Background Freezing of gait (FOG) is a walking disturbance in advanced stage Parkinson’s disease (PD) that has been associated with increased fall risk and decreased quality of life. Freezing episodes can be mitigated or prevented with external intervention such as visual or auditory cues, activated by FOG prediction and detection systems. While most research on FOG detection and prediction has been based on inertial measurement unit (IMU) and accelerometer data, plantar-pressure data may capture subtle weight shifts unique to FOG episodes. Different machine learning algorithms have been used for FOG detection and prediction; however, long short-term memory (LSTM) deep learning methods hold an advantage when dealing with time-series data, such as sensor data. This research aimed to determine if LSTM can be used to detect and predict FOG from plantar pressure data alone, specifically for use in a real-time wearable system. Methods Plantar pressure data were collected from pressure-sensing insole sensors worn by 11 participants with PD as they walked a predefined freeze-provoking path. FOG instances were labelled, 16 features were extracted, and the dataset was balanced and normalized (z-score). The resulting datasets were classified using long short-term memory neural-network models. Separate models were trained for detection and prediction. For prediction models, data before FOG were included in the target class. Leave-one-freezer-out cross validation was used for model evaluation. In addition, the models were tested on all non-freezer data to determine model specificity. Results The best FOG detection model had 82.1% (SD 6.2%) mean sensitivity and 89.5% (SD 3.6%) mean specificity for one-freezer-held-out cross validation. Specificity improved to 93.3% (SD 4.0%) when ignoring inactive state data (standing) and analyzing the model only on active states (turning and walking). The model correctly detected 95% of freeze episodes. The best FOG prediction method achieved 72.5% (SD 13.6%) mean sensitivity and 81.2% (SD 6.8%) mean specificity for one-freezer-held-out cross validation. Conclusions Based on FOG data collected in a laboratory, the results suggest that plantar pressure data can be used for FOG detection and prediction. However, further research is required to improve FOG prediction performance, including training with a larger sample of people who experience FOG.

Freezing of gait (FOG) is a sudden and highly disruptive gait dysfunction that appears in mid to late-stage Parkinson’s disease (PD) and can lead to falling and injury. A system that predicts freezing before it occurs or detects freezing immediately after onset would generate an opportunity for FOG prevention or mitigation and thus enhance safe mobility and quality of life. This research used accelerometer, gyroscope, and plantar pressure sensors to extract 861 features from walking data collected from 11 people with FOG. Minimum-redundancy maximum-relevance and Relief-F feature selection were performed prior to training boosted ensembles of decision trees. The binary classification models identified Total-FOG or No FOG states, wherein the Total-FOG class included data windows from 2 s before the FOG onset until the end of the FOG episode. Three feature sets were compared: plantar pressure, inertial measurement unit (IMU), and both plantar pressure and IMU features. The plantar-pressure-only model had the greatest sensitivity and the IMU-only model had the greatest specificity. The best overall model used the combination of plantar pressure and IMU features, achieving 76.4% sensitivity and 86.2% specificity. Next, the Total-FOG class components were evaluated individually (i.e., Pre-FOG windows, Freeze windows, transition windows between Pre-FOG and Freeze). The best model detected windows that contained both Pre-FOG and FOG data with 85.2% sensitivity, which is equivalent to detecting FOG less than 1 s after the freeze began. Windows of FOG data were detected with 93.4% sensitivity. The IMU and plantar pressure feature-based model slightly outperformed models that used data from a single sensor type. The model achieved early detection by identifying the transition from Pre-FOG to FOG while maintaining excellent FOG detection performance (93.4% sensitivity). Therefore, if used as part of an intelligent, real-time FOG identification and cueing system, even if the Pre-FOG state were missed, the model would perform well as a freeze detection and cueing system that could improve the mobility and independence of people with PD during their daily activities.

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Freezing of gait (FOG) is an intermittent walking disturbance experienced by people with Parkinson’s disease (PD). Wearable FOG identification systems can improve gait and reduce the risk of falling due to FOG by detecting FOG in real-time and providing a cue to reduce freeze duration. However, FOG prediction and prevention is desirable. Datasets used to train machine learning models often generate ground truth FOG labels based on visual observation of specific lower limb movements (event-based definition) or an overall inability to walk effectively (period of gait disruption based definition). FOG definition ambiguity may affect model performance, especially with respect to multiple FOG in rapid succession. This research examined whether merging multiple freezes that occurred in rapid succession could improve FOG detection and prediction model performance. Plantar pressure and lower limb acceleration data were used to extract a feature set and train decision tree ensembles. FOG was labeled using an event-based definition. Additional datasets were then produced by merging FOG that occurred in rapid succession. A merging threshold was introduced where FOG that were separated by less than the merging threshold were merged into one episode. FOG detection and prediction models were trained for merging thresholds of 0, 1, 2, and 3 s. Merging slightly improved FOG detection model performance; however, for the prediction model, merging resulted in slightly later FOG identification and lower precision. FOG prediction models may benefit from using event-based FOG definitions and avoiding merging multiple FOG in rapid succession.