A new quantitative method for evaluating freezing of gait and dual-attention task deficits in Parkinson's disease

People with Parkinson's disease (PD) can exhibit disabling gait symptoms such as freezing of gait especially when distracted by a secondary task. Quantitative measurement method of this type of cognitive-motor abnormality, however, remains poorly developed. Here we examined whether stepping-in-place (SIP) with a concurrent mental task (e.g., subtraction) can be used as a simple method for evaluating cognitive-motor deficits in PD. We used a 4th generation iPod Touch sensor system to capture hip flexion data and obtain step height (SH) measurements (z axis). The accuracy of the method was compared to and validated by kinematic video analysis software. We found a general trend of reduced SH for PD subjects relative to controls under all conditions. However, the SH of PD freezers was significantly worse than PD non-freezers and controls during concurrent serial 7 subtraction and SIP tasking. During serial 7 subtraction, SH was significantly associated with whether or not a PD patient was a self-reported freezer even when controlling for disease severity. Given that this SIP-based dual-task paradigm is not limited by space requirements and can be quantified using a mobile tracking device that delivers specifically designed auditory task instructions, the method reported here may be used to standardize clinical assessment of cognitive-motor deficits under a variety of dual-task conditions in PD.