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

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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Opposite Effects of Visual Cueing During Writing-Like Movements of Different Amplitudes in Parkinson’s Disease

Neurorehabilitation and Neural Repair ◽

10.1177/1545968315601361 ◽

2015 ◽

Vol 30 (5) ◽

pp. 431-439 ◽

Cited By ~ 14

Author(s):

Evelien Nackaerts ◽

Alice Nieuwboer ◽

Sanne Broeder ◽

Bouwien C. M. Smits-Engelsman ◽

Stephan P. Swinnen ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Visual Cues ◽

Fine Motor ◽

Motor Tasks ◽

Visual Cueing ◽

Dependent Variables ◽

Size Variability ◽

The Difference ◽

Accuracy Constraints

Background. Handwriting is often impaired in Parkinson’s disease (PD). Several studies have shown that writing in PD benefits from the use of cues. However, this was typically studied with writing and drawing sizes that are usually not used in daily life. Objective. This study examines the effect of visual cueing on a prewriting task at small amplitudes (≤1.0 cm) in PD patients and healthy controls to better understand the working action of cueing for writing. Methods. A total of 15 PD patients and 15 healthy, age-matched controls performed a prewriting task at 0.6 cm and 1.0 cm in the presence and absence of visual cues (target lines). Writing amplitude, variability of amplitude, and speed were chosen as dependent variables, measured using a newly developed touch-sensitive tablet. Results. Cueing led to immediate improvements in writing size, variability of writing size, and speed in both groups in the 1.0 cm condition. However, when writing at 0.6 cm with cues, a decrease in writing size was apparent in both groups ( P < .001) and the difference in variability of amplitude between cued and uncued writing disappeared. In addition, the writing speed of controls decreased when the cue was present. Conclusions. Visual target lines of 1.0 cm improved the writing of sequential loops in contrast to lines spaced at 0.6 cm. These results illustrate that, unlike for gait, visual cueing for fine-motor tasks requires a differentiated approach, taking into account the possible increases of accuracy constraints imposed by cueing.

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Technology-Assisted Rehabilitation of Writing Skills in Parkinson’s Disease: Visual Cueing versus Intelligent Feedback

Parkinson s Disease ◽

10.1155/2017/9198037 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Evelien Nackaerts ◽

Alice Nieuwboer ◽

Elisabetta Farella

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Visual Cues ◽

Healthy Controls ◽

Short Term ◽

Future Studies ◽

Visual Cueing ◽

Sensory Modalities ◽

Larger Sample

Recent research showed that visual cueing can have both beneficial and detrimental effects on handwriting of patients with Parkinson’s disease (PD) and healthy controls depending on the circumstances. Hence, using other sensory modalities to deliver cueing or feedback may be a valuable alternative. Therefore, the current study compared the effects of short-term training with either continuous visual cues or intermittent intelligent verbal feedback. Ten PD patients and nine healthy controls were randomly assigned to one of these training modes. To assess transfer of learning, writing performance was assessed in the absence of cueing and feedback on both trained and untrained writing sequences. The feedback pen and a touch-sensitive writing tablet were used for testing. Both training types resulted in improved writing amplitudes for the trained and untrained sequences. In conclusion, these results suggest that the feedback pen is a valuable tool to implement writing training in a tailor-made fashion for people with PD. Future studies should include larger sample sizes and different subgroups of PD for long-term training with the feedback pen.

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The Effects of Augmented Reality Visual Cues on Turning in Place in Parkinson's Disease Patients With Freezing of Gait

Frontiers in Neurology ◽

10.3389/fneur.2020.00185 ◽

2020 ◽

Vol 11 ◽

Author(s):

Sabine Janssen ◽

Jaap de Ruyter van Steveninck ◽

Hizirwan S. Salim ◽

Helena M. Cockx ◽

Bastiaan R. Bloem ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Augmented Reality ◽

Visual Cues ◽

Freezing Of Gait

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A Manipulation of Visual Feedback during Gait Training in Parkinson's Disease

Parkinson s Disease ◽

10.1155/2012/508720 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Quincy J. Almeida ◽

Haseel Bhatt

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Optic Flow ◽

Visual Cues ◽

Step Length ◽

Gait Training ◽

Control Group ◽

Training Interventions ◽

Visual Cueing ◽

Walking Velocity

Visual cues are known to improve gait in Parkinson's disease (PD); however, the contribution of optic flow continues to be disputed. This study manipulated transverse line cues during two gait training interventions (6 weeks). PD subjects (N=42) were assigned to one of three groups: treadmill (TG), overground (OG), or control group (CG). Participants walked across lines placed on either treadmills or 16-meter carpets, respectively. The treadmill (TG) offered a reduced dynamic flow from the environment, while lines presented on the ground (OG) emphasized optic flow related to the participant's own displacement. Both interventions significantly improved (and maintained through retention period) step length, thus improving walking velocity. Only the OG improved in the TUG test, while only the TG showed hints of improving (and maintaining) motor symptoms. Since gait improvements were found in both training groups, we conclude that by reducing optic flow, gait benefits associated with visual cueing training can still be achieved.

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3D visual cueing shortens the double support phase of the gait cycle in patients with advanced Parkinson's disease treated with DBS of the STN

PLoS ONE ◽

10.1371/journal.pone.0244676 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244676

Author(s):

Kamila Poláková ◽

Evžen Růžička ◽

Robert Jech ◽

David Kemlink ◽

Jan Rusz ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Freezing Of Gait ◽

Step Length ◽

Double Support ◽

Visual Cueing ◽

Stn Dbs ◽

Support Phase ◽

Double Support Phase

Background Gait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson’s disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters. Aim To evaluate the effect of 3D visual cues and STN-DBS on gait in PD group. Methods We enrolled 35 PD patients treated with DBS of nucleus subthalamicus (STN-DBS). Twenty-five patients (5 females; mean age 58.9 ±6.3) and 25 sex- and age-matched controls completed the gait examination. The gait in 10 patients deteriorated in OFF state. The severity of PD was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY). The PD group filled the Falls Efficacy Scale-International (FES) and Freezing of Gait Questionnaire (FOGQ). Gait was examined using the GaitRite Analysis System, placed in the middle of the 10m marked path. The PD group was tested without dopaminergic medication with and without visual cueing together with the DBS switched ON and OFF. The setting of DBS was double-blind and performed in random order. Results The UPDRS was 21.9 ±9.5 in DBS ON state and 41.3 ±13.7 in DBS OFF state. HY was 2.5 ±0.6, FES 12.4 ±4.1 and FOGQ 9.4 ±5.7. In the DBS OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls. The walking speed and step length increased in the DBS ON state. The double support phase was reduced with 3D visual cueing and DBS; the combination of both cueing and DBS was even more effective. Conclusion Cueing with 3D visual stimuli shortens the double support phase in PD patients treated with DBS-STN. The DBS is more effective in prolonging step length and increasing gait speed. We conclude that 3D visual cueing can improve walking in patients with DBS.

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

10.1109/embc46164.2021.9629712 ◽

2021 ◽

Author(s):

He Wang ◽

Mirabel Ewura Esi Acquah ◽

Xinmiao Zhang ◽

Qian Xu ◽

Wei Chen ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Visual Cues ◽

Freezing Of Gait ◽

Lower Limbs ◽

Preliminary Study ◽

Muscular Activation

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223 ARE WHEELED WALKERS WITH VISUAL CUES EFFICACIOUS TO TREAT FREEZING OF GAIT IN PARKINSON'S DISEASE?

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(10)70224-8 ◽

2010 ◽

Vol 16 ◽

pp. S64 ◽

Cited By ~ 5

Author(s):

H. Cianci ◽

K. Robinson ◽

L. Bunting-Perry ◽

J. Sollenberger ◽

J. Nooregian ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Visual Cues ◽

Freezing Of Gait

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The CuePed Trial: How Does Environmental Complexity Impact Cue Effectiveness? A Comparison of Tonic and Phasic Visual Cueing in Simple and Complex Environments in a Parkinson’s Disease Population with Freezing of Gait

Parkinson s Disease ◽

10.1155/2019/2478980 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Rodney Marsh ◽

Michael H. Cole ◽

Nadeeka N. W. Dissanayaka ◽

Tiffany R. Au ◽

Sandra Clewett ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Freezing Of Gait ◽

Comparative Trial ◽

Difficult Problem ◽

Walk Test ◽

Complex Environments ◽

Environmental Complexity ◽

Visual Cueing ◽

Minute Walk

Background. The optimal prescription of cueing for the treatment of freezing of gait (FoG) in Parkinson’s disease (PD) is currently a difficult problem for clinicians due to the heterogeneity of cueing modalities, devices, and the limited comparative trial evidence. There has been a rise in the development of motion-sensitive, wearable cueing devices for the treatment of FoG in PD. These devices generally produce cues after signature gait or electroencephalographic antecedents of FoG episodes are detected (phasic cues). It is not known whether these devices offer benefit over simple (tonic) cueing devices. Methods. We assembled 20 participants with PD and FoG and familiarized them with a belt-worn, laser-light cueing device (Agilitas™). The device was designed with 2 cueing modalities—gait-dependent or “phasic” cueing and gait-independent or “tonic” cueing. Participants used the device sequentially in the off, phasic, or tonic modes, across 2 tasks—a 2-minute walk and an obstacle course. Results. A significant improvement in mean distance walked during the 2-minute walk test was observed for the tonic mode (127.3 m) compared with the off (111.4 m) and phasic (116.1 m) conditions. In contrast, there was a nonsignificant trend toward improvement in FoG frequency, duration, and course time when the device was switched from off to tonic and to phasic modes for the obstacle course. Conclusions. Parkinson’s disease patients with FoG demonstrated an improvement in distance walked during the two-minute walk test when a cueing device was switched from off to phasic and to tonic modes of operation. However, this benefit was lost when patients negotiated an obstacle course.

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