Assistive Devices for Personal Mobility in Parkinson's Disease: A Systematic Review of the Literature

Abstract

Background Gait abnormalities are a hallmark of Parkinson's disease and contribute to falling risk. As disease symptoms progress, assistive devices are often prescribed. However, there are no guidelines for choosing appropriate ambulatory devices for gait impairment. Objective To review the scientific evidence on assistive devices for gait impairment in Parkinson's disease. Methods We performed a systematic literature review for articles relating to parkinsonian gait impairment and assistive devices. We assessed the studies’ methodological quality and risk of bias using the PEDro scale. Results Seventeen articles were reviewed. Four articles (23.53%) showed that canes and standard and two‐wheeled walkers without visual cues decreased gait speed and stride length, with no significant effects on freezing of gait or falls. Instead, improvements were observed with the use of visual [seven articles (41.18%)] and auditory cues [three articles (17.65%)], including decreased number of freezing episodes and increased stride length. Conclusions Although assistive devices seem to improve confidence, there is still limited information about the efficacy of assistive devices on gait parameters and functional disability in Parkinson's disease. Further, longitudinal, multicenter, randomized, blinded, and controlled studies using assistive devices in a free‐living context are required to provide the best scientific evidence

Freezing of gait: pharmacological and surgical options

“…According to a recent systematic literature review, canes, standard and two-wheeled walkers without visual cues were associated with decreased gait speed and stride length and did not significantly affect FoG or falls. Instead, improvements in terms of decreased freezing episodes and increased stride length were observed using devices with visual and auditory cues [58 ▪ ].…”

Assisted technology in Parkinson's disease gait: what's up?

“…AT may be an asset in the rehabilitation program 4 and development of devices enabling objective, accurate, and better gait assessment and monitoring is crucial for people with PD. 5 In response to this pressing need, novel rehabilitation interventions and technology have emerged, offering new avenues for assisting individuals with PD in managing their gait difficulties. 6,7 The search for innovative interventions has led to the surge of numerous gait AP such as wearable devices, 8 robotic exoskeletons, 9,10 Robot-assisted and treadmill, 11 virtual reality (VR), 12,13 exergames-based interventions, 14 smartphone or mobile health applications, 15 and sensor-based systems 16 among others.…”

“…These AP, with diverse mechanisms of action, provide real-time feedback on gait parameters, promote targeted rehabilitative exercises, and may enhance overall gait performance. 5,15 A better understanding of emerging AT to assess gait in PD is important since it continues to advance and become more available. However, keeping pace with rapidly evolving technologies is challenging.…”

Single-trial movement intention detection estimation in patients with Parkinson’s disease: a movement-related cortical potential study

“…Physiotherapy and occupational therapy are other alternatives that generally are useful for reducing the effect of motor symptoms on activities of daily living in general [2]. An alternative to treating motor symptoms is to use assistive devices and technology to reduce the impact of motor impairments in activities of daily living [3]. Examples of such devices include canes and walkers for improving mobility [3], or technology such as neuroprosthet-ics utilizing electrical stimulation to suppress tremor [4].…”