Freezing of gait is a phenomenon common in Parkinson's patients and significantly affects quality of life. Sensory cues have been known to improve walking performance and reduce freezing of gait. Visual cues are reported to be particularly effective for this purpose. So far, sensory cues have generally been provided continuously, even when currently not needed. However, a recent approach suggests the provision of cues just in the case that freezing actually occurs. The arguments in favor of this "on-demand" cueing are reduced intrusiveness and reduced habituation to cues. Here, we analyzed the effect of visual cues on the number and duration of freezing episodes when activated either just "on-demand" or continuously and compare it to the baseline condition where no cue is provided. For this purpose, 7 Parkinson's patients regularly suffering from freezing of gait repeatedly walked a pre-defined course and their reaction to parallel laser lines projected in front of them on the floor was analyzed. The results show that, in comparison to the baseline condition, the mean duration of freezing was reduced by 51% in continuous cueing and by 69% in "on-demand" cueing. Concerning the number of freezing episodes, 43% fewer episodes were observed for continuous cueing and 9% less episodes for "on-demand" cueing.

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Stroke is the leading cause of long term disability among adults in industrialized nations. The majority of these disabilities include deficiencies in arm function, which can make independent living very difficult. Research shows that better results in rehabilitation are obtained when patients receive more intensive therapy. However this intensive therapy is currently too expensive to be provided by the public health system, and at home few patients perform the repetitive exercises recommended by their therapists. Computer games can provide an affordable, enjoyable, and effective way to intensify treatment, while keeping the patient as well as their therapists informed about their progress. This paper presents the study, design, implementation and user-testing of a set of computer games for at-home assessment and training of upper-limb motor impairment after stroke.

Freezing of gait (FOG) is a common and disabling symptom of Parkinson's disease. It is an episodic and non predictable phenomenon that affects most commonly the gait in the form of start hesitation and sudden immobility. It often results in falls and consequent injuries reducing quality of life. In this pilot study sensors measuring acceleration in 3 axes and angular velocity in 2 axes have been used to monitor foot, shank and thigh movements. Also the magnitude of acceleration was calculated for each 3-axis accelerometer. To determine changes in the power spectral density (PSD) the short time Fourier transform (STFT) was used. The results showed significant shift of the PSD towards higher frequencies during FOG episodes (p=0.00002) in vertical linear acceleration and in the angular velocity of the heel (p=0.00003). 82,7 % of the FOG episodes were detected correctly using motion parameters obtained from the acceleration perpendicular to the coronal plane of the heel.

IntroductionFunctional electrical stimulation applies electrical pulses to the peripheral nerves to artificially achieve a sensory/motor function. When applied for the compensation of foot drop it provides both assistive and therapeutic effects. Multi-field electrodes have shown great potential but may increase the complexity of these systems. Usability aspects should be checked to ensure their success in clinical environments.MethodsWe developed the Fesia Walk device, based on a surface multi-field electrode and an automatic calibration algorithm, and carried out a usability study to check the feasibility of integrating this device in therapeutic programs in clinical environments. The study included 4 therapists and 10 acquired brain injury subjects (8 stroke and 2 traumatic brain injury).ResultsTherapists and users were “very satisfied” with the device according to the Quebec User Evaluation of Satisfaction with Assistive Technology scale, with average scores of 4.1 and 4.2 out of 5, respectively. Therapists considered the Fesia Walk device as “excellent” according to the System Usability Scale with an average score of 85.6 out of 100.ConclusionsThis study showed us that it is feasible to include surface multi-field technology while keeping a device simple and intuitive for successful integration in common neurorehabilitation programs.