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External input for gait in people with Parkinson’s disease with and without freezing of gait: One size does not fit all

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Abstract

Cueing or feedback provided when gait deviates from a predefined goal (intelligent input) can now be provided with wearable technology for Parkinson’s disease (PD). As people with and without freezing of gait (FOG) have distinct cognitive profiles, they may respond differently to various types of input. This study compared the effects of four input modalities during prolonged walking and explored the relationship with cognition, subjective preference, and FOG. Participants (15 with and 13 without FOG) walked 30 min while exposed to continuous cueing; intelligent cueing; intelligent feedback; or no input. Cueing consisted of metronome beats matched to comfortable cadence. Intelligent input represented bouts of ten beats indicating comfortable cadence (intelligent cueing) or an instruction to adapt gait speed (intelligent feedback) when cadence deviated from the comfortable target. Preference for one condition over the other was gathered. Freezers produced most stable gait under continuous cueing, but the majority favored intelligent feedback. Non-freezers showed no differences between conditions, but gait was more stable under intelligent input than in freezers. Interestingly, lower cognitive scores were related to worse gait during intelligent input, most prominently seen in freezers. These results suggest that cognitive ability is an aspect to take into account when deciding on the most appropriate cueing modality in different PD subgroups.

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Acknowledgements

The authors would like to thank all volunteers who were willing to participate in this study.

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Authors and Affiliations

  1. Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium

    Pieter Ginis, Elke Heremans, Esther M. J. Bekkers & Alice Nieuwboer

  2. Department of Electrical, Electronic and Information Engineering-Guglielmo Marconi, University of Bologna, Bologna, Italy

    Alberto Ferrari

  3. Faculty of Health Sciences, University of Sydney, Sydney, Australia

    Colleen G. Canning

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  1. Pieter Ginis
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Correspondence to Pieter Ginis.

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This work was supported by the European Union Seventh Framework Programme (FP7/2007-2013) CuPiD project [Grant Number 288516].

Conflicts of interest

AF has a significant financial interest in mHealth Technologies, a company that may have a commercial interest in the results of this research. All other authors declare that they have no competing interests.

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Ginis, P., Heremans, E., Ferrari, A. et al. External input for gait in people with Parkinson’s disease with and without freezing of gait: One size does not fit all. J Neurol 264, 1488–1496 (2017). https://doi.org/10.1007/s00415-017-8552-6

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