Executive Control of Walking in People With Parkinson's Disease With Freezing of Gait.
Rodrigo Vitorio, Samuel Stuart, Martina Mancini
PMID 33155506WHAT IT FOUND
People with Parkinson's who report freezing of gait showed higher prefrontal brain activity while walking than those without freezing.
This suggests their brains work harder to control movement. However, their actual walking speed and step variability looked the same as non-freezers once disease severity was accounted for.
Key findings
01When controlling for disease severity and cognitive status, people with freezing of gait showed significantly higher oxygenated hemoglobin in the prefrontal cortex during the late phase of walking compared to those without freezing.
02Spatiotemporal gait parameters, including speed and stride length, did not significantly differ between the freezing and non-freezing groups when controlling for covariates, despite the difference in brain activity.
03In the freezing group, higher prefrontal activity during dual-task walking was associated with less severe self-reported freezing and lower step time variability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was cross-sectional, so it cannot determine if the increased brain activity causes freezing or is a compensation for it. The sample size was small (47 participants), and the results for brain activity were only significant when controlling for covariates, suggesting the effect might be subtle. No actual freezing episodes occurred during the testing, so the findings apply to the baseline state of people who experience freezing, not the freezing event itself. The study only measured prefrontal cortex activity, ignoring other brain regions involved in locomotion. Cognitive task accuracy data was missing for some participants due to technical issues.
Declared interests
The authors reported no conflicts of interest. The study was supported by the NIH and non-US government research grants.
The easy way to misread this
Do not conclude that people with freezing of gait have worse walking mechanics than non-freezers. When disease severity and cognition were accounted for, their gait speed and variability were statistically similar. The difference was in the brain effort required to produce that gait.