Advantages of timing the duration of a freezing of gait-provoking test in individuals with Parkinson’s disease

Herman, Talia; Dagan, Moria; Shema-Shiratzky, Shirley; Reches, Tal; Brozgol, Marina; Giladi, Nir; Manor, Brad; Hausdorff, Jeffrey M.

doi:10.1007/s00415-020-09856-7

Cited by 8 publications

(20 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although tDCS did not affect FOG‐provoking test performance, it was associated with reduced self‐reported FOG severity immediately after the intervention. This discrepancy between in‐laboratory tests and self‐report is not surprising because low correlations between the two forms of evaluation have been reported previously 20,29 . Although self‐reported outcomes may be prone to relatively large test–retest error, 29 these results suggest that tDCS might be able to positively impact FOG, but that a larger “dose” (ie, the number, intensity, and/or frequency of stimulation sessions) may be needed to induce larger between‐group changes within laboratory‐based FOG‐provoking tests.…”

Section: Discussionmentioning

confidence: 88%

“…This discrepancy between in-laboratory tests and self-report is not surprising because low correlations between the two forms of evaluation have been reported previously. 20,29 Although self-reported outcomes may be prone to relatively large test-retest error, 29 these results suggest that tDCS might be able to positively impact FOG, but that a larger "dose" (ie, the number, intensity, and/or frequency of stimulation sessions) may be needed to induce larger between-group changes within laboratory-based FOG-provoking tests. Future trials should consider the use of longer interventions, additional methods of capturing FOG including the percent of freezing during daily living activities, 30,31 and diaries by participants and/or their caregivers.…”

Section: Discussionmentioning

confidence: 98%

“…Motivated by the positive effects of our pilot study, 17,19 the primary FOG outcome was the FOGprovoking test performance score (FOG severity score) after the intensive phase (ie, after 10 sessions of tDCS given over 2 weeks) in the on medication state. 19 Secondary outcomes included additional measures derived from the FOG-provoking test (ie, FOG episodes number, percentage total test time frozen, and total time to complete the test 20 ), the Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III, 21 the Timed Up and Go, 22 a computerized executive function battery (Neurotrax Inc.), 23 and an accelerometer that captured 7-day daily living step counts. 24 If patients agreed, the assessment was also completed in the off medication state for exploratory analyses.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

A BS T RA C T : Background: Treatments of freezing of gait (FOG) in Parkinson's disease are suboptimal.Objective: The aim of this study was to evaluate the effects of multiple sessions of transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex and primary motor cortex (M1) on FOG. Methods: Seventy-seven individuals with Parkinson's disease and FOG were enrolled in a double-blinded randomized trial. tDCS and sham interventions comprised 10 sessions over 2 weeks followed by five once-weekly sessions. FOG-provoking test performance (primary outcome), functional outcomes, and self-reported FOG severity were assessed.Results: Primary analyses demonstrated no advantage for tDCS in the FOG-provoking test. In secondary analyses, tDCS, compared with sham, decreased self-reported FOG severity and increased daily living step counts. Among individuals with mild-to-moderate FOG severity, tDCS improved FOG-provoking test time and self-report of FOG. Conclusions: Multisession tDCS targeting the left dorsolateral prefrontal cortex and M1 did not improve laboratory-based FOG-provoking test performance. Improvements observed in participants with mild-tomoderate FOG severity warrant further investigation.

show abstract

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

See 1 more Smart Citation

Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Scoring of the test also requires clinical expertise, potentially limiting its widespread applicability. Furthermore, the number of episodes and FOG duration are not evaluated, and the detection of very short FOG episodes is difficult to quantify [11]. Tools enabling the objective assessment of FOG, the tracking of its progression, and the evaluation of the efficacy of related interventions are needed [6,8,12].…”

Section: Introductionmentioning

confidence: 99%

Using Wearable Sensors and Machine Learning to Automatically Detect Freezing of Gait during a FOG-Provoking Test

Reches

Dagan

Herman

et al. 2020

Sensors

Self Cite

View full text Add to dashboard Cite

Freezing of gait (FOG) is a debilitating motor phenomenon that is common among individuals with advanced Parkinson’s disease. Objective and sensitive measures are needed to better quantify FOG. The present work addresses this need by leveraging wearable devices and machine-learning methods to develop and evaluate automated detection of FOG and quantification of its severity. Seventy-one subjects with FOG completed a FOG-provoking test while wearing three wearable sensors (lower back and each ankle). Subjects were videotaped before (OFF state) and after (ON state) they took their antiparkinsonian medications. Annotations of the videos provided the “ground-truth” for FOG detection. A leave-one-patient-out validation process with a training set of 57 subjects resulted in 84.1% sensitivity, 83.4% specificity, and 85.0% accuracy for FOG detection. Similar results were seen in an independent test set (data from 14 other subjects). Two derived outcomes, percent time frozen and number of FOG episodes, were associated with self-report of FOG. Bother derived-metrics were higher in the OFF state than in the ON state and in the most challenging level of the FOG-provoking test, compared to the least challenging level. These results suggest that this automated machine-learning approach can objectively assess FOG and that its outcomes are responsive to therapeutic interventions.

show abstract

“…Two assessors (KAEM and JS) determined the percentage of time frozen for each freezing of gait provoking test, plus the time taken to complete the Ziegler test, via offline video analyses [ 43 , 44 ]. They were blinded to the baseline and postintervention testing conditions.…”

Section: Methodsmentioning

confidence: 99%

A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study

Goh¹,

Allen²,

Ahmadpour³

et al. 2021

JMIR Form Res

View full text Add to dashboard Cite

Background Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease.

show abstract

Advantages of timing the duration of a freezing of gait-provoking test in individuals with Parkinson’s disease

Cited by 8 publications

References 30 publications

Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial

Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial

Using Wearable Sensors and Machine Learning to Automatically Detect Freezing of Gait during a FOG-Provoking Test

A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study

Contact Info

Product

Resources

About