The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson's disease

Objective: To compare the effect of rhythmic auditory and attentional cues, and a combination of both cues on gait, in people with Parkinson's disease (PD) during single and dual tasks. Design: A repeated-measures study requiring participants to perform single and dual-motor tasks under different cueing conditions. Setting: Human movement analysis laboratory. Participants: Fifteen participants with idiopathic PD and a comparison group of 12 healthy participants. Interventions: Three cueing strategies were compared: a rhythmic auditory cue (walking in time to a metronome beat), an attentional strategy (asked to focus on taking big step), and a combination cue (asked to walk in time to a metronome beat while taking big steps). Main Outcome Measures: Walking speed, step amplitude, and step frequency. Results: Walking speed of PD participants improved significantly compared with noncued walking in the single- and dual-task condition with the attentional (P<.001, P=.037) and combination cue strategies (P=.013, P=.028). Step amplitude also increased significantly with the attentional and combination cue strategies in single- (P<.001, P<.001) and dual-task (P<.001, P<.001) conditions. Step frequency was reduced significantly with the attentional strategy (P=.042) in the single and dual tasks (P<.001) and combination cue strategy (P=.009) in the dual task. The rhythmic auditory cue alone did not alter significantly any parameter of gait in the single or dual tasks. Conclusions: The attentional strategy and the combination of a rhythmic auditory cue with an attentional strategy were equally effective, and improved walking speed and step amplitude significantly during both single and dual tasks. The combination cue, however, may still be a useful alternative in situations of increased attentional demand, or where problems exist with executive function.