Self-triggered assistive stimulus training improves step initiation in persons with Parkinson's disease

Robert A. Creath, Michelle Prettyman, Lisa Shulman, Marjorie Hilliard, Katherine Martinez, Colum D. MacKinnon, Marie Laure Mille, Tanya Simuni, Jane Zhang, Mark W. Rogers

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Prior studies demonstrated that hesitation-prone persons with Parkinson's disease (PDs) acutely improve step initiation using a novel self-triggered stimulus that enhances lateral weight shift prior to step onset. PDs showed reduced anticipatory postural adjustment (APA) durations, earlier step onsets, and faster 1st step speed immediately following stimulus exposure. Objective. This study investigated the effects of long-term stimulus exposure. Methods. Two groups of hesitation-prone subjects with Parkinson's disease (PD) participated in a 6-week step-initiation training program involving one of two stimulus conditions: 1) Drop. The stance-side support surface was lowered quickly (1.5 cm); 2) Vibration. A short vibration (100 ms) was applied beneath the stance-side support surface. Stimuli were self-triggered by a 5% reduction in vertical force under the stance foot during the APA. Testing was at baseline, immediately post-training, and 6 weeks post-training. Measurements included timing and magnitude of ground reaction forces, and step speed and length. Results: Both groups improved their APA force modulation after training. Contrary to previous results, neither group showed reduced APA durations or earlier step onset times. The vibration group showed 55% increase in step speed and a 39% increase in step length which were retained 6 weeks post-training. The drop group showed no stepping-performance improvements. Conclusions: The acute sensitivity to the quickness-enhancing effects of stimulus exposure demonstrated in previous studies was supplanted by improved force modulation following prolonged stimulus exposure. The results suggest a potential approach to reduce the severity of start hesitation in PDs, but further study is needed to understand the relationship between short- and long-term effects of stimulus exposure.

Original languageEnglish (US)
Article number11
JournalJournal of NeuroEngineering and Rehabilitation
Issue number1
StatePublished - 2013

Bibliographical note

Funding Information:
Supported by National Institutes of Health grant number 1R21HD055386, M. W. Rogers, P.I., and the National Institute on Aging (NIA) Claude D. Pepper Older Americans Independence Center P30-AG028747.


  • Freezing
  • Hesitation
  • Initiation
  • Intervention
  • Parkinson's
  • Step


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