リズミカルな聴覚的合図は、パーキンソン病患者の障害物回避には影響を及ぼさないが、障害物なし歩行における歩行の非対称性を改善する-AsymmGait-Parkinson研究

Rhythmic auditory cues improve gait asymmetry during unobstructed walking in people with Parkinson's disease but have no effect on obstacle avoidance - AsymmGait-Parkinson study.

抄録

はじめに:

本研究では、パーキンソン病(PD)患者と神経学的に健常な人を対象に、リズム聴覚的手がかり(RAC)が非障害歩行時および障害物回避歩行時の歩行非対称性(GA)に及ぼす影響について検討した。

INTRODUCTION: This study investigated the influence of rhythmic auditory cues (RAC) on gait asymmetry (GA) during unobstructed and obstacle avoidance walking in people with Parkinson's disease (PD) and neurologically healthy individuals.

方法:

13名のPD患者（70.33±6.02歳）と13名の健常対照者（CG）（70.77±7.56歳）が本研究に参加した。それぞれの聴覚的手がかり条件（RACなし、RACあり）において、障害物なし歩行で5試行、障害物歩行で10試行を行った。障害物歩行では、障害物回避時に各手足をリードとして5試行を行った。まず、RACなしの試行を行った。障害物なし歩行と障害物あり歩行の試行順序はランダムに決められ、合図（メトロノームで制御）は参加者のケイデンスに応じてパーソナライズされた。歩行パラメータの対称指数は、歩行タイプ（障害物なし歩行と障害物あり歩行）ごとに分けて、2×2要因分散分析（因子として群とRAC）を用いて分析した。

METHODS: Thirteen individuals with PD (70.33 ± 6.02 years) and 13 healthy controls (CG) (70.77 ± 7.56 years) participated in this study. They performed a total of five trials during unobstructed walking and 10 trials during obstacle walking under each auditory cue condition (without and with RAC). For obstacle walking, five trials were performed with each limb as leading during obstacle avoidance. First, the volunteers performed the trials without RAC. The trial order, unobstructed or obstacle walking, was randomly defined, and the cues (controlled by a metronome) were personalized according to participants' cadence. The symmetric index of gait parameters was analyzed using 2 × 2 factorial analysis of variance (group and RAC as factors) separately for each gait type (unobstructed and obstructed walking).

結果:

歩行速度に関する群間相互作用（= 0.027）の結果、PD群では非閉塞歩行時にRACとの非対称性が57.6％減少し、CGでは有意な効果は認められなかった。しかし、RACは障害物回避歩行中のGAには影響を及ぼさなかった。逆に、CGでは、RACにより障害物回避歩行中の歩幅非対称性が10.5％、歩幅持続時間非対称性が7.1％、歩幅速度非対称性が7.0％、二重支持持続時間非対称性が10.6％大きくなった（< 0.001）。

RESULTS: A group-by-auditory cue interaction for step velocity ( = 0.027) showed that the PD group exhibited 57.6% reduced asymmetry with RAC during unobstructed walking, with no significant effects observed for the CG. However, RAC had no effect on GA during obstacle avoidance walking in people with PD. Conversely, the CG exhibited 10.5% greater step length asymmetry, 7.1% greater step duration asymmetry, 7.0% greater step velocity asymmetry, and 10.6% greater double support duration asymmetry during obstacle avoidance with RAC ( < 0.001).

結論:

我々は、RACはPD患者の障害物なし歩行時のGAを減少させるが、PD患者と神経学的に健常な人の障害物歩行時のGAにはそれぞれ効果がなく、負の影響を及ぼすと結論づけた。

CONCLUSION: We conclude that RAC can reduce GA in people with PD during unobstructed walking, but appear to have no effect and negative effects on GA during obstacle walking in people with PD and neurologically healthy individuals, respectively.