Objective: 1) To determine the efficacy of our cognitively challenging Agility Boot Camp (ABC-C) rehabilitation intervention and 2) to evaluate neural mechanisms and plasticity within functional brain networks underlying improvements in mobility and freezing of gait.

Background: Freezing of gait (FoG), the intermittent failure to initiate or maintain walking for people with Parkinson’s disease (PD) is a major reason for mobility disability in PD, leading to falls and mortality. While previous data suggest that communication between midbrain locomotor centers and the frontal cortices within the brain’s right hemisphere are partly responsible for FoG, it has not been possible to test novel, effective rehabilitation due to the lack of valid outcome measures for FoG or clearly defined changes in brain physiology associated with FoG.

Methods: Participants were randomized into an ABC-C physical therapy intervention group or an educational control group for 6-weeks prior to crossing over into the other arm of the study. To date, 10 PD subjects, all with clinical FoG, underwent resting-state functional Magnetic Resonance Imaging (fcMRI) as well as instrumented measures of gait, balance and FoG severity (with inertial sensors). A blinded examiner conducted objective mobility assessments, along with fcMRI before and after the 6-week rehabilitation protocol.

Results: Six weeks of ABC-C rehabilitation resulted in a significant reduction of the FoG severity, as objectively measured in a 360° turn test (P = 0.04). Other aspects of mobility showed a trend towards improvements including reduced double support time and larger arm swing while walking, as well as reduced postural sway amplitude. Participants also demonstrated a significant reduction in fcMRI between the right hemisphere’s mesencephalic locomotor region and the supplementary motor areas (fcMRI reductions ranged from 2-19%), revealing a functional neural network similar to healthy, age-matched control participants following ABC. Reductions in fcMRI were significantly associated with reduced gait cycle duration (r = 0.73; P = 0.01).

Conclusions: Following our cognitively challenging 6-week ABC-C rehabilitation intervention, participants with PD showed significant mobility improvements coupled with neural plasticity within brain regions comprising the locomotor network that we have previously shown to have abnormal functional communication in those with PD who experience FoG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neural-plasticity-and-freezing-of-gait-stepping-through-the-fog/