Document Type

Thesis

Degree Name

Master of Kinesiology (MKin)

Department

Kinesiology and Physical Education

Faculty/School

Faculty of Science

First Advisor

Dr. Quincy J. Almeida

Advisor Role

Supervisor

Abstract

Freezing of Gait (FOG) is a highly disabling motor symptom experienced by individuals with Parkinson’s disease (PD). Yet, there are currently no effective treatments for FOG. Treatments which target the potential underlying mechanism of FOG may be the most effective strategy. According to the cross-talk model of FOG, competing demands from the cognitive, limbic, and sensorimotor domains may be the cause of FOG episodes. Thus, treatments of the cognitive, limbic, and sensorimotor cortical domains may be beneficial to FOG. This thesis is an exploratory investigation of these three different types of treatment in individuals with FOG. Specifically, computerized cognitive training, cognitive behavioural therapy (CBT), and proprioceptive training were employed as treatments towards the cognitive, limbic, and sensorimotor domains, respectively.

A single-blinded randomized crossover trial was conducted. Fifteen individuals with FOG were randomized into different groups with a counterbalanced order of interventions. Each of the three interventions involved eight one-hour sessions occurring twice weekly for a four-week period. A two-week washout period (cessation of intervention) was employed between intervention periods to prevent carryover effects. Severity of FOG and spatiotemporal gait parameters were objectively assessed using a gait paradigm which included three conditions evaluating walking when the cognitive, limbic, or sensorimotor domains were independently challenged.

Following the completion of the cognitive training intervention, participants demonstrated an improvement in severity of FOG, but only in the cognitive walking assessment. Interestingly, while there was no effect of cognitive training on freezing in the proprioceptive walking assessment, some gait characteristics did improve. After completing CBT, the severity iii of FOG worsened over all gait conditions, except in the sensorimotor assessment condition, where there appeared to be no change. Gait characteristics, however, did show improvements in the proprioceptive and limbic walking assessments. Proprioceptive training results revealed improvements to FOG severity in all gait conditions except in the proprioceptive walking assessment, with additional improvements to specific gait parameters also demonstrated in the limbic walking assessment condition.

Collectively, the results indicated that all three types of treatment have the potential to improve different aspects of FOG. Thus, any one of these interventions could be a viable option for the treatment of FOG. When weighing the benefits of each intervention, it was determined that proprioceptive training would be the best and most relevant treatment option of the three, since it demonstrated improvements in the most number of outcomes. Furthermore, proprioceptive training was effective on its own, and combining additional interventions demonstrated no further benefit. Therefore, proprioceptive training would be the most ideal treatment for FOG.

Convocation Year

2018

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