Effect of On-Demand Cueing on Freezing of Gait in Parkinson’s Patients

Gait disturbance, particularly freezing of gait (FOG), is a phenomenon that is common in Parkinson’s patients and significantly contributes to a loss of function and independence. Walking performance and number of freezing episodes have been known to respond favorably to sensory cues of different modalities. However, a topic that has so far barely been touched is how to resolve freezing episodes via sensory cues once they have appeared. In this study, we analyze the effect of five different sensory cues on the duration of freezing episodes: (1) vibratory alert, (2) auditory alert, (3) vibratory rhythm, (4) auditory rhythm, (5) visual cue in form of parallel lines projected to the floor. The motivation for this study is to investigate the possibility of the design of a gait assistive device for Parkinson’s patients. Test subjects were 7 Parkinson’s patients regularly suffering from FOG. The patients had to repeatedly walk a pre-defined course and cues were triggered always 2 s after freezing onset. The effect was analyzed via experimental measurements and patient interviews. The measurements showed that all 5 sensory cues led to a decrease of the average duration of freezing: baseline (7.9s), vibratory alert (7.1s), auditory alert (6.7s), auditory rhythm (6.4s), vibratory rhythm (6.3s), and visual cue (5.3s). Nevertheless, interestingly, patients subjectively evaluated the audio alert and vibratory signals to have a significantly better effect for reducing their freezing duration than the visual cue. Keywords—Auditory cueing, freezing of gait, gait assistance, Parkinson’s disease, vibratory cueing, visual cueing.