The clinical significance of freezing while turning in Parkinson’s disease

Mancini, Martina; Smulders, Katrijn; Cohen, Rajal G.; Horak, Fay B.; Giladi, Nir; Nutt, John G.

doi:10.1016/j.neuroscience.2016.11.045

Cited by 105 publications

(137 citation statements)

References 39 publications

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“…The sample sizes varied from 1 [28] to 48 PD [51] per study, with a non-PD group being included in a few studies [28, 40, 48, 51, 53, 56]. Disease severity, when reported, ranged from 2 to 4 according to the Hoehn and Yahr scale.…”

Section: Resultsmentioning

confidence: 99%

Freezing of gait and fall detection in Parkinson’s disease using wearable sensors: a systematic review

et al. 2017

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Despite the large number of studies that have investigated the use of wearable sensors to detect gait disturbances such as Freezing of gait (FOG) and falls, there is little consensus regarding appropriate methodologies for how to optimally apply such devices. Here, an overview of the use of wearable systems to assess FOG and falls in Parkinson’s disease (PD) and validation performance is presented. A systematic search in the PubMed and Web of Science databases was performed using a group of concept key words. The final search was performed in January 2017, and articles were selected based upon a set of eligibility criteria. In total, 27 articles were selected. Of those, 23 related to FOG and 4 to falls. FOG studies were performed in either laboratory or home settings, with sample sizes ranging from 1 PD up to 48 PD presenting Hoehn and Yahr stage from 2 to 4. The shin was the most common sensor location and accelerometer was the most frequently used sensor type. Validity measures ranged from 73–100% for sensitivity and 67–100% for specificity. Falls and fall risk studies were all home-based, including samples sizes of 1 PD up to 107 PD, mostly using one sensor containing accelerometers, worn at various body locations. Despite the promising validation initiatives reported in these studies, they were all performed in relatively small sample sizes, and there was a significant variability in outcomes measured and results reported. Given these limitations, the validation of sensor-derived assessments of PD features would benefit from more focused research efforts, increased collaboration among researchers, aligning data collection protocols, and sharing data sets.

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Section: Resultsmentioning

confidence: 99%

Freezing of gait and fall detection in Parkinson’s disease using wearable sensors: a systematic review

et al. 2017

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“…to provoke FOG. Stepping in place and rapid turning on the spot are both effective ways to provoke FOG [5][6][7][8]. However, these two tests have not been compared back to back.…”

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confidence: 99%

Provoking Freezing of Gait in Clinical Practice: Turning in Place is More Effective than Stepping in Place

Dijsseldonk

Wang

Wezel

et al. 2018

JPD

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Freezing of gait (FOG) is common and debilitating in Parkinson's disease (PD) [1], and significantly contributes to the occurrence of falls [2]. To prevent falls and fall-related injuries, timely detection of FOG in clinical practice is needed, as this can be the start of tailored interventions [3]. However, provoking FOG in a clinical environment is challenging, for several reasons. First, freezing is provoked by constraints in the physical environment, and the typically wide and well-lit hospital corridors are not ideal to provoke FOG. Moreover, clinicians are usually on a tight schedule and do not always have time to perform a complete FOG-provoking test battery [4]. It is therefore important to identify the most effective task * Correspondence to: Jorik Nonnekes, MD, PhD, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: jorik.nonnekes@radboudumc.nl. to provoke FOG. Stepping in place and rapid turning on the spot are both effective ways to provoke FOG [5][6][7][8]. However, these two tests have not been compared back to back. Moreover, it is unknown whether combining both tests yields a higher sensitivity than either test alone.To answer these questions, we included 16 patients with PD and subjective experience of daily FOG, as determined using the N-FOGQ [9]. Mean age of these patients was 70 years (range 51-89 years), with a mean disease duration of 10 years (range 3-20), mean MDS-UPDRS subsection III score of 36 (range 24-49) and mean N-FOGQ score of 19 (range 10-25). Hoehn and Yahr staging showed a modal score of 2 (range 2-4). All patients were examined in a practically defined OFF state, i.e., >12 hours after intake of the last dose of dopaminergic medication.

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“…Two studies used the more stringent criterion of the NFOG‐Q > 3 to define a participant as a freezer . The results of one of these studies showed that none of the participants with a NFOG‐Q score < 3 experienced freezing during their FOG‐provoking protocol in the off medication state . The NFOG‐Q was not always administered by the same testers on both occasions, but protocols in both studies were rigorously standardized between testers and across centers in both studies.…”

Section: Discussionmentioning

confidence: 99%

“…43,44 The results of one of these studies showed that none of the participants with a NFOG-Q score < 3 experienced freezing during their FOG-provoking protocol in the off medication state. 43 The NFOG-Q was not always administered by the same testers on both occasions, but protocols in both studies were rigorously standardized between testers and across centers in both studies. We also statistically checked whether the same tester scores and varying tester scorers showed more variability, but this was not the case.…”

Section: Discussionmentioning

confidence: 99%

The New Freezing of Gait Questionnaire: Unsuitable as an Outcome in Clinical Trials?

Hulzinga

Nieuwboer

Dijkstra

et al. 2020

Movement Disord Clin Pract

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Background Background: Freezing of gait (FOG) is a common gait deficit in Parkinson's disease. The New Freezing of Gait Questionnaire (NFOG-Q) is a widely used and valid tool to quantify freezing of gait severity. However, its test-retest reliability and minimal detectable change remain unknown. Objective Objective: To determine the test-retest reliability and responsiveness of the NFOG-Q. Methods Methods: Two groups of freezers, involved in 2 previous rehabilitation trials, completed the NFOG-Q at 2 time points (T1 and T2), separated by a 6-week control period without active intervention. Sample 1 (N = 57) was measured in ON and sample 2 (N = 14) in OFF. We calculated various reliability statistics for the NFOG-Q scores between T1 and T2 as well as correlation coefficients with clinical descriptors to explain the variability between time points. Results Results: In sample 1 the NFOG-Q showed modest reliability (intraclass correlation coefficient = 0.68 [0.52-0.80]) without differences between T1 and T2. However, a minimal detectable change of 9.95 (7.90-12.27) points emerged for the total score (range 28 points, relative minimal detectable change of 35.5%). Sample 2 showed largely similar results. We found no associations between cognitive-related or disease severity-related outcomes and variability in NFOG-Q scores. Conclusions Conclusions: We conclude that the NFOG-Q is insufficiently reliable or responsive to detect small effect sizes, as changes need to go beyond 35% to surpass measurement error. Therefore, we warrant caution in using the NFOG-Q as a primary outcome in clinical trials. These results emphasize the need for robust and objective freezing of gait outcome measures.Freezing of gait (FOG) is a prominent and debilitating symptom of Parkinson's disease (PD). It affects up to 80% of PD patients during the course of the disease. 1-3 FOG is defined as the inability to progress forward stepping despite the intention to walk and reach a destination. 4 Furthermore, FOG is one of the most frequent causes of falls in PD, thus contributing to high fall rates ranging from 35% up to 90%. 1,5,6 FOG seriously impedes daily life functioning and overall quality of life. 7,8 So far, the treatment of FOG, including pharmacological, surgical, and rehabilitation interventions, is only partially effective. 4,9 Therefore, new and more personalized rehabilitation approaches are now being developed. To evaluate their effectiveness, valid and reliable assessment is necessary to document FOG severity and its progression.A recent review of Mancini and colleagues 10 highlighted that FOG assessment is hampered by several factors in clinical and laboratory settings. First, the episodic and unpredictable nature of FOG increases the likelihood of missing the event during formal or "online" performance tests of gait. Second, various "testing effects" may be at play that enhance or reduce the occurrence of FOG, such as consciously attending to walking, stepping in broad and well-lit corridors, and experiencing medication effects and...

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The clinical significance of freezing while turning in Parkinson’s disease

Cited by 105 publications

References 39 publications

Freezing of gait and fall detection in Parkinson’s disease using wearable sensors: a systematic review

Freezing of gait and fall detection in Parkinson’s disease using wearable sensors: a systematic review

Provoking Freezing of Gait in Clinical Practice: Turning in Place is More Effective than Stepping in Place

The New Freezing of Gait Questionnaire: Unsuitable as an Outcome in Clinical Trials?

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