The effect of visual cues on muscular activation in the lower limbs of Parkinson’s disease patients with freezing of gait: a preliminary study

This study aims to investigate the effect of a sensitive cueing on Freezing of Gait (FOG) and gait disorders in subjects suffering from Parkinson’s disease (PD). 13 participants with Parkinson’s disease were equipped with an electrical stimulator and a foot mounted inertial measurement unit (IMU). An IMU based algorithm triggered in real time an electrical stimulus applied on the arch of foot at heel off detection. Starting from standing, subjects were asked to walk at their preferred speed on a path comprising 5m straight, u-turn and walk around tasks. Cueing globally decreased the time to achieve the different tasks in all the subjects. In “freezer” subjects, the time to complete the entire path was reduced by 19%. FOG events occurrence was lowered by 12% compared to baseline before and after cueing. This preliminary work showed a positive global effect of an electrical stimulation based cueing on gait and FOG in PD.

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Muscular activation changes in lower limbs after underwater gait training in Parkinson’s disease: A surface emg pilot study

Gait & Posture ◽

10.1016/j.gaitpost.2020.03.017 ◽

2020 ◽

Vol 80 ◽

pp. 185-191

Author(s):

D. Volpe ◽

F. Spolaor ◽

Z. Sawacha ◽

A. Guiotto ◽

D. Pavan ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Pilot Study ◽

Gait Training ◽

Surface Emg ◽

Lower Limbs ◽

Muscular Activation

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Evaluating the Contributions of Dynamic Flow to Freezing of Gait in Parkinson's Disease

Parkinson s Disease ◽

10.4061/2010/732508 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Chad A. Lebold ◽

Q. J. Almeida

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Optic Flow ◽

Visual Cues ◽

Freezing Of Gait ◽

Underlying Mechanism ◽

Step Length ◽

Double Support ◽

Double Support Time ◽

Conscious Control

Although visual cues can improve gait in Parkinson's disease (PD), their underlying mechanism is poorly understood. Previous research suggests that cues contribute optical flow that is essential to elicit gait improvement. The present study manipulated how optic flow was provided, and how this might influence freezing of gait (FOG) in PD. Therefore, three groups; 15 PD FOG, 16 PD non-FOG, and 16 healthy controls were tested in 3 narrow doorway conditions; baseline (Narrow), ground lines (Ground), and laser (Laser). Step length indicated that the PD FOG group was only able to improve with ground lines, while the laser increased gait variability and double support time. These results suggest that optic flow in itself is not enough to elicit gait improvement in PD. When PD patients use visual cues, gait becomes less automatically controlled and hence preplanned conscious control may be an important factor contributing to gait improvement.

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Holocue: A Wearable Holographic Cueing Application for Alleviating Freezing of Gait in Parkinson's Disease

Frontiers in Neurology ◽

10.3389/fneur.2021.628388 ◽

2022 ◽

Vol 12 ◽

Author(s):

Daphne J. Geerse ◽

Bert Coolen ◽

Jacobus J. van Hilten ◽

Melvyn Roerdink

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Home Environment ◽

Visual Cues ◽

Mixed Reality ◽

Freezing Of Gait ◽

Future Design ◽

Visual Cueing ◽

Research Designs ◽

2D And 3D

External visual cueing is a well-known means to target freezing of gait (FOG) in Parkinson's disease patients. Holocue is a wearable visual cueing application that allows the HoloLens 1 mixed-reality headset to present on-demand patient-tailored action-relevant 2D and 3D holographic visual cues in free-living environments. The aim of this study involving 24 Parkinson's disease patients with dopaminergic “ON state” FOG was two-fold. First, to explore unfamiliarity and habituation effects associated with wearing the HoloLens on FOG. Second, to evaluate the potential immediate effect of Holocue on alleviating FOG in the home environment. Three sessions were conducted to examine (1) the effect of wearing the unfamiliar HoloLens on FOG by comparing walking with and without the HoloLens, (2) habituation effects to wearing the HoloLens by comparing FOG while walking with HoloLens over sessions, and (3) the potential immediate effect of Holocue on FOG by comparing walking with HoloLens with and without Holocue. Wearing the HoloLens (without Holocue) did significantly increase the number and duration of FOG episodes, but this unfamiliarity effect disappeared with habituation over sessions. This not only emphasizes the need for sufficient habituation to unfamiliar devices, but also testifies to the need for research designs with appropriate control conditions when examining effects of unfamiliar wearable cueing devices. Holocue had overall no immediate effect on FOG, although objective and subjective benefits were observed for some individuals, most notably those with long and/or many FOG episodes. Our participants raised valuable opportunities to improve Holocue and confirmed our assumptions about current and anticipated future design choices, which supports ongoing Holocue development for and with end users.

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Brain Activity Response to Visual Cues for Gait Impairment in Parkinson’s Disease: An EEG Study

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211041317 ◽

2021 ◽

pp. 154596832110413

Author(s):

Samuel Stuart ◽

Johanna Wagner ◽

Scott Makeig ◽

Martina Mancini

Keyword(s):

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Visual Processing ◽

Visual Cues ◽

Brain Activity ◽

Freezing Of Gait ◽

Occipital Lobe ◽

Brain Regions ◽

Healthy Older Adults

Background. Gait impairments are common in Parkinson’s disease (PD) and increase falls risk. Visual cues can improve gait in PD, particularly freezing of gait (FOG), but mechanisms involved in visual cue response are unknown. This study aimed to examine brain activity in response to visual cues in people with PD who do (PD+FOG) and do not report FOG (PD-FOG) and explore relationships between attention, brain activity and gait. Methods. Mobile EEG measured brain activity during gait in 20 healthy older adults and 43 PD participants (n=22 PD+FOG, n=21 PD-FOG). Participants walked for 2-minutes with and without visual cues (transverse lines to step over). We report power spectral density (PSD) in Delta (1-4 Hz), Theta (4-7 Hz), Alpha (8-12 Hz), Beta (14-24 Hz) and Gamma (30-50 Hz) bands within clusters of similarly brain localized independent component sources. Results. PSDs within the parietal and occipital lobes were altered when walking with visual cues in PD, particularly in PD+FOG. Between group, differences suggested that parietal sources in PD, particularly with PD+FOG, had larger activity compared to healthy older adults when walking. Within group, visual cues altered brain activity in PD, particularly in PD+FOG, within visual processing brain regions. In PD participants, brain activity differences with cues correlated with gait improvements, and in PD+FOG those with worse attention required more visual attentional processing (reduced alpha PSD) in the occipital lobe. Conclusions. Visual cues improve gait and influence brain activity during walking in PD, particularly in PD+FOG. Findings may allow development of more effective therapeutics.

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Usability of Three-dimensional Augmented Visual Cues Delivered by Smart Glasses on (Freezing of) Gait in Parkinson’s Disease

Frontiers in Neurology ◽

10.3389/fneur.2017.00279 ◽

2017 ◽

Vol 8 ◽

Cited By ~ 28

Author(s):

Sabine Janssen ◽

Benjamin Bolte ◽

Jorik Nonnekes ◽

Marian Bittner ◽

Bastiaan R. Bloem ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Visual Cues ◽

Freezing Of Gait ◽

Three Dimensional ◽

Smart Glasses

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The Beneficial Effects of Conventional Visual Cues Are Retained When Augmented Reality Glasses Are Worn

Parkinson s Disease ◽

10.1155/2020/4104712 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Sabine Janssen ◽

Jaap de Ruyter van Steveninck ◽

Hizirwan S. Salim ◽

Bastiaan R. Bloem ◽

Tjitske Heida ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Augmented Reality ◽

Visual Cues ◽

Freezing Of Gait ◽

Single Patient ◽

Patient Study ◽

Beneficial Effects ◽

Smart Glasses ◽

Current Design

Wearing smart glasses may be distracting and thus annihilate the beneficial effects of cues on freezing of gait in Parkinson’s disease. Furthermore, augmented reality cues might be effective in reducing FOG specifically in cueing-responsive patients. We present a single-patient study in which a patient with Parkinson’s disease traversed a doorway under different cueing conditions. Wearing augmented reality (AR) glasses did not deteriorate FOG nor affect the beneficial effects of cues. The AR visual cues did not improve FOG. This single-patient study implies that the current design of AR glasses does not stand in the way of the development of augmented reality visual cues. However, the effectivity of augmented reality visual cues remains to be proven.

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