Influence of visual cues on gait in Parkinson's disease: Contribution to attention or sensory dependence?
Introduction
Several studies have shown that sensory and attentional stimuli play important role in gait. A common paradigm was used (stripes on floor) in different works to demonstrate both effects. We will review the main experimental results demonstrating the role of each factor and will try to show the possible imbalance that may exist between sensory inputs and attention.
Section snippets
Gait in Parkinson's disease
Gait in Parkinson's disease (PD) belong to the group of hypokinetic gait characterized by a decreased stride length which is probably the most frequent gait trouble representing 35% of all the gait disorders [1]. Normal pressure hydrocephalus and PD are the two main diseases of this group, the others being progressive supranuclear palsy, artherioclerotic encephalopathy, Alzheimer's disease. The common findings in this group are a reduced stride length and a reduced velocity. In PD, some more
Attention and locomotion
External visual cues may act to focus attention on the stride length process. In this case, people are asked to walk on the stripes to normalize their stride length. Patients with PD are able to do so even if they are not able when relying on internal cues, and they normalize also their cadence and their velocity demonstrating that the internal regulation of stride length is the fundamental deficit in gait hypokinesia [7]. Moreover, when patients are trained with visual cues or with a mental
Visual control of locomotion
During locomotion, it is possible to differentiate static visual cues that are available in a single flash of stroboscopic light, namely position and orientation visual cues, from dynamic visual cues that are perceptible under permanent illumination and are involved in the visual perception of movement produced by the subject's own actions (16), also called optic flow. Dynamic visual cues have been shown to provide an important contribution to body balance, in standing [15] as well as in
Common mechanisms between sensory integration and attention
It appears from these different experiments that external visual cueing may be effective to improve locomotion in PD because it may compensate 2 different deficits depending on the experimental paradigm: normalization of the deficit of internal cueing when patients are instructed to step on the markers because the visual cues draw attention to the stepping process and reduce the degree of automaticity of locomotion or compensation of a deficit of proprioceptive integration when visual cues
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