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

Abstract

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.

Kinematic Relations during Double Support Phase in Parkinsonian Gait

“…It has been shown that the gait of PD patients differs from the gait of healthy controls in many motor aspects [4,[15][16][17][18][19][20]22,23]. Our MoCap-based research supports the findings and provides greater insight into the topic by unveiling relations that have not been fully considered hitherto.…”

“…The extended DST is viewed as a pattern of disrupted gait control (in PD, it extends when in OFF state [17] and shortens when 3D cueing is provided [4]). The extension in the PD patients often breaks physiological ratio of SST:DST (4:1) [4, [15][16][17][18][19]; according to a meta-analysis [20], it changes to 3.93:1.08.…”

“…Parkinson's disease (PD) is the second most common neurodegenerative disorder, severely affecting the elderly population [1,2]. Pathology of the disease consists of loss of dopaminergic neurons in the brainstem and their projections to basal ganglia deterioration between excitatory and inhibitory neural oscillators [3] that leads to inappropriate extent and timing of movement sequences [4,5]. In addition to the cardinal motor symptoms (rest tremor, muscle rigidity, and bradykinesia), fatigue [1,6], postural instability [1,7], problems in turning [1,8], standing up, or movement initiation [1,9], and/or freezing of gait [1,10] are associated with the disease.…”

“…All these symptoms disrupt the gait cycle [1,[6][7][8][9][10][11][12]. The ratio of single support time (SST) and double support time (DST) is consistent in a healthy population (4:1) [13,14]; in PD the DST is more lengthy [4,[15][16][17][18][19][20]. The PD gait is shuffling and slow, and the stride is shorter [7,18,20,21], although it sustains its natural width [18].…”

One cue does not fit all: A systematic review with meta-analysis of the effectiveness of cueing on freezing of gait in Parkinson’s disease

“…Below, data are reported as mean ± SD. Twenty trials (Arias and Cudeiro, 2010;Barthel et al, 2018;Beck et al, 2015;Bryant et al, 2010;Bunting-Perry et al, 2013;Cao et al, 2020;Cubo et al, 2003;Gál et al, 2019;Holmes et al, 2015;Horin et al, 2020;Kompoliti et al, 2000;Lebold and Almeida, 2010;Lee et al, 2012;Rosenthal et al, 2018;Poláková et al, 2020;Sijobert et al, 2017;Willems et al, 2006;Stuart et al, 2021;Zhao et al, 2016;Janssen et al, 2017) assessed cueing effectiveness on FOG exclusively during walking tasks, while one study (Russo et al, 2022), tested the effect of cues during gait initiation and walking. The total sample was 353 PD patients with FOG with an overall mean age of 69.8 ± 7.9 years.…”