gait dysfunction (stride length), only external cues target stride to stride fluctuations in gait. Despite an overlap with dopaminergic pathways, external cues may effectively address nondopaminergic gait dysfunction and potentially increase mobility and reduce gait instability and falls. © 2010 Movement Disorder Society
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DOI: 10.1002/mds.23450
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues</title><author><name sortKey="Rochester, Lynn" sort="Rochester, Lynn" uniqKey="Rochester L" first="Lynn" last="Rochester">Lynn Rochester</name><affiliation><mods:affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Baker, Katherine" sort="Baker, Katherine" uniqKey="Baker K" first="Katherine" last="Baker">Katherine Baker</name><affiliation><mods:affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Nieuwboer, Alice" sort="Nieuwboer, Alice" uniqKey="Nieuwboer A" first="Alice" last="Nieuwboer">Alice Nieuwboer</name><affiliation><mods:affiliation>Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Burn, David" sort="Burn, David" uniqKey="Burn D" first="David" last="Burn">David Burn</name><affiliation><mods:affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:CD906250882BD7CBEE75696ACB8E657735DED4CE</idno><date when="2011" year="2011">2011</date><idno type="doi">10.1002/mds.23450</idno><idno type="url">https://api.istex.fr/document/CD906250882BD7CBEE75696ACB8E657735DED4CE/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">002415</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues</title><author><name sortKey="Rochester, Lynn" sort="Rochester, Lynn" uniqKey="Rochester L" first="Lynn" last="Rochester">Lynn Rochester</name><affiliation><mods:affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Baker, Katherine" sort="Baker, Katherine" uniqKey="Baker K" first="Katherine" last="Baker">Katherine Baker</name><affiliation><mods:affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Nieuwboer, Alice" sort="Nieuwboer, Alice" uniqKey="Nieuwboer A" first="Alice" last="Nieuwboer">Alice Nieuwboer</name><affiliation><mods:affiliation>Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Burn, David" sort="Burn, David" uniqKey="Burn D" first="David" last="Burn">David Burn</name><affiliation><mods:affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-02-15">2011-02-15</date><biblScope unit="volume">26</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="430">430</biblScope><biblScope unit="page" to="435">435</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">CD906250882BD7CBEE75696ACB8E657735DED4CE</idno><idno type="DOI">10.1002/mds.23450</idno><idno type="ArticleID">MDS23450</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>attentional strategies</term><term>dopaminergic medications</term><term>dopa‐resistant</term><term>external cues</term><term>gait</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background:: Independence of certain gait characteristics from dopamine replacement therapies highlights its complex pathophysiology in Parkinson's disease (PD). We explored the effect of two different cue strategies on gait characteristics in relation to their response to dopaminergic medications. Patients and Methods:: Fifty people with PD (age 69.22 ± 6.6 years) were studied. Participants walked with and without cues presented in a randomized order. Cue strategies were: (1) internal cue (attention to increase step length) and (2) external cue (auditory cue with instruction to take large step to the beat). Testing was carried out two times at home (on and off medication). Gait was measured using a Stride Analyzer (B&L Engineering). Gait outcomes were walking speed, stride length, step frequency, and coefficient of variation (CV) of stride time and double limb support duration (DLS). Results:: Walking speed, stride length, and stride time CV improved on dopaminergic medications, whereas step frequency and DLS CV did not. Internal and external cues increased stride time and walking speed (on and off dopaminergic medications). Only the external cue significantly improved stride time CV and DLS CV, whereas the internal cue had no effect (on and off dopaminergic medications). Conclusions:: Internal and external cues selectively modify gait characteristics in relation to the type of gait disturbance and its dopa‐responsiveness. Although internal (attention) and external cues target dopaminergic gait dysfunction (stride length), only external cues target stride to stride fluctuations in gait. Despite an overlap with dopaminergic pathways, external cues may effectively address nondopaminergic gait dysfunction and potentially increase mobility and reduce gait instability and falls. © 2010 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Lynn Rochester PhD</name><affiliations><json:string>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</json:string><json:string>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</json:string></affiliations></json:item><json:item><name>Katherine Baker PhD</name><affiliations><json:string>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</json:string></affiliations></json:item><json:item><name>Alice Nieuwboer PhD</name><affiliations><json:string>Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium</json:string></affiliations></json:item><json:item><name>David Burn MD</name><affiliations><json:string>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>attentional strategies</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>external cues</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gait</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>dopaminergic medications</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>dopa‐resistant</value></json:item></subject><articleId><json:string>MDS23450</json:string></articleId><language><json:string>eng</json:string></language><abstract>Background:: Independence of certain gait characteristics from dopamine replacement therapies highlights its complex pathophysiology in Parkinson's disease (PD). We explored the effect of two different cue strategies on gait characteristics in relation to their response to dopaminergic medications. Patients and Methods:: Fifty people with PD (age 69.22 ± 6.6 years) were studied. Participants walked with and without cues presented in a randomized order. Cue strategies were: (1) internal cue (attention to increase step length) and (2) external cue (auditory cue with instruction to take large step to the beat). Testing was carried out two times at home (on and off medication). Gait was measured using a Stride Analyzer (B&L Engineering). Gait outcomes were walking speed, stride length, step frequency, and coefficient of variation (CV) of stride time and double limb support duration (DLS). Results:: Walking speed, stride length, and stride time CV improved on dopaminergic medications, whereas step frequency and DLS CV did not. Internal and external cues increased stride time and walking speed (on and off dopaminergic medications). Only the external cue significantly improved stride time CV and DLS CV, whereas the internal cue had no effect (on and off dopaminergic medications). Conclusions:: Internal and external cues selectively modify gait characteristics in relation to the type of gait disturbance and its dopa‐responsiveness. Although internal (attention) and external cues target dopaminergic gait dysfunction (stride length), only external cues target stride to stride fluctuations in gait. Despite an overlap with dopaminergic pathways, external cues may effectively address nondopaminergic gait dysfunction and potentially increase mobility and reduce gait instability and falls. © 2010 Movement Disorder Society</abstract><qualityIndicators><score>6.801</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 810 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>6</keywordCount><abstractCharCount>1838</abstractCharCount><pdfWordCount>3801</pdfWordCount><pdfCharCount>24992</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>264</abstractWordCount></qualityIndicators><title>Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues</title><genre><json:string>article</json:string></genre><host><volume>26</volume><publisherId><json:string>MDS</json:string></publisherId><pages><total>6</total><last>435</last><first>430</first></pages><issn><json:string>0885-3185</json:string></issn><issue>3</issue><subject><json:item><value>Research Article</value></json:item></subject><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1531-8257</json:string></eissn><title>Movement Disorders</title><doi><json:string>10.1002/(ISSN)1531-8257</json:string></doi></host><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1002/mds.23450</json:string></doi><id>CD906250882BD7CBEE75696ACB8E657735DED4CE</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/CD906250882BD7CBEE75696ACB8E657735DED4CE/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/CD906250882BD7CBEE75696ACB8E657735DED4CE/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/CD906250882BD7CBEE75696ACB8E657735DED4CE/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>WILEY</p></availability><date>2011</date></publicationStmt><notesStmt><note type="content">*Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles may be found in the online version of this article.</note><note>Parkinson's UK - No. 0510;</note><note>UK NIHR Biomedical Research Centre for Ageing and Age‐Related Disease award to the Newcastle upon Tyne Hospitals NHS Foundation Trust</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues</title><author><persName><forename type="first">Lynn</forename><surname>Rochester</surname></persName><roleName type="degree">PhD</roleName><note type="correspondence"><p>Correspondence: Clinical Ageing Research Unit, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom</p></note><affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</affiliation><affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</affiliation></author><author><persName><forename type="first">Katherine</forename><surname>Baker</surname></persName><roleName type="degree">PhD</roleName><affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</affiliation></author><author><persName><forename type="first">Alice</forename><surname>Nieuwboer</surname></persName><roleName type="degree">PhD</roleName><affiliation>Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium</affiliation></author><author><persName><forename type="first">David</forename><surname>Burn</surname></persName><roleName type="degree">MD</roleName><note type="biography">Balance test scores refer to the number of subjects able to maintain the test for 30 s or more.</note><affiliation>Balance test scores refer to the number of subjects able to maintain the test for 30 s or more.</affiliation><affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-02-15"></date><biblScope unit="volume">26</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="430">430</biblScope><biblScope unit="page" to="435">435</biblScope></imprint></monogr><idno type="istex">CD906250882BD7CBEE75696ACB8E657735DED4CE</idno><idno type="DOI">10.1002/mds.23450</idno><idno type="ArticleID">MDS23450</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background:: Independence of certain gait characteristics from dopamine replacement therapies highlights its complex pathophysiology in Parkinson's disease (PD). We explored the effect of two different cue strategies on gait characteristics in relation to their response to dopaminergic medications. Patients and Methods:: Fifty people with PD (age 69.22 ± 6.6 years) were studied. Participants walked with and without cues presented in a randomized order. Cue strategies were: (1) internal cue (attention to increase step length) and (2) external cue (auditory cue with instruction to take large step to the beat). Testing was carried out two times at home (on and off medication). Gait was measured using a Stride Analyzer (B&L Engineering). Gait outcomes were walking speed, stride length, step frequency, and coefficient of variation (CV) of stride time and double limb support duration (DLS). Results:: Walking speed, stride length, and stride time CV improved on dopaminergic medications, whereas step frequency and DLS CV did not. Internal and external cues increased stride time and walking speed (on and off dopaminergic medications). Only the external cue significantly improved stride time CV and DLS CV, whereas the internal cue had no effect (on and off dopaminergic medications). Conclusions:: Internal and external cues selectively modify gait characteristics in relation to the type of gait disturbance and its dopa‐responsiveness. Although internal (attention) and external cues target dopaminergic gait dysfunction (stride length), only external cues target stride to stride fluctuations in gait. Despite an overlap with dopaminergic pathways, external cues may effectively address nondopaminergic gait dysfunction and potentially increase mobility and reduce gait instability and falls. © 2010 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>attentional strategies</term></item><item><term>external cues</term></item><item><term>gait</term></item><item><term>dopaminergic medications</term></item><item><term>dopa‐resistant</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-05-12">Received</change><change when="2010-09-01">Registration</change><change when="2011-02-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/CD906250882BD7CBEE75696ACB8E657735DED4CE/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. 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href="file:MDS.MDS23450.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="2"></count><count type="referenceTotal" number="34"></count><count type="wordTotal" number="5046"></count></countGroup><titleGroup><title type="main" xml:lang="en">Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues<link href="#fn4"></link></title><title type="short" xml:lang="en">The Influence of Medication on Cues in PD</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1 #af2" corresponding="yes"><personName><givenNames>Lynn</givenNames><familyName>Rochester</familyName><degrees>PhD</degrees></personName><contactDetails><email>lynn.rochester@ncl.ac.uk</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Katherine</givenNames><familyName>Baker</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Alice</givenNames><familyName>Nieuwboer</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1" noteRef="#fn1"><personName><givenNames>David</givenNames><familyName>Burn</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="GB" type="organization"><unparsedAffiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="GB" type="organization"><unparsedAffiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="BE" type="organization"><unparsedAffiliation>Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Parkinson's disease</keyword><keyword xml:id="kwd2">attentional strategies</keyword><keyword xml:id="kwd3">external cues</keyword><keyword xml:id="kwd4">gait</keyword><keyword xml:id="kwd5">dopaminergic medications</keyword><keyword xml:id="kwd6">dopa‐resistant</keyword></keywordGroup><fundingInfo><fundingAgency>Parkinson's UK</fundingAgency><fundingNumber>0510</fundingNumber></fundingInfo><fundingInfo><fundingAgency>UK NIHR Biomedical Research Centre for Ageing and Age‐Related Disease award to the Newcastle upon Tyne Hospitals NHS Foundation Trust</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><section xml:id="abs1-1"><title type="main">Background:</title><p>Independence of certain gait characteristics from dopamine replacement therapies highlights its complex pathophysiology in Parkinson's disease (PD). We explored the effect of two different cue strategies on gait characteristics in relation to their response to dopaminergic medications.</p></section><section xml:id="abs1-2"><title type="main">Patients and Methods:</title><p>Fifty people with PD (age 69.22 ± 6.6 years) were studied. Participants walked with and without cues presented in a randomized order. Cue strategies were: (1) internal cue (attention to increase step length) and (2) external cue (auditory cue with instruction to take large step to the beat). Testing was carried out two times at home (<i>on</i> and <i>off</i> medication). Gait was measured using a Stride Analyzer (B&L Engineering). Gait outcomes were walking speed, stride length, step frequency, and coefficient of variation (CV) of stride time and double limb support duration (DLS).</p></section><section xml:id="abs1-3"><title type="main">Results:</title><p>Walking speed, stride length, and stride time CV improved on dopaminergic medications, whereas step frequency and DLS CV did not. Internal and external cues increased stride time and walking speed (<i>on</i> and <i>off</i> dopaminergic medications). Only the external cue significantly improved stride time CV and DLS CV, whereas the internal cue had no effect (<i>on</i> and <i>off</i> dopaminergic medications).</p></section><section xml:id="abs1-4"><title type="main">Conclusions:</title><p>Internal and external cues selectively modify gait characteristics in relation to the type of gait disturbance and its dopa‐responsiveness. Although internal (attention) and external cues target dopaminergic gait dysfunction (stride length), only external cues target stride to stride fluctuations in gait. Despite an overlap with dopaminergic pathways, external cues may effectively address nondopaminergic gait dysfunction and potentially increase mobility and reduce gait instability and falls. © 2010 Movement Disorder Society</p></section></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn4"><p><b>Relevant conflicts of interest/financial disclosures:</b> Nothing to report. Full financial disclosures and author roles may be found in the online version of this article.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>The Influence of Medication on Cues in PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Targeting dopa‐sensitive and dopa‐resistant gait dysfunction in Parkinson's disease: Selective responses to internal and external cues</title></titleInfo><name type="personal"><namePart type="given">Lynn</namePart><namePart type="family">Rochester</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</affiliation><affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</affiliation><description>Correspondence: Clinical Ageing Research Unit, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Katherine</namePart><namePart type="family">Baker</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alice</namePart><namePart type="family">Nieuwboer</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David</namePart><namePart type="family">Burn</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom</affiliation><description>Balance test scores refer to the number of subjects able to maintain the test for 30 s or more.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2011-02-15</dateIssued><dateCaptured encoding="w3cdtf">2010-05-12</dateCaptured><dateValid encoding="w3cdtf">2010-09-01</dateValid><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">2</extent><extent unit="references">34</extent><extent unit="words">5046</extent></physicalDescription><abstract lang="en">Background:: Independence of certain gait characteristics from dopamine replacement therapies highlights its complex pathophysiology in Parkinson's disease (PD). We explored the effect of two different cue strategies on gait characteristics in relation to their response to dopaminergic medications. Patients and Methods:: Fifty people with PD (age 69.22 ± 6.6 years) were studied. Participants walked with and without cues presented in a randomized order. Cue strategies were: (1) internal cue (attention to increase step length) and (2) external cue (auditory cue with instruction to take large step to the beat). Testing was carried out two times at home (on and off medication). Gait was measured using a Stride Analyzer (B&L Engineering). Gait outcomes were walking speed, stride length, step frequency, and coefficient of variation (CV) of stride time and double limb support duration (DLS). Results:: Walking speed, stride length, and stride time CV improved on dopaminergic medications, whereas step frequency and DLS CV did not. Internal and external cues increased stride time and walking speed (on and off dopaminergic medications). Only the external cue significantly improved stride time CV and DLS CV, whereas the internal cue had no effect (on and off dopaminergic medications). Conclusions:: Internal and external cues selectively modify gait characteristics in relation to the type of gait disturbance and its dopa‐responsiveness. Although internal (attention) and external cues target dopaminergic gait dysfunction (stride length), only external cues target stride to stride fluctuations in gait. Despite an overlap with dopaminergic pathways, external cues may effectively address nondopaminergic gait dysfunction and potentially increase mobility and reduce gait instability and falls. © 2010 Movement Disorder Society</abstract><note type="content">*Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles may be found in the online version of this article.</note><note type="funding">Parkinson's UK - No. 0510; </note><note type="funding">UK NIHR Biomedical Research Centre for Ageing and Age‐Related Disease award to the Newcastle upon Tyne Hospitals NHS Foundation Trust</note><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>attentional strategies</topic><topic>external cues</topic><topic>gait</topic><topic>dopaminergic medications</topic><topic>dopa‐resistant</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>26</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>430</start><end>435</end><total>6</total></extent></part></relatedItem><identifier type="istex">CD906250882BD7CBEE75696ACB8E657735DED4CE</identifier><identifier type="DOI">10.1002/mds.23450</identifier><identifier type="ArticleID">MDS23450</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2010 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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