Objective: To investigate the dual task walking training effects with different attentional focus strategies in patient with Parkinson’s Disease (PD) who had freezing of gait (FOG).

Background: With automatic control dysfunction in PD with FOG, gait impairments are pronounced under dual-task walking condition. Effective strategies for improving dual-task walking are required. Attentional focus strategies, including internal focus (IF) and external focus (EF), are often used in motor and postural learning. However, an optimal attentional focus strategy for dual-task walking training in PD has not been investigated.

Method: Twenty patients with PD and FOG randomly assigned to IF and EF groups. All participants participated in 60-minute dual-task walking training sessions twice weekly for 6 weeks. During training, the IF group was instructed to focus on body movement (i.e. limb motion amplitude); whereas, the EF group was instructed to focus on movement effects (i.e. height of obstacles). A dual-task test with walking at preferred speed and performing an auditory memory task concurrently was conducted at baseline, after 6-week intervention, and 2 months after completion of the intervention. Outcome measured included walking speed, step length, step length variability and cadence.

Results: Both the IF and EF groups increased walking speed after 6-week training and maintained the training effect to follow-up testing. Interesting, the IF group showed longer step length at both post-test and follow-up test than baseline. However, in the EF group, the increased step length was only shown at post-test and the greater cadence was observed at both post-test and follow-up test than baseline. In addition, decreased step length variability was only found in the IF group at post-test.

Conclusion: Although both IF and EF groups led to greater gait speed and maintained the effect to follow-up period, underlying gait control was different. Since small step length was a walking characteristic in PD with FOG, and small step length with greater cadence may induce festination gait. Comparing with EF strategy, dual-task training with IF strategy would be a better training strategy for improving step length and gait stability. In clinic, IF strategy could be suggested as an effective and safe strategy in dual-task walking and fall-prevention education.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improving-dual-task-walking-control-after-training-with-internal-focus-strategy-in-parkinson-disease-with-freezing-of-gait/