Effects of dual task training and treadmill training on physical and cognitive functions in patients with parkinson's disease

Objective: The ability to perform multi-tasking procedures, which is crucial in daily life, is impaired in patients with Parkinson Disease. Conventional rehabilitation approaches are mostly based on balance and walking trainings but patients with Parkinson Disease depends on performing multiple tasks like any other individual. Dual-task (DT) training is a methodology which mainly focuses on perfoming two tasks simultaneously. In this study, our goal was to detect the effects of DT training with treadmill training on walking and balance and to compare its effects on quality of life, cognitive functions and risk of fall, to treadmill training in addition to conventional exercises and conventional exercises alone. Patients and Methods: Forty-five patients with Idiopathic Parkinson's Disease who admitted to Istanbul University Istanbul Faculty of Medicine Neurologic Rehabilitation Unit were included in this prospective, randomized, controlled, double-blinded study. The patients were randomized to three groups as; Dual task (DT) group (DTG, n=15), single task (ST) group (STG, n=15) and control group (n=15). All of the patients were scheduled on standard exercise programme. The patients in DTG received treadmill training with cognitive tasks and the patients in STG received treadmill training alone in addition to standard exercise programme. The training was scheduled as 30 minute sessions under supervision of a specialist, three times in a week for four weeks. All of the assessments and treadmill training sessions was carried out in "on" period, 1 hour after patients received their medication. Primary outcomes were; comfortable speed walking test and 10-meters walking speed test with cognitive tasks for assessment of walking speed, Timed Up and Go test for balance, Montreal Cognitive Assessment (MoCA) for cognition. Secondary outcomes were assessments of Freezing of Gait Questionnaire (FOGQ) for freezing, International Falls Efficacy Scale (FES-I) for fear of fall, Falls Diary for fall counts, Stroop Test for executive functions, Parkinson's Disease Questionnaire (PDQ-39) for quality of life. These tests were performed at the time recruitment in the study, after the 4-week schedule (4th week) and 3 months after the training schedule was ended (16th week). Findings: There was a statistically significant increase in comfortable walking speed in DTG; compared to control group, immediately after the treatment and 3 months after the treatment. In STG, a significant increase in comfortable walking speed was detected only immediately after the treatment. A significant increase in dual walking speed after the treatment and 3 months after the treatment was observed in both DT and ST groups. A statistically significant imrovement was detected in all groups in TUG, FOGQ and FES-I tests after the treatment. There was a significant decrease in FOGQ test in DTG, compared to control group 3 months after the treatment. No increase was observed in fall counts in any of the groups. There was a significant decrease in PDQ-39 total score in all of the groups and a significant decrease was observed in DT and ST groups compared to control group 3 months after the treatment. There was a significant decrease in PDQ-39 emotional well being, cognitions and bodily discomfort scores in all groups after the treatment. In DTG; compared to control group, a significant increase was observed in PDQ-39 cognitions score after the treatment and 3 months after the treatment, and in PDQ-39 communications score after the treatment. A significant increase was also detected in PDQ-39 mobility and cognitions scores after the treatment in DTG, compared to STG. There was a significant improvement in MoCA scores in DTG, compared to ST and control groups, after the treatment and after 3 months. Reading time in Stroop 1 was lowered in DTG after the treatment and after 3 months. There was also a significant improvement in DTG, compared to control group, in Stroop 2 reading time, at 3 months after treatment. In STG, improvement in reading time was observed after the treatment compared to control group. A significant decrease was observed in DTG after the treatment and after 3 months in Stroop 3 reading time and mistake counts. There was a statistically significant decrease in mistake counts in DTG, compared to STG, immediately after the treatment and after 3 months. There was also a significant decrease in reading time and mistake counts in DTG, compared to control group, after 3 months. Results: Comfortable walking speed was improved with DT and ST training in patients with Parkinson Disease. DT training was found to be superior to conventional exercises by means of comfortable walking speed and freezing of gait after 3 months. No benefit was observed in functional balance, neither in DTG nor in STG, compared to control group. An improvement in fear of falling was observed in all groups, and there were no increase in fall counts. Dual-task training was found to be beneficial for motor, cognitive and executive functions. In our study, quality of life was improved in patients receiving either treadmill training or conventional exercises. Both DT and ST training were found to be equally beneficial for improving the quality of life or decreasing fear of falling or the freezing of gait. Dual-task training, which is a safe methodology that have beneficial effects on walking performance, cognitive functions, balance, fall couns and fear of fall, is a decent treatment of choice in patients with Parkinson Disease.