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Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation

Daniel S. Peterson, Laurie A. King, Rajal G. Cohen, Fay B. Horak
DOI: 10.2522/ptj.20140603 Published 1 May 2016
Daniel S. Peterson
D.S. Peterson, PhD, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon, and Department of Neurology, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (USA).
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Laurie A. King
L.A. King, PT, PhD, Veterans Affairs Portland Health Care System (VAPORHCS) and Department of Neurology, School of Medicine, Oregon Health and Science University.
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Rajal G. Cohen
R.G. Cohen, PhD, Department of Psychology and Communication Studies, University of Idaho, Moscow, Idaho.
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Fay B. Horak
F.B. Horak, PT, PhD, Veterans Affairs Portland Health Care System (VAPORHCS) and Department of Neurology, School of Medicine, Oregon Health and Science University.
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Figures

Figure 1.
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Figure 1.

Overlap across models of executive function30 and attention.31,32 Domains within each model are grouped to show similarity among models (eg, inhibition, executive control, and selective attention). The domains in the shaded red box (broadly: inhibition and divided/switching attention) are most commonly dysfunctional in people with Parkinson disease (PD) who freeze. Dysfunction of these domains can lead to changes in functional mobility and falls in this population.

Figure 2.
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Figure 2.

(A) Example of task prioritization during agility training. The patient completes a secondary cognitive task during agility training and is instructed to switch prioritization between the mobility/stepping component (left) and the cognitive component (right). (B) Example of visual-auditory cue conflict during boxing. Simultaneously, the instructor visually cues for a left punch and verbally cues for a right punch. For this trial, the patient is instructed to respond to the visual cue only and ignore the auditory cue.

Tables

Table 2.
Table 2.

Examples of Cognitive Domains Associated With Freezing and Exercises That Challenge These Deficits

Table 1.
Table 1.

Common Examinations to Assess Domains of Executive Function, Attention, and Visuospatial Function

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Vol 96 Issue 5 Table of Contents
Physical Therapy: 96 (5)

Issue highlights

  • Group Versus Individual Physical Therapy for Veterans With Knee Osteoarthritis: Randomized Clinical Trial
  • What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis
  • Identifying Patients With Chronic Low Back Pain Who Respond Best to Mechanical Diagnosis and Therapy: Secondary Analysis of a Randomized Controlled Trial
  • Therapeutic Exercise Training to Reduce Chronic Headache in Working Women: Design of a Randomized Controlled Trial
  • Effects of Nonpharmacological Interventions for Dizziness in Older People: Systematic Review
  • Effects of Cooling During Exercise on Thermoregulatory Responses of Men With Paraplegia
  • Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation
  • Neck Pain and Proprioception Revisited Using the Proprioception Incongruence Detection Test
  • 10-m Shuttle Ride Test in Youth With Osteogenesis Imperfecta Who Use Wheelchairs: Feasibility, Reproducibility, and Physiological Responses
  • Tonic Stretch Reflex Threshold as a Measure of Ankle Plantar-Flexor Spasticity After Stroke
  • Diaphragm Pacing as a Rehabilitative Tool for Patients With Pompe Disease Who Are Ventilator-Dependent: Case Series
  • NF-κB Signaling Pathway in Controlling Intervertebral Disk Cell Response to Inflammatory and Mechanical Stressors
  • Mechanotransduction: Relevance to Physical Therapist Practice—Understanding Our Ability to Affect Genetic Expression Through Mechanical Forces
  • Developmental Biology and Regenerative Medicine: Addressing the Vexing Problem of Persistent Muscle Atrophy in the Chronically Torn Human Rotator Cuff
  • Neural Stem Cell Therapy and Rehabilitation in the Central Nervous System: Emerging Partnerships
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Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation
Daniel S. Peterson, Laurie A. King, Rajal G. Cohen, Fay B. Horak
Physical Therapy May 2016, 96 (5) 659-670; DOI: 10.2522/ptj.20140603

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Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation
Daniel S. Peterson, Laurie A. King, Rajal G. Cohen, Fay B. Horak
Physical Therapy May 2016, 96 (5) 659-670; DOI: 10.2522/ptj.20140603
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  • Article
    • Abstract
    • Mobility Requires Cognitive Function
    • Models of Executive Function and Attention
    • Altered Cognition Affects Mobility in Patients With PD Who Freeze
    • Attention
    • Executive Function
    • Visuospatial Function
    • Combining Cognitive and Exercise Training for People With PD Who Freeze
    • Integrating FoG-Specific Cognitive Training With Mobility Training
    • Summary and Conclusions
    • Footnotes
    • References
  • Figures & Data
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  • Education Research in Physical Therapy: Visions of the Possible
  • Seven-Step Framework for Critical Analysis and Its Application in the Field of Physical Therapy
  • Medical Marijuana: Just the Beginning of a Long, Strange Trip?
Show more Neurology

Subjects

  • Neurology/Neuromuscular System
    • Parkinson Disease and Parkinsonian Disorders
  • Perspectives
  • Musculoskeletal System/Orthopedic
    • Gait Disorders

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