Therapeutic protocol for Parkinson’s patient with freezing based on action observation plus sonification : preliminary results

Objective: To evaluate the effects of a novel experimental protocol to treat patients with Parkinson’s disease (PwP) and freezing of gait (FoG), using functional, and clinical scales, and gait analysis. Background: FoG is a disabling symptom strictly associated to falls. The little or no pharmacological responsiveness of FoG has led to an increasing interest in rehabilitation interventions aimed at functional recovery and autonomy. Currently, standard protocols employed for rehabilitation are based on the use of external sensory cues. However, cued strategies generate an important dependence on the environment. Teaching motor strategies without cues (i.e.action observation) can be an alternative/innovative approach to rehabilitation that matters most on appropriate allocation of attention and lightening cognitive load. Methods: We compared the effects of two different therapeutic pro- tocols on three gait movements: walk, step initiation, and sit-to-step. The experimental protocol was based on action observation plus sonifi- cation; patients re-learned 8 motor gestures watching video-clips showing an actor performing the same gestures, and then tried to repeat the gesture. Each video-clip was composed by images and sounds of the gestures. The sounds of gestures were obtained with the sonification technique, by transforming kinematic data (velocity) recorded during the execution of gesture, into pitch variations (for an example see: bit.ly/ sonif_example). The same 8 motor gestures were re-learned in the stand- ard protocol, with a common sensory stimulation method. We evaluated patients with functional and clinical scales before, immediately after, at 1 month, and 3 months after the treatment. We also compared gait indi- ces with those of a normative sample of PwP and FoG (Mezzarobba et al. 2015). Preliminary data are based on two patients. Results: Overall, data showed that both protocols have positive effects on functional and clinical tests. Larger performance improve- ments were seen with the experimental protocol. In the after treatment evaluations, the number of indices that differed from those of the norma- tive sample, were larger in the experimental protocol than the baseline protocol. Conclusions: These preliminary data suggest that a multisensory approach could help PwP with FoG to re-learn gait movements, to reduce freezing episodes, and that these effects could be prolonged over time.