Interactive Rhythmic Cue Facilitates Gait Relearning in Patients with Parkinson's Disease

To develop a method for cooperative human gait training, we investigated whether interactive rhythmic cues could improve the gait performance of Parkinson's disease patients. The interactive rhythmic cues ware generated based on the mutual entrainment between the patient's gait rhythms and the cue rhythms input to the patient while the patient walked. Previously, we found that the dynamic characteristics of stride interval fluctuation in Parkinson's disease patients were improved to a healthy 1/f fluctuation level using interactive rhythmic cues and that this effect was maintained in the short term. However, two problems remained in our previous study. First, it was not clear whether the key factor underpinning the effect was the mutual entrainment between the gait rhythms and the cue rhythms or the rhythmic cue fluctuation itself. Second, it was not clear whether or not the gait restoration was maintained longitudinally and was relearned after repeating the cue-based gait training. Thus, the present study clarified these issues using 32 patients who participated in a four-day experimental program. The patients were assigned randomly to one of four experimental groups with the following rhythmic cues: (a) interactive rhythmic cue, (b) fixed tempo cue, (c) 1/f fluctuating tempo cue, and (d) no cue. It has been reported that the 1/f fluctuation of stride interval in healthy gait is absent in Parkinson's disease patients. Therefore, we used this dynamic characteristic as an evaluation index to analyze gait relearning in the four different conditions. We observed a significant effect in condition (a) that the gait fluctuation of the patients gradually returned to a healthy 1/f fluctuation level, whereas this did not occur in the other conditions. This result suggests that the mutual entrainment can facilitate gait relearning effectively. It is expected that interactive rhythmic cues will be widely applicable in the fields of rehabilitation and assistive technology.