The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Action Observation Training and Visual Cueing Training on Walking Ability and Balance in Parkinson's Disease Patients

  • Jun Su Kang (Department of Physical Therapy, Graduate School of Health Sciences, Cheongju University) ;
  • Sung-Min Son (Department of Physical Therapy, Graduate School of Health Sciences, Cheongju University)
  • Received : 2025.01.17
  • Accepted : 2025.04.30
  • Published : 2025.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study examined the effects of action observation training (AOT) and visual cueing training (VC) on the gait performance, balance, functional mobility, and quality of life in Parkinson's disease patients. Methods: A randomized controlled trial was conducted from June to August 2024 at C Hospital in Cheongju, involving 15 Parkinson's disease patients. The participants were selected based on Hoehn- Yahr stages 1-3 and a score of 24 or higher on the MMSE-K; those with a history of neurological or orthopedic disorders were excluded. The participants were assigned randomly to the AOT or VC group and underwent training five times weekly for four weeks, each session lasting 20 minutes. The VC group performed gait training using the visual cues placed on the floor, while the AOT group watched videos related to gait and then performed the same movements. The gait and balance abilities were assessed using the 10M Walking Test (10MWT), Timed Up & Go TEST (TUG), 5 Times Sit to Stand Test (5STS), Berg balance scale (BBS), the Parkinson's disease quality of life questionnaire (PDQL), and G-WALK. All statistical analyses were conducted using SPSS version 24.0. Results: AOT induced greater improvement in TUG and 10MWT, indicating a positive effect on motor learning and neuroplasticity. By contrast, VC was more effective in enhancing the stride length and balance than AOT by strengthening the gait rhythm and stability. Conclusion: AOT helped promote motor learning and social engagement, while VC improved balance and gait rhythm.

Keywords

References

  1. Kim DY. Effects of 16-week combined exercise on blood dopamine concentrations, functional fitness and qol in patients with Parkinson's disease. KOCS. 2021;38(4):1081-92.
  2. Kang DY, Cheon SM, Lee KS et al. Correlations amang respiratoty function, UPDRS and senior fitness in Parkinson's disease patients. J Kor Phys Ther. 2014;26(2):48-55.
  3. Bang DH, Noh HJ. Effects of aerobic exercise on disease severity and walking ability in patients with Parkinson's disease. J Kor Phys Ther. 2016;28(4):227-31. https://doi.org/10.18857/jkpt.2016.28.4.227
  4. Song HS, Kim JY. Clinical feasibility of mental practice for gait ability improvement of Parkinson disease patients: ABA single subject design. J Kor Phys Ther. 2014;26(6):398-402.
  5. Lee DK, Kim EK, Kim YN et al. Effects of a virtual reality training program on balance and lower muscular strength of Parkinson's disease patients. J Kor Phys Ther. 2013;25(2):96-102. https://doi.org/10.18857/jkpt.2015.27.2.96
  6. Kang DY, Cheon SM, Son MJ et al. Effects of sagittal spinopelvic alignment on motor symptom and respiratory function in mild to moderate Parkinson's disease. J Kor Phys Ther. 2019;31(2):122-8. https://doi.org/10.18857/jkpt.2019.31.2.122
  7. Van Uem JMT, Cerff B, Kampmeyer M et al. The association between objectively measured physical activity, depression, cognition, and healthrelated quality of life in Parkinson's disease. Parkinsonism Relat Disord. 2018;48:74-81. https://doi.org/10.1016/j.parkreldis.2017.12.023
  8. Giladi N, Balash J. Paroxysmal locomotion gait disturbances in Parkinson's disease. Neurol Neurochir. 2001;35(3):57-63.
  9. Nieuwboer A, De Weerdt W, Dom R et al. The effect of a home physiotherapy program for persons with Parkinson's disease. J Rehabil Med. 2001;33(6):266-72. https://doi.org/10.1080/165019701753236455
  10. Gantchev N, Viallet F, Aurenty R et al. Impairment of posturo-kinetic coordination during initiation of forward-oriented stepping movements in parkinsonian patients. Electroencephalogr Clin Neurophysiol. 1996;101(2):110-20. https://doi.org/10.1016/0924-980X(95)00253-H
  11. Crizzle AM, Newhouse IJ. Is physical exercise beneficial for persons with Parkinson's disease? Clin J Sport Med. 2006;16(5):422-5. https://doi.org/10.1097/01.jsm.0000244612.55550.7d
  12. Nijkrake MJ, Bloem BR, Keus SH et al. Quality of allied health care in Parkinson's disease. Mov Disord. 2006;21(Suppl 13):S131. https://doi.org/10.1016/S1353-8020(08)70054-3
  13. Keus SH, Bloem BR, Verbaan D et al. Physiotherapy in Parkinson's disease: utilization and patient satisfaction. J Neurol. 2004;251(6):680-7. https://doi.org/10.1007/s00415-004-0402-7
  14. Halsband U, Matsuzaka Y, Tanji J. Neuronal activity in the primate supplementary, pre supplementary and premotor cortex during externally and internally instructed sequential movements. Neurosci Res. 1994;20(2):149-55. https://doi.org/10.1016/0168-0102(94)90032-9
  15. Nieuwboer A, Kwakkel G, Rochester L et al. Cueing training in the home improves gait- related mobility in Parkinson's disease: The RESCUE trial. J Neurol Neurosurg Psychiatry. 2007;78(2):134-40. https://doi.org/10.1136/jnnp.200X.097923
  16. Glickstein M, Stein J. Paradoxical movement in Parkinson's disease. Trends Neurosci. 1991;14(11):480-2. https://doi.org/10.1016/0166-2236(91)90055-Y
  17. Azulay JP, Mesure S, Blin O. Influence of visual cues on gait in Parkinson's disease: Contribution to attention or sensory dependence? J Neurol Sci. 2006;248(1-2):192-5. https://doi.org/10.1016/j.jns.2006.05.008
  18. Nieuwboer A. Cueing for freezing of gait in patients with Parkinson's disease: a rehabilitation perspective. Mov Disord. 2008;23(Suppl 2):S475-81. https://doi.org/10.1002/mds.21978
  19. Lago-Rodriguez A, Lopez-Alonso V, Fernandez-Del-Olmo M. Mirror neuron system and observational learning: behavioral and neurophysiological evidence. Behav Brain Res. 2013;248:104-13. https://doi.org/10.1016/j.bbr.2013.03.033
  20. Molnar-Szakacs I, Wang MJ, Laugeson EA et al. Autism, emotion recognition, and the mirror neuron system: the case of music. McGill J Med. 2009;12(2):87. https://doi.org/10.26443/mjm.v12i2.273
  21. Jeon H, Lee SH. From neurons to social beings: short review of the mirror neuron system research and its socio-psychological and psychiatric implications. Clin Psychopharmacol Neurosci. 2018;16(1):18-31. https://doi.org/10.9758/cpn.2018.16.1.18
  22. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004;27:169-92. https://doi.org/10.1146/annurev.neuro.27.070203.144230
  23. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm. 2007;114(10):1265-78. https://doi.org/10.1007/s00702-007-0763-z
  24. Celnik P, Stefan K, Hummel F et al. Encoding a motor memory in the older adult by action observation. Neuroimage. 2006;29(2):677-84. https://doi.org/10.1016/j.neuroimage.2005.07.039
  25. Mezzarobba S, Grassi M, Pellegrini L et al. Action observation plus sonification: a novel therapeutic protocol for Parkinson's patient with freezing of gait. Front Neurol. 2017;8:723. https://doi.org/10.3389/fneur.2017.00723
  26. Wang W, Collinger JL, Perez MA et al. Neural interface technology for rehabilitation: exploiting and promoting neuroplasticity. Phys Med Rehabil Clin N Am. 2010;21(1):157-78. https://doi.org/10.1016/j.pmr.2009.07.003
  27. De Ridder R, Lebleu J, Willems T et al. Concurrent validity of a commercial wireless trunk triaxial accelerometer system for gait analysis. J Sport Rehabil. 2019;28(6):jsr.2018-0295. https://doi.org/10.1123/jsr.2018-0295
  28. Dobkin BH. Short-distance walking speed and timed walking distance: redundant measures for clinical trials? Neurology. 2006;66(4):584-6. https://doi.org/10.1212/01.wnl.0000198502.88147.dd
  29. Podsiadlo D, Richardson S. The timed "up & go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  30. Teo TW, Mong Y, Ng SS. The repetitive five-times-sit-to-stand test: its reliability in older adults. Int J Ther Rehabil. 2013;20(3):122-30. https://doi.org/10.12968/ijtr.2013.20.3.122
  31. Downs S, Marquez J, Chiarelli P. The Berg Balance Scale has high intraand inter-rater reliability but absolute reliability varies across the scale: a systematic review. J Physiother. 2013;59(2):93-9. https://doi.org/10.1016/S1836-9553(13)70161-9
  32. Kim SR, Jung SJ, Sung YH et al. Factors affecting quality of life in patients with Parkinson's disease. J Korean Neurol Assoc. 2005;23(6):770-5.
  33. Suteerawattananon M, Morris GS, Etnyre BR et al. Effects of visual and auditory cues on gait in individuals with Parkinson's disease. J Neurol Sci. 2004;219(1-2):63-9. https://doi.org/10.1016/j.jns.2003.12.007
  34. Federica A, Roberto G, Elisabetta S et al. Brain plasticity in Parkinson's disease with freezing of gait induced by action observation training. J Neurol. 2017;264(1):88-101.
  35. Zhang W, Han Y, Shi Y et al. Effects of wearable visual cueing on gait pattern and stability in patients with Parkinson's disease. Front Neurol. 2023;14:1077871. https://doi.org/10.3389/fneur.2023.1077871
  36. Kim JW, Son YR, Kim YN. Action observation training improves lower limb muscle activity and dynamic balance in chronic stroke patients. PNF & Mov. 2019;17(2):245-52.
  37. Kalia LV, Lang AE. Cueing paradigms to improve gait and posture in Parkinson's disease: a narrative review. J Clin Neurol. 2022;12(2):134-42.
  38. Cimolin V, Vismara L, Ferraris C et al. Computation of gait parameters in post-stroke and Parkinson's disease: a comparative study using RGB-D sensors and optoelectronic systems. Sensors. 2022;22(3):824. https://doi.org/10.3390/s22030824
  39. Mezzarobba S, Grassi M, Pellegrini L et al. Action observation plus sonification. A novel therapeutic protocol for parkinson's patient with freezing of gait. Front Neurol. 2018;8:723. https://doi.org/10.3389/fneur.2017.00723
  40. Choi SJ, Shin WS. The effect of patient-selected, task-oriented training on activities of daily living, quality of life, and depression in stroke patients. J Korean Soc Phys Med. 2014;9(2):213-22. https://doi.org/10.13066/kspm.2014.9.2.213