Abstract
Background: The sequence effect (SE), referring to step-to-step reduction in amplitude, is considered to lead to freezing of gait (FOG) in Parkinson's disease (PD). Visual cues may alleviate SE and help reduce freezing episodes. FOG patients show significant SE prior to turning or toward a doorway, but the SE toward a destination has not been clearly studied.Objectives: To examine the SE when approaching a destination in PD patients with FOG, and to further explore the effects of different types of visual cues on destination SE.Methods: Thirty-five PD patients were divided into a freezing (PD+FOG, n = 15) group and a non-freezing (PD–FOG, n = 20) group. Walking trials were tested under three conditions, including without cues (no-cue condition), with wearable laser lights (laser condition), and with transverse strips placed on the floor (strip condition). Kinematic data was recorded by a portable Inertial Measurement Unit (IMU) system. The destination SE and some key gait parameters were evaluated.Results: The PD+FOG group showed greater destination SE in the no-cue and laser conditions when compared to the PD–FOG group. There were no significant differences in the strip condition when comparing destination SE of the two groups. The destination SE was alleviated only by using the transverse strips on the floor. In contrast, transverse strips and wearable laser lights could increase the step length.Conclusions: The significant destination SE may explain why FOG patients are prone to freezing when heading toward their destination. Visual cues using transverse strips on the floor may be a more effective strategy for FOG rehabilitation in PD patients.
Highlights
Freezing of gait (FOG), defined as “a brief, episodic absence or a marked reduction of forward progression of the feet despite the intention to walk” [1], is a debilitating symptom in Parkinson’s disease (PD)
The PD+FOG group and the PD–FOG group were well-matched for age and height (p = 0.057 and p = 0.434, respectively)
There were no significant differences in Mini-Mental State Examination (MMSE) (p > 0.05) between the two groups, while the Montreal Cognitive Assessment-Basic (MoCA-B) and Geriatric Depression Scale (GDS) score of the PD+FOG group was significantly higher than that of the PD– FOG group (p = 0.011 and p = 0.001, respectively)
Summary
Freezing of gait (FOG), defined as “a brief, episodic absence or a marked reduction of forward progression of the feet despite the intention to walk” [1], is a debilitating symptom in Parkinson’s disease (PD). The phenomenon of gradual step to step reduction is termed sequence effect (SE), which may attribute to the inability of basal ganglia (BG) to provide timing cues and is believed to cause FOG in PD patients [11, 12]. Chee et al reported that FOG episodes were induced more frequently through voluntarily diminishing step length if a significant SE was co-existent in the PD patient [14]. The sequence effect (SE), referring to step-to-step reduction in amplitude, is considered to lead to freezing of gait (FOG) in Parkinson’s disease (PD). FOG patients show significant SE prior to turning or toward a doorway, but the SE toward a destination has not been clearly studied
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