Objective: To investigate the influence of freezing of gait (FoG) on automaticity of walking in people with Parkinson’s disease (PD).

Background: A hallmark of healthy walking is automaticity, defined as the ability of the nervous system to successfully control movement with minimal use of executive-attentional resources. It has been proposed that many walking abnormalities in people with PD are characterized by a shift in locomotor control from healthy automaticity to compensatory executive control, largely located in the pre-frontal cortex (PFC). Indirect measures of automaticity of walking (e.g., step-to-step variability and dual-task cost) suggest that FoG is associated with reduced automaticity in the control of walking. However, the influence of FoG on PFC during walking is still unclear.

Method: Forty-seven people with PD were distributed into two groups related to FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD-FoG (n=23; age = 70.8 years, UPDRS-III = 35) and PD+FoG (n=24; age = 70.3 years, UPDRS-III = 43.1). Two conditions were tested: single and dual-task walking (i.e., walking and performing the AX Continuous Performance Test). Participants were tested Off medication. A portable 8-channel functional near-infrared spectroscopy system recorded changes in oxy- and deoxygenated hemoglobin bilaterally in the PFC while walking. Wearable inertial sensors were used to calculate spatiotemporal gait parameters. Linear mixed-effects models were used to analyze the dependent variables while controlling for clinical and demographic differences between groups (i.e., disease duration, severity of motor symptoms, disease stage, global cognition and executive function).

Results: A group main effect revealed that PD+FoG had greater levels of relative oxygenated hemoglobin while walking than PD-FoG (p=0.031). A trend for reduced deoxygenated hemoglobin was also observed in PD+FoG. No significant results were observed for step time variability. Gait speed and stride length were similar between groups. Both groups decreased gait speed (p=0.029) and stride length (p<0.001) during dual-task walking compared to single walking.

Conclusion: These findings suggest that people with PD and FoG have reduced automaticity of walking. PFC activity while walking seems to be more sensitive than indirect measures in identifying reduced automaticity of walking.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prefrontal-cortical-activity-and-the-control-of-walking-in-people-with-freezing-of-gait/