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The challenge of dual-tasking for Parkinson’s Disease patients

At Gondola Medical Technologies, we have observed that dual-tasking is a real challenge for many patients with neurological disorders like Parkinson’s Disease (PD). The ability to walk while simultaneously talking or thinking about a complex issue is easily taken for granted. It does not usually require conscious or cognitive efforts. However, walking is not as simple, as it relies on efficient coordination of multiple muscles and continuous posture adjustments. Most people will perceive it as almost automatic because it’s largely handled by an ensemble of deep brain nuclei called the Basal Ganglia (BG) in our subconscious.

Pathological conditions like PD, stroke, and other neurological disorders are known to interfere with the normal functioning of BG, turning walking and many other automatic actions of everyday life into a real challenge for the brain. When BG fail to coordinate complex ensembles of actions, other brain regions must take the lead in this process, even if they are not optimally structured (Wu T, 2015). Cortical Areas, physiologically and anatomically conceived to take care of higher cognitive tasks, often see most automatic behaviors like walking become part of their responsibilities as the BG nuclei deteriorate. This translates into the appearance of the first gait abnormalities that we observe in most PD and other neurologic patients. As cortical areas take control over walking, this process becomes less automatic for the patients, whose brains need to think about planning, executing, and completing each step.

Combining the activity of walking with a cognitive task such as asking a PD patient to engage in a discussion about a complex topic can generate a conflict due to the limited amount of cognitive resources available in the brain (Friedman A, 1982). The inability to handle two or more tasks simultaneously is widespread in neurologic patients experiencing BG degeneration. It often results in the exacerbation of gait abnormalities, balance disorders, and falls.

Innovative and non-invasive approaches such as Gondola’s Automated Mechanical Peripheral Stimulation (AMPS) have recently gained the attention of patients and physicians for their beneficial effects on a number of gait and posture disorders (Kleiner AFR, 2018). Gondola Medical Technologies enables patients to improve their ability to dual-task with AMPS therapy and regain independence in their day-to-day life. A clinical study on Gondola AMPS therapy in its combination with standard surgical and pharmacological interventions is currently being conducted at the University Hospital Cologne, Germany.

This study represents a promising therapeutic option for PD patients to improve motor function and gait when standard approaches failed to improve these symptoms.

REFERENCES:

Wu T, Hallett M, Chan P. Motor automaticity in Parkinson’s disease. Neurobiol Dis. 2015 Oct;82:226-234. doi: 10.1016/j.nbd.2015.06.014. Epub 2015 Jun 21. PMID: 26102020; PMCID: PMC5565272.

Friedman A, Polson MC, Dafoe CG, Gaskill SJ. Dividing attention within and between hemispheres: testing a multiple resources approach to limited-capacity information processing. J Exp Psychol Hum Percept Perform. 1982 Oct;8(5):625-50. doi: 10.1037//0096-1523.8.5.625. PMID: 6218226.

Kleiner AFR, Souza Pagnussat A, Pinto C, Redivo Marchese R, Salazar AP, Galli M. Automated Mechanical Peripheral Stimulation Effects on Gait Variability in Individuals With Parkinson Disease and Freezing of Gait: A Double-Blind, Randomized Controlled Trial. Arch Phys Med Rehabil. 2018 Dec;99(12):2420-2429. doi: 10.1016/j.apmr.2018.05.009. Epub 2018 Jun 11. PMID: 29902470.

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