Overview
The purpose of this research study is to examine the effects of a 3-month personalized community-based walking program called MyMusiQ. The study uses music cues delivered through a digital device in people with Parkinson disease (PD). The investigators want to know if personalized music cueing through the digital device can improve walking quality, walking ability, daily walking amount and intensity, and quality of life, while helping walking feel more automatic and require less mental effort. Participants will take part in this research study for approximately 18 weeks in total. During this time, participants will complete 4 study visits at designated research centers at Boston University, Washington University in St. Louis, or the University of Utah, depending on the site of enrollment.
Description
The overall goal of this 3-month single-arm multi-center repeated baselines study (N=162) is to examine the effects of a personalized closed-loop music-based digital gait intervention on improving gait quality, capacity, real-world walking performance, and gait automaticity in Parkinson disease (PD). This study builds on a stepwise investigation beginning with a proof-of-concept feasibility study (N=23) followed by a 6-week randomized controlled trial (RCT; N=44). This mechanistic-focused study will examine the substrates of a personalized approach that underlie changes in walking outcomes, as well as identify determinants that determine responsiveness to the intervention. This study is a critical next step to elucidate mechanistic understanding of closed-loop personalized gait approaches and to determine those with PD who benefit most.
The main aims of this mechanistic study seek to examine whether a personalized closed-loop gait intervention improves gait quality, walking capacity, and real-world walking performance beyond baseline variability, and to assess how personalized features influence targeted gait outcomes (Aim 1). Additionally, this study will investigate the effects of the intervention on improving gait automaticity (Aim 2), and identify baseline determinants that predict responsiveness and durability to the intervention on walking capacity (Aim 3). The investigators hypothesize that the intervention will meaningfully improve gait quality (speed, stride length), walking capacity (6-Minute Walk Test), and real-world walking performance (walking intensity and amount) during cued and uncued walking during and after intervention. Furthermore, they hypothesize improvements in gait automaticity (reduced gait variability, dual-tasking costs) following the intervention, and that individuals with worse baseline cognitive-motor capacities may benefit more.
This study will utilize a digital music device (MedRhythms, Inc., Portland, ME). To examine the effects of the intervention, the investigators will use clinical measures of motor and gait function, and quantified movement data on walking using wearable sensors. This study will be implemented by carrying out the following study visits: (1) Primary screen over the phone, (2) In-Person Screening and Baseline Assessment #1, (3) Baseline Assessment #2 (2-3 weeks after Baseline Assessment #1) (4) Personalized, Closed-Loop Music-Based Gait Intervention (3 months) (5) Post-Intervention Assessment (immediately after the intervention, about 3 months), and (6) Durability / Follow-Up Assessment (about 1 month post-intervention). Altogether, these procedures may take about 4 months.
Eligibility
Inclusion Criteria:
- Self-report of diagnosis of typical Parkinson disease determined by a medical doctor
-≥ 40 years of age
- Community-dwelling (e.g. home, independent living, senior housing)
- Have stable PD medications for at least two weeks prior to enrollment
- Modified Hoehn and Yahr stages 1-3 per physical exam by a licensed physical therapist
- Able to walk independently without physical assistance for at least 10 minutes (assistive devices allowed with reciprocal gait pattern)
- Willing and able to provide informed consent
- Provide HIPAA Authorization to allow communication with the primary healthcare provider for communication (as needed) during the study period
Exclusion Criteria:
- \< 40 years of age
- Diagnosis of atypical Parkinsonism
- Modified Hoehn and Yahr stages 4-5
- Significantly disturbing freezing episodes during daily walking based on the New Freezing of Gait Questionnaire (Part III Item 7)
- Fall frequencies \>1x/week on average, over the past month.
- Currently participating in physical therapy for Parkinson gait rehabilitation
- Currently performing walking exercise at moderate intensities or higher for at least 30 min. per session ≥ 3x/week
- Self-reported cardiac problems that interfere with the ability to safely exercise (e.g., congestive heart failure, uncontrolled cardiac arrhythmias, chest pain;
- Orthopedic problems in the lower extremities or spine that may limit walking distance (e.g., severe arthritis, spinal stenosis, or significant pain)
- Any other medical conditions that would preclude successful participation as determined by the researcher/ physical therapist
- Cognitive impairment (i.e., Montreal Cognitive Assessment, MoCA \< 21)
- Unable to walk independently (i.e., without physical assistance) at a comfortable speed ≥ 0.4m/s as measured using the 10-meter Walk Test (10mWT) as examined in Baseline #1
- Resting tachycardia (\> 100 beats/min) or uncontrolled blood pressure (resting systolic BP \> 160 mmHg or diastolic BP \>100 mmHg)) as measured by the researcher/ physical therapist
- Unable to independently use the music-based digital therapeutic during training
- Significant hearing impairment
