Objective: This systematic review and meta-analysis were performed to examine the effect of tactile cueing on dual task (DT) performance in adults with idiopathic Parkinson’s disease (PD) over 18 years of age, with the primary outcome measured by dual task cost (DTC) for outcome measures included in the studies.

Background: DT performance refers to the ability to concurrently manage and execute two distinct tasks that need the allocation of attention and cognitive resources to both activities. The ability to DT is affected in PD. Greater (e.g., poorer performance) DTC which is the percentage change in performance from DT compared to single task, is associated with bradykinesia, postural instability, freezing of gait, and falls [1,2]. Previous research suggests that tactile cueing, including vibrotactile stimulation, might improve postural stability, decrease FOG [3,4] and thus, improve DT and decrease DTC in PD.

Method: A systematic review was conducted in PubMed and EMBASE databases from inception to October 30, 2023. DTC was used to measure the percentage change in the performance from DT to single task of the outcome measures based on the equation: [single task-dual task]/single task*100] [5].  Effect sizes standardized mean difference (SMD) of DTC were pooled in a meta-analysis based on a random-effects model. Confidence intervals (CI) (95%) are reported. Statistical significance was set at p<0.05.

Results: From 130 studies initially identified, eight were included for systematic review. Of these, four studies with a total of 374 participants, were included for meta-analysis on walking speed and step length. Three out of these four studies showed independently that the DTC decreased (e.g., improved) for walking speed and step length with tactile cueing versus without it. The SMD for DTC of walking speed (-109.69; 95%CI -454.89–235.51, p=0.39) and step length (-14.21; 95%CI -53.25–24.83, p=0.33), showed weak evidence that tactile cueing can improve the DTC for these gait parameters.

Conclusion: Pooled effect estimates in the meta-analyses revealed weak evidence that tactile cueing including vibrotactile stimulation, improves walking speed or step length in PD. However, there were a limited number of studies and a need for standardized protocols in this area.

References: 1. Heinzel, S., Maechtel, M., Hasmann, S. E., Hobert, M. A., Heger, T., Berg, D., & Maetzler, W. (2016). Motor dual-tasking deficits predict falls in Parkinson’s disease: A prospective study. Parkinsonism & related disorders, 26, 73–77. https://doi.org/10.1016/j.parkreldis.2016.03.007

2. Onder, H., & Ozyurek, O. (2021). The impact of distinct cognitive dual-tasks on gait in Parkinson’s disease and the associations with the clinical features of Parkinson’s disease. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 42(7), 2775–2783. https://doi.org/10.1007/s10072-020-04874-9

3. Sweeney, D., Quinlan, L. R., Browne, P., Richardson, M., Meskell, P., & ÓLaighin, G. (2019). A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease. Sensors (Basel, Switzerland), 19(6), 1277. https://doi.org/10.3390/s19061277

4. Muthukrishnan, N., Abbas, J. J., Shill, H. A., & Krishnamurthi, N. (2019). Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review. Sensors (Basel, Switzerland), 19(24), 5468. https://doi.org/10.3390/s19245468

5. Plummer, P., & Eskes, G. (2015). Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Frontiers in human neuroscience, 9, 225. https://doi.org/10.3389/fnhum.2015.00225

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-tactile-cueing-on-dual-task-performance-in-parkinsons-disease-a-systematic-review-and-meta-analysis/