Exploring Outcome Differences of a Rhythmic Auditory Stimulation-enhanced Walking Program for Veterans with Parkinson’s Disease with and Without Subthalamic Nucleus Deep Brain Stimulation
Alexandria Umbarger1, Sandra Kletzel1, Christine Jelinek1, Sadie Walker1, Katie Burress Kestner1, Kelly Krese1, Blake McReavy1, Miloni Shah1, Frances Weaver1, Kalea Colletta1
1Edward Hines Jr. VA Hospital
Objective:

Explore outcome differences of a 12-week home-based RAS-enhanced walking program completed by Veterans with PD with and without STN-DBS.

Background:

Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for some motor symptoms of Parkinson’s disease (PD) due to mitigation of beta oscillations. Rhythmic auditory stimulation (RAS)-enhanced gait training is known to improve gait and motor dysfunction in PD through external cueing but has not been well-studied when paired with STN-DBS. Internal cueing from STN-DBS coupled with external cueing from music may potentially contribute to further mitigation of beta oscillations and therefore confer enhanced benefits.

Design/Methods:

Veterans were instructed to walk 30-45 minutes, three times per week, listening to a personalized RAS-enhanced music playlist and wearing a FitBit to track activity. Weekly phone calls were made by an exercise coach to assess safety and compliance during the intervention. Motor and neuropsychological assessments were collected pre-, mid-, and post-intervention.

Results:

Currently, one (female) Veteran with STN-DBS and four (three male; one female) Veterans without STN-DBS have completed the intervention. The MDS-UPDRS Motor III Subscale score improved in all 5 participants from baseline to endpoint, with the STN-DBS participant demonstrating superior overall improvements. Timed Up and Go (TUG) improved in all participants from baseline to midpoint, with only the STN-DBS participant improving from midpoint to endpoint. The seven-day average total step count reported by the FitBit increased in all participants from baseline to endpoint. Data collection is ongoing.

Conclusions:
A 12-week home-based, personalized RAS-enhanced walking program was safe and contributed to an improvement in motor function in both DBS and non-DBS PD Veterans, while increasing overall activity. The STN-DBS patient demonstrated superior overall improvements on the MDS-UPDRS Motor III Subscale and TUG, suggesting potential enhanced benefits of STN-DBS plus RAS-enhanced gait training compared to RAS-enhanced gait training in PD patients without STN-DBS. 
10.1212/WNL.0000000000206691