节律性听觉注意刺激对帕金森病患者步态的影响

Effects of rhythmic auditory stimulation on the gait of patients with Parkinson＇ s disease

目的探讨节律性听觉注意刺激对帕金森病患者步态的影响。方法8例帕金森病患者（帕金森病组）和6名健康对照受试者（对照组）参与本研究。要求受试者完成以下2种条件下的步行：一是让受试者以自己感觉最舒适的速度自由步行2min，二是要求受试者注意聆听频率高于基线步频10％的节拍器的声音（即加载节律性听觉注意刺激）且按此节律步行。采用三维运动分析仪记录受试者2种条件下的步态参数，使用额叶功能评定量表和Stroop-3测试评估患者的执行能力。结果节律性听觉注意刺激明显提高了对照组的步频和步速，而帕金森病组步频明显提高，步长和步幅明显减小。在自由步行和加载节律性听觉刺激两种条件下，帕金森病组的步长、步幅和步速均显著低于对照组。听觉刺激减小了对照组的步速变异，增大了帕金森病组的步幅变异。自由步行条件下，2组受试者步态变异系数比较，差异无统计学意义；加载节律性听觉注意刺激后，帕金森病组的步长、步幅和步速变异系数明显高于对照组。执行能力测试显示，帕金森病患者存在执行能力障碍，且Stroop-3的错误率与加载听觉注意刺激条件下的步长呈显著负相关（r=-0．724，P=0．037）。结论外加高于基线步频10％的听觉注意刺激并不会改善帕金森病患者的步态，反而增加了患者的认知负荷，从而加剧步态紊乱，这可能是由于其执行功能障碍所致。

Objective To explore the effects of rhythmic auditory stimulation on the gait of patients with Parkinson＇s disease （PD）. Methods Eight patients with PD and six healthy control subjects were studied. All subjects walked as usual for 2 min and then walked for 2 min with rhythmic auditory attentional stimulation with a frequency 10% faster than their basic pace. The gait parameters in the two walking conditions were measured with three- dimension motion analysis equipment. In addition, executive function was evaluated using a frontal assessment battery （FAB） scale and the Stroop-3 test. Results In both walking conditions, average stride length and velocity were significantly lower in the PD patients than among the controls. The metronome at the higher frequency increased the cadence and stride velocity significantly in the controls, but in the PD patients it was associated with increased cadence but decreased stride length. With auditory stimulation, the variability of velocity decreased significantly in the controls, but the variability in stride length increased significantly in the PD patients. Even with the auditory stimulation, the variability in step length, stride length and velocity were still significantly higher in the PD patients than among the controls. Executive dysfunction was clearly evident in the PD patients. Stroop-3 error rates were significantly negatively correlated with step length in the condition involving auditory stimulation. Conclusion Auditory attentional stimulation at a higher frequency becomes a new cognitive load for PD patients, and it cannot improve their gait. This may be related to executive dysfunction.