Abstract
New mobile technologies like smartglasses can deliver external cues that may improve gait in people with Parkinson’s disease in their natural environment. However, the potential of these devices must first be assessed in controlled experiments. Therefore, we evaluated rhythmic visual and auditory cueing in a laboratory setting with a custom-made application for the Google Glass. Twelve participants (mean age = 66.8; mean disease duration = 13.6 years) were tested at end of dose. We compared several key gait parameters (walking speed, cadence, stride length, and stride length variability) and freezing of gait for three types of external cues (metronome, flashing light, and optic flow) and a control condition (no-cue). For all cueing conditions, the subjects completed several walking tasks of varying complexity. Seven inertial sensors attached to the feet, legs and pelvis captured motion data for gait analysis. Two experienced raters scored the presence and severity of freezing of gait using video recordings. User experience was evaluated through a semi-open interview. During cueing, a more stable gait pattern emerged, particularly on complicated walking courses; however, freezing of gait did not significantly decrease. The metronome was more effective than rhythmic visual cues and most preferred by the participants. Participants were overall positive about the usability of the Google Glass and willing to use it at home. Thus, smartglasses like the Google Glass could be used to provide personalized mobile cueing to support gait; however, in its current form, auditory cues seemed more effective than rhythmic visual cues.
Highlights
New mobile technologies like smartglasses can deliver external cues that may improve gait in people with Parkinson’s disease in their natural environment
Using Android Studio, we developed an app for Glass (Explorer version 2, XE 22.0, Android 4.0?) (Fig. 1a) that delivered three possible audiovisual cues (metronome, Table 1 Clinical characteristics of the subjects (N = 12) including scores for the Unified Parkinson’s disease rating scale Part III (UPDRS III, score/132), Hoehn and Yahr, New Freezing of Gait Questionnaire (N-FOGQ, score/ 33), Frontal Assessment Battery (FAB, score/18) and daily levodopa dosage
There was a high variability in freezing of gait (FOG) and gait performance within and amongst the participants
Summary
The subjects fine-tuned the cueing frequency for the app according to their preferred walking speed by performing one to two test runs on a 10-m walk for each of the three different cues. While wearing Glass, the subjects performed a series of walking tasks on four different walking courses (Fig. 1c) in combination with four cueing conditions (no cue, metronome, LED, and optic flow). The order of the walking courses and cueing conditions were predetermined using a random number generator without replacement by ES. Each parameter was modeled as a linear mixed model with two crossed within-patient factors (cue and walking course, each with four levels) and their interaction as fixed effects. The cueing frequency selected by the patient was added as a between-subjects fixed effect. Two independent raters categorized patient responses from voice recordings of the interviews and resolved any disagreements through discussion
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