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Look where you’re going! Do visual cues enhance visual exploration while walking in Parkinson’s disease?

Lookup NU author(s): Dr Sam Stuart, Dr Brook Galna, Dr Alan Godfrey, Dr Susan Lord, Professor Lynn Rochester


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People with Parkinson’s disease (PwPD) commonly experience gait disturbance (e.g. shuffling steps, freezing and falls), as well as visual and cognitive impairment (1). Visual cues (transverse taped lines) are a physiotherapy technique commonly used to improve gait in PwPD. However, response varies and the underlying mechanisms involved are not clear, although evidence suggests cognition may play an important role. A second influence is likely to be the visual strategies used by individuals when exploring their environment. Effective visual exploration is required for navigation and safe negotiation of hazards, and may be compromised in PwPD. Understanding response to cues is important to effectively individualise therapy.This study evaluated; 1) the effect of visual cues on visual exploration during gait in Parkinson’s disease, and 2) the association of visual exploration with disease severity, cognition and vision.Visual exploration (specifically saccade frequency) was measured via a Dikablis mobile eye-tracker (2) in 60 PwPD and 40 controls. Participants underwent visual, cognitive and clinical assessments, and then walked straight with and without a visual cue under single and dual-task (attentional distraction, representative of real-world gait). The primary outcome was change (∆) in saccade frequency (number of fast eye movements per second) with a cue. A saccade (fast eye movement) was classed as an eye movement with a velocity threshold of ≥240 degrees/second (~5° amplitude). Secondary outcomes included association between disease severity, cognitive and visual functions and saccade frequency within each group. All participants gave written informed consent and ethical approval was obtained for the study (Newcastle and North Tyneside 1 REC; REF: 13/NE/0128).Vision (VA and CS) and cognition were significantly impaired in PwPD compared to controlsDuring gait PwPD made fewer saccades than controls (Figure 4)Visual cues increased saccade frequency during gait in both PwPD and controls (p < .001), which was maintained under dual task (p = .008)Surprisingly, poorer attention was associated with increased saccade frequency during gait in PwPD (r = .26, p = .052) but better attention was related to greater change in saccade frequency with a visual cue (r = -.27, p = .049)Similarly, greater disease severity was associated with increased saccade frequency during gait (r = .27, p = .05) but lower disease severity was related to greater change in saccade frequency with a visual cue under single and dual task (Table 3)• In agreement with our previous work (3) PwPD explore their environment less frequently than controls during gait • Visual cues increase exploration in both PwPD and controls, which was maintained under dual task with greater response shown in PwPD • Interestingly within PwPD, poorer attention and greater disease severity was related to more frequent exploration during gait, which may reflect reduced capacity to cognitively prevent non-purposeful saccades to irrelevant stimuli (4) • All participants increased exploration with a visual cue, but better attention and less severe disease within PwPD was related to greater change in visual exploration with a visual cue Clinical implications • Visual cues may help increase attention to walking in PwPD and reduce falls risk • Disease severity and attentional impairment may impact response to visual cues in PwPD and should be considered when administering such intervention

Publication metadata

Author(s): Stuart S, Galna B, Godfrey A, Lord S, Rochester L

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Physiotherapy UK

Year of Conference: 2015

Online publication date: 19/10/2015

Acceptance date: 27/03/2015

Publisher: Chartered Society of Physiotherapy


DOI: 10.13140/RG.2.1.2459.5606

Notes: Abstract also at: