A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease

Abstract

Freezing of gait is one of the most debilitating symptoms of Parkinson’s disease and is an important contributor to falls, leading to it being a major cause of hospitalization and nursing home admissions. When the management of freezing episodes cannot be achieved through medication or surgery, non-pharmacological methods such as cueing have received attention in recent years. Novel cueing systems were developed over the last decade and have been evaluated predominantly in laboratory settings. However, to provide benefit to people with Parkinson’s and improve their quality of life, these systems must have the potential to be used at home as a self-administer intervention. This paper aims to provide a technological review of the literature related to wearable cueing systems and it focuses on current auditory, visual and somatosensory cueing systems, which may provide a suitable intervention for use in home-based environments. The paper describes the technical operation and effectiveness of the different cueing systems in overcoming freezing of gait. The “What Works Clearinghouse (WWC)” tool was used to assess the quality of each study described. The paper findings should prove instructive for further researchers looking to enhance the effectiveness of future cueing systems.

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

“…Nine of 12 participants were willing to use Google Glass at home to address FOG. Recently, Sweeney et al reviewed wearable cueing devices delivering visual, auditory or vibration cue and addressing FOG in PD in recent years, and found that cueing was generally effective and promising [163]. However, it should be noted that some devices although seems promising, efficacy of various cueing devices need to be further tested outside the home or laboratory and in a larger PD patients with FOG.…”

“…Multicenter, double-blind, placebo/sham-controlled randomized trials are needed to confirm theses exciting and promising findings. Of physiotherapy, wearable cueing devices was generally effective and promising [163]. However, the efficacy of various cueing devices need to be further tested outside the home or laboratory and in a larger PD patients with FOG.…”

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

“…This results in increased neuronal firing activity in the output nuclei of the basal ganglia that leads to excessive inhibition of thalamo-cortical and brainstem motor systems which, in turn, interferes with movement onset and execution [28,29]. (B) Representation of brain areas activated during external cueing reported from findings of image analysis studies conducted on people with PD during cueing experiments [17,[30][31][32].…”

“…The hypothesized neural mechanism for external cueing, suggested by Morris et al [92], bypasses the hypoactive basal ganglia-supplementary motor cortex (SMA) circuit by slightly altering the way the neural circuits control movement in individuals with PD [31,35,99]. In general, sensory cues are known to enable the dorsolateral pre-motor control system [30,32,63] which bypasses the SMA that is deficient in PD. Specifically, it has been suggested that auditory cues help in improving the temporal parameters, such as cadence and gait speed, and that external cues help because they are able to bypass the internal rhythm deficit associated with PD.…”

“…For people in the early stage of disease severity, external cues can compensate for small deviations from their normal gait pattern thereby maintaining optimal gait quality and preventing deconditioning through training. Severely affected individuals with PD rely on external cues to compensate for deficits in the automatic control mechanisms (i.e., the ability to automatically generate normal stride length in a timely manner) thus improving gait and reducing the incidence of falls and freezing of gait [30,32,37,55].…”