Exploring the Mechanisms Underlying the Compensation Strategies for Gait Impairments in Parkinson’s Disease using Electroencephalography

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Individuals with Parkinson’s disease often modify their behavior to compensate for their gait impairments. This compensation behavior is also referred to as compensation strategies. However, the underlying mechanisms of such compensation strategies and how these mechanisms enhance gait remain unexplained. In this study it is hypothesized that compensation strategies enhance gait by switching from automatic gait control towards goal-directed gait control, presumably requiring increased cortical activation. Moreover, it is expected that different compensation strategies show different cortical activation patterns. The data was recorded using a high-density electroencephalography. In total 18 individuals with Parkinson’s disease were included in the study and recorded during two different tasks (standing and treadmill walking), while performing three different compensation strategies (internal cueing, external cueing, and action observation) and a control condition involving no strategy. The data was analyzed using independent component analysis to separate electrocortical brain activity from physiological artifacts and other spurious signals. The obtained brain-related independent components were grouped across participants into 10 different clusters. Within each cluster the significant difference between the control condition and strategy-specific gait was computed using a two-tailed t-test for repeated measure and a non-parametric permutation test. The results show that there is an increased cortical activation as a result of increased recruitment of various cortical areas when using compensation strategies in contrast with no strategy. This is in line with the current field suggesting that a goal-directed approach enhances the cortical activation due to the recruitment of compensational underlying mechanisms. Moreover, it is shown that the different strategies recruit different cortical regions. This provides more insight into how the different compensation strategies influence the underlying mechanisms that presumably influence the enhancement of gait impairments.
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