The Relationship between Freezing of Gait and Executive Dysfunction in Patients with Parkinsonʼs Disease

Abstract

  I briefly reviewed the rehabilitation of gait disorders, especially freezing of gait (FOG) , in patients with Parkinson's disease (PD) and considered applications of cue techniques, including external and internal cueing. The therapeutic intervention methods give each different system a chance to start movements, for example gait. The different systems are the external loop, including the cerebellum, parietal cortex and lateral premotor cortex, and the internal loop, which includes the basal ganglia and supplementary motor area. The external loop starts the movement to induce external stimulation during the processing of voluntary movement. The internal loop voluntarily activates well-learned and self-guided movements. Interventions for external cueing are widely known, but those for internal cueing remain unclear. However, techniques for external cueing may not be effective because of executive dysfunction. On the other hand, internal rhythmic exercises, such as tapping for spontaneous exercise, are performed poorly by PD patients. For internal rhythm formation disorders, the effectiveness of internal cueing has also been reported in recent years. I summarized why such a complex phenomenon occurs based on a neural network specific to PD patients. In addition, I will introduce some of our studies and case reports on the internal cue approach. This paper confirms the importance of therapeutic intervention tailored to each individual PD patient.