The development of a home-based technology to improve gait in people with Parkinson's disease: a feasibility study

Abstract

Background People with Parkinson’s disease (PwP) may experience gait impairment and freezing of gait (FOG), a major cause of falls. External cueing, including visual (e.g., spaced lines on the floor) and auditory (e.g., rhythmic metronome beats) stimuli, are considered effective in alleviating mobility deficits and FOG. Currently, there is a need for a technology that delivers automatic, individually adjusted cues in the homes of PwP. The aims of this feasibility study were to describe the first step toward the development of a home-based technology that delivers external cues, test its effect on gait, and assess user experience. Methods Iterative system development was performed by our multidisciplinary team. The system was designed to deliver visual and auditory cues: light stripes projected on the floor and metronome beats, separately. Initial testing was performed using the feedback of five healthy elderly individuals on the cues’ clarity (clear visibility of the light stripes and the sound of metronome beats) and discomfort experienced. A pilot study was subsequently conducted in the homes of 15 PwP with daily FOG. We measured participants' walking under three conditions: baseline (with no cues), walking with light stripes, and walking to metronome beats. Outcome measures included step length and step time. User experience was also captured in semi-structured interviews. Results Repeated-measures ANOVA of gait assessment in PwP revealed that light stripes significantly improved step length (p = 0.009) and step time (p = 0.019) of PwP. No significant changes were measured in the metronome condition. PwP reported that both cueing modalities improved their gait, confidence, and stability. Most PwP did not report any discomfort in either modality and expressed a desire to have such a technology in their homes. The metronome was preferred by the majority of participants. Conclusions This feasibility study demonstrated the usability and potential effect of a novel cueing technology on gait, and represents an important first step toward the development of a technology aimed to prevent FOG by delivering individually adjusted cues automatically. A further full-scale study is needed. Trial registration This study was registered in ClinicalTrials.gov at 1/2/2022 NCT05211687.

A Computer Vision-Based System to Help Health Professionals to Apply Tests for Fall Risk Assessment

“…On the other hand, some investigations use Computer Vision techniques [ 56 , 57 , 58 , 59 , 60 ], while others have gone a step further and implement robots equipped with cameras and/or sensors. In the study described in [ 56 ], a person performs three types of exercises, and it is recorded by a camera located in a robot that follows a rectilinear trajectory, but the results are not correlated with any of the previously exposed tests, and many parameters of interest are not measured.…”

Auditory cues modulate the short timescale dynamics of STN activity during stepping in Parkinson’s disease

“…Recent studies of patients undergoing DBS surgery have revealed how synchronized oscillatory activity across the cortico-basal ganglia circuit can contribute to gait kinematics and motoric impairments in PD [8][9][10][11] . For example, it has been shown that excessive STN activity at beta frequencies (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), which is traditionally thought to be related to both bradykinesia and rigidity, can also precede paroxysmal episodes of freezing of gait (FOG). Consistent with this observation is the finding that both motor cortical and STN beta activity display gait phase-locked modulations during walking 9 .…”

“…One way of improving gait coordination in PD is to present rhythmic visual or auditory cues during stepping [12][13][14][15] . Auditory cueing may enhance both walking speed and stride length, in addition to ameliorating FOG episodes [14][15][16][17][18][19][20][21][22][23] .…”

“…One way of improving gait coordination in PD is to present rhythmic visual or auditory cues during stepping [12][13][14][15] . Auditory cueing may enhance both walking speed and stride length, in addition to ameliorating FOG episodes [14][15][16][17][18][19][20][21][22][23] . Although we have previously shown that cueing to the timing of a heel strike can modulate STN beta activity, it remains unclear whether cues can modulate STN activity at shorter timescales 9 .…”