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Attentional focus effect on dual-task walking in Parkinson’s disease with and without freezing of gait

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Abstract

In Parkinson’s disease, the optimal attentional focus strategy for dual-task walking may vary with freezing of gait (FOG), due to different severities of impaired automaticity. The study aimed to investigate (i) the immediate effect of attentional focus on dual-task walking in participants with and without FOG, and (ii) the training effect of attentional focus on walking, FOG, and falls. In experiment 1, FOG and non-FOG groups (16 participants each) performed a dual-task of holding two interlocking rings apart while walking, either without attention instruction or with instructions to focus attention internally or externally. Gait parameters and ring-touching times were measured. In experiment 2, 30 participants with FOG were randomized to 6 weeks of dual-task training with internal-focus or external-focus instruction. Before and after training, we recorded timed up-and-go (TUG) and TUG dual-task (TUGdt) in on-medication and off-medication states, and the numbers of FOG episodes and falls. The non-FOG group showed less step length variability and shorter ring-touching times with external-focus. The FOG group showed less step length variability, less cadence, increased gait velocity, and longer step lengths with internal-focus compared to external-focus and no-focus instructions. Both internal-focus and external-focus training reduced FOG and falls after intervention, but only internal-focus training reduced TUG and TUGdt in both on-medication and off-medication states. Our findings suggest external-focus would enhance walking automaticity and the concurrent task accuracy for non-freezers, whereas for freezers, internal-focus could increase gait stability and lead to a more positive effect on improving locomotion control and reducing falling risk.

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Data availability

The data sets generated and analyzed in this study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by a grant from the Ministry of Science and Technology, R.O.C. Taiwan (grant no. MOST 109–2314-B-002–115-MY3).

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Authors and Affiliations

  1. Division of Physical Therapy, Department of Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

    Yu-An Chen

  2. Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    Ruey-Meei Wu & Chin-Hsien Lin

  3. School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Chen-Hsing Sheu & Cheng-Ya Huang

  4. Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan

    Cheng-Ya Huang

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Contributions

Conceptualization: R.M.W., C.H.L., and C.Y.H. Methodology: Y.A.C. and C.Y.H. Formal analysis: Y.A.C., C.H.S., and C.Y.H. Writing − original draft preparation: Y.A.C. and C.Y.H. Writing − review and editing: Y.A.C, R.M.W., and C.Y.H. Funding acquisition: C.Y.H.

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Correspondence to Cheng-Ya Huang.

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Chen, YA., Wu, RM., Sheu, CH. et al. Attentional focus effect on dual-task walking in Parkinson’s disease with and without freezing of gait. GeroScience 45, 177–195 (2023). https://doi.org/10.1007/s11357-022-00606-3

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