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Improvement in Gait Performance after Training Based on Declarative Memory Cues in Patients with Parkinsons Disease: A Randomized Clinical Trial

Maria Elisa Pimentel Piemonte, Erika Okamoto, Carina Assis Ruggiero Cardoso, Tatiana de Paula Oliveira, MS, Camila Souza Miranda, Marina Rigolin Pikel, Felipe Augusto dos Santos Mendes and Gilberto Fernando Xavier

Background: Deficits in automatic motor control, a typical feature of Parkinson’s disease (PD), contribute to progressive impairment in gait performance. The use of declarative memory cues in order to promote the engagement of attention and activation of the next movement in gait may minimize the consequences of lack of automatic control.

Objectives: To verify the long-term efficiency of a new strategy based on declarative memory cues to improve the gait performance and independence in activities of daily living (ADL) in patients with PD.

Design: Parallel prospective, single blind, randomized clinical trial.

Setting: Brazil Parkinson Association.

Participants: Forty-four patients with PD in stages 2-3 of disease evolution according to Hoehn and Yahr Classification.

Interventions: The experimental training (ET) consisted of eight gait training sessions, twice a week, using the declarative memory cue strategy (DMCS). The control training (CT) consisted of a similar gait training without DMCS.

Primary outcome measure: Gait performance in terms of speed and stride length.

Secondary outcome measure: Independence in ADL according to Section II of the Unified Parkinson’s Disease Rating Scale.

Randomization: Participants were randomized into a control group (CG), which performed the CT, and an experimental group (EG), which performed the ET, through blinded drawing of names.

Statistical analysis: Gait performance and independence in ADL before, 2 and 60 days after the end of training were compared for CG and EG using RM-ANOVA.

Results: RM-ANOVA revealed a significant improvement of the gait performance in terms of speed and stride length and independence in ADL, remained until 2 months after the end of training, exclusively for the EG after ET.

Conclusion: Gait training associated to declarative memory cues promotes significant long-term improvements in gait performance and can be considered a new useful strategy to compensate the deficiency in automatic motor control of gait in PD patients.