An architecture for reducing the freezing of gait during the daily life of patients with Parkinson's disease

Abstract

Introduction: In consideration of population aging and budget limitation for the health systems, growing attention should be paid to low-cost care instruments aimed at fostering the patient’s independence. Especially in the case of neurodegenerative diseases such as Parkinson’s Disease: in fact, some of its symptoms (such as freezing) can be contrasted applying simple interventions: timely sensory cues [1], should be provided as soon as the event occurs, be recurrent and not lead to tolerance. In order to avoid habituation, the cues, even being of the same nature, like sounds and rhythm [2], should change at each delivery. In the perspective of allowing autonomy, the actions of recognition of the problem and generation of the cues should take place during the patients’ ordinary everyday life and without the intervention of human assistants, like therapists or carers; moreover, they should exploit devices able to reliably perform both actions, thus producing a “behavioral” learning in the patient [3]. The scientific literature has proposed devices that are able to recognize freezing of gait or to generate acoustic cues in order to facilitate walking, though none of such systems proved to be suitable to a full integration into the activity of daily life [4]. In this regard, at least two requisites should be met under the technical and ecological point of view: the usability of the device and its acceptability. Acceptability [5] implies that devices are noninvasive and nonembarrassing for the wearer, since they cannot be recognized as tools for care from either their aspect or mode of operation. With the fulfillment of these requirements, in addition to the patient’s functional benefit, the opportunity of recording events and their solutions would be satisfied, while continuously monitoring the patients. In thisway, quantitative data, potentially useful for better understanding the phenomenon of “freezing”, could be easily collected in order to clarify mechanisms which are not yet completely known [6]. Methods: This paper presents the preliminary results of the experiments carried out in a controlled environment in order to verify the reliability of awearable systemarchitecture thathasbeen defined in relation to the requirements set out above. The system is based on a smartphone, as an ecologically acceptable device, of which it uses: