Investigator:
Franchino Porciuncula, PT, DScPT, EdD
Name of Institution:
Trustees of Boston University, CRC
Project Title:
Does rhythmic auditory stimulus reduce the cognitive demands of walking in Parkinson’s disease?
Investigator Bio:
Dr. Porciuncula is a Research Assistant Professor at Sargent College of Health & Rehabilitation Sciences at Boston University. Trained as a Physical Therapist and as a rehabilitation scientist, Dr. Porciuncula’s research focuses on developing innovative gait rehabilitation interventions in Parkinson’s disease (PD) by targeting biomechanical, cognitive, and behavioral processes that underlie gait dysfunction. His research seeks to develop and leverage next-generation wearable technologies including sensors, robotics and digital health solutions to improve gait outcomes in PD.
Dr. Porciuncula received his Doctorate in Movement Sciences (Motor Learning & Control) from Columbia University. He completed a Post-Doctoral Fellowship in clinical biomechanics from Harvard University, focusing on the development of wearable robots to improve walking in neurological disorders, including PD. At Harvard, he co-led a study with Professors Conor Walsh (Harvard) and Terry Ellis (Boston University) on the use of robotic apparel to avert freezing of gait in PD, which was published recently in Nature Medicine. At Boston University, Dr. Porciuncula was Principal Investigator for a recently completed randomized controlled trial that examined the effects of a novel autonomous music-based rhythmic auditory stimulation (RAS) intervention on real-world walking in people with PD. Dr. Porciuncula’s work has been recognized through awards from the National Institutes of Health/ National Institute on Aging and The Michael J. Fox Foundation.
Objective:
To examine the effects of rhythmic cues on cognitive demands as indexed by brain activation during walking.
Background:
Walking is one of the most accessible and effective ways to exercise – an important component of PD management. However, walking in PD is attention-demanding on its own. The loss of walking automaticity increases cognitive (attention) demands during walking, leading to compromised walking quality and stability, which ultimately impedes overall mobility. Innovative solutions are urgently needed to reduce cognitive load thereby facilitating automaticity during daily walking. Rhythmic auditory stimulation (RAS) has important therapeutic value in promoting stepping rhythmicity, walking quality, and overall stability – benefits that are useful in promoting real-world walking in PD. Currently RAS is not widely employed to help walking in PD, largely due to uncertainty of whether RAS increases or decreases cognitive demands during walking.
Methods/Design:
In this project, we will enroll 30 people with PD. Our study protocol involves walking with and without RAS. Under each walking condition, we will study brain activation using functional near infrared spectroscopy (fNIRS), which is a non-invasive mobile brain imaging technique. Additionally, we will use wearable sensors to precisely measure leg movements during walking. Together, our measurements of brain activation and leg movements will give us a thorough examination of walking automaticity and its response to rhythmic cueing via RAS. Finally, we will administer standard cognitive assessments to characterize our sample. These tests on cognition will allow us to examine whether baseline cognitive/attentional abilities have an impact on response to RAS.
Relevance to Diagnosis/Treatment of Parkinson’s Disease:
Interventions that reduce cognitive processing during walking are critically needed in developing sustainable interventions that will promote daily walking and quality of life in PD. RAS has the potential to serve as assistive technology for facilitating motor automaticity during daily walking in people with PD. The robust application of RAS during real-world use will depend on whether RAS reduces cognitive/attentional capacity. fNIRS is a promising brain imaging technique that can elucidate brain-behavior mechanisms underlying RAS. This study will elucidate processes related to walking automaticity in PD, thereby allowing gait rehabilitation in PD to be more effective.