Abstract
Background The optimal prescription of cueing for the treatment of freezing of gait (FoG) in Parkinson's disease (PD) is currently a difficult problem for clinicians due to the heterogeneity of cueing modalities, devices, and the limited comparative trial evidence. There has been a rise in the development of motion-sensitive, wearable cueing devices for the treatment of FoG in PD. These devices generally produce cues after signature gait or electroencephalographic antecedents of FoG episodes are detected (phasic cues). It is not known whether these devices offer benefit over simple (tonic) cueing devices. Methods We assembled 20 participants with PD and FoG and familiarized them with a belt-worn, laser-light cueing device (Agilitas™). The device was designed with 2 cueing modalities—gait-dependent or “phasic” cueing and gait-independent or “tonic” cueing. Participants used the device sequentially in the off, phasic, or tonic modes, across 2 tasks—a 2-minute walk and an obstacle course. Results A significant improvement in mean distance walked during the 2-minute walk test was observed for the tonic mode (127.3 m) compared with the off (111.4 m) and phasic (116.1 m) conditions. In contrast, there was a nonsignificant trend toward improvement in FoG frequency, duration, and course time when the device was switched from off to tonic and to phasic modes for the obstacle course. Conclusions Parkinson's disease patients with FoG demonstrated an improvement in distance walked during the two-minute walk test when a cueing device was switched from off to phasic and to tonic modes of operation. However, this benefit was lost when patients negotiated an obstacle course.
Highlights
Freezing of gait (FoG) is a common problem in people with Parkinson’s disease (PD) and affects up to 87% of patients who have lived with the disease for over 10 years [1]
Current treatments for FoG generally involve manipulation of daily levodopa dose and timing, coupled with exercise and physiotherapy. ere is promising evidence for amantadine, methylphenidate, and subthalamic nucleus stimulation for the management of FoG, as well as case report level evidence for serotonin and norepinephrine reuptake inhibitors (SNRIs) [3, 4]. e clinical benefit from these interventions is often limited, and a clear need exists for further research aimed at establishing the efficacy of alternate methods of FoG management
Directions is study suggests a superiority of tonic visual cueing over phasic or no visual cueing in a PD population with FoG when performing a 2-minute walk test in a simple environment
Summary
Freezing of gait (FoG) is a common problem in people with Parkinson’s disease (PD) and affects up to 87% of patients who have lived with the disease for over 10 years [1]. Cueing has long been recognized as a remarkably effective treatment in some patients with FoG [5]. Given the complex neurobiology of FoG, each patient may respond differently to different cue modalities (e.g., visual, auditory, somatosensory, or cognitive) [6]. An experimental study reported that visual cues were superior to auditory and vibration cues at assisting people with PD who had difficulties with gait initiation [7]. Much less is known about the efficacy of motion-triggered (phasic) cues for managing symptoms of FoG in people with PD. Ginis et al [8, 9] have identified that there are difficulties with the long-term consolidation and transfer of the effects of cueing and further explored the possibilities that exist with advancing technologies, for the management of FoG with external cueing
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