Alleviating freezing of gait using phase-dependent tactile biofeedback

Harrington, Will; Greenberg, Andrew S.; King, Edward; McNames, James; Holmstrom, Lars; Horak, Fay B.; Mancini, Martina

doi:10.1109/embc.2016.7592056

Cited by 18 publications

(42 citation statements)

References 16 publications

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“…In this paper, Mancini et al hypothesized that enhancing proprioceptive stimuli, in the form of tactile stimulation, may be useful in improving sensory integration and therefore alleviating FoG in PwP. To test the hypothesize Mancini et al used the VibroGait, a wearable somatosensory cueing system, previously described in [95] (Figure 17). The system plugged into inertial sensors placed on the shins of the user and consists of a novel controller unit (Arduino microcontroller) that senses through a gyroscope when the foot is on the ground and activates the tactor unit to generate a vibration.…”

Section: Resultsmentioning

confidence: 99%

A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease

Sweeney

Quinlan

Browne

et al. 2019

Sensors

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Freezing of gait is one of the most debilitating symptoms of Parkinson’s disease and is an important contributor to falls, leading to it being a major cause of hospitalization and nursing home admissions. When the management of freezing episodes cannot be achieved through medication or surgery, non-pharmacological methods such as cueing have received attention in recent years. Novel cueing systems were developed over the last decade and have been evaluated predominantly in laboratory settings. However, to provide benefit to people with Parkinson’s and improve their quality of life, these systems must have the potential to be used at home as a self-administer intervention. This paper aims to provide a technological review of the literature related to wearable cueing systems and it focuses on current auditory, visual and somatosensory cueing systems, which may provide a suitable intervention for use in home-based environments. The paper describes the technical operation and effectiveness of the different cueing systems in overcoming freezing of gait. The “What Works Clearinghouse (WWC)” tool was used to assess the quality of each study described. The paper findings should prove instructive for further researchers looking to enhance the effectiveness of future cueing systems.

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Section: Resultsmentioning

confidence: 99%

A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease

Sweeney

Quinlan

Browne

et al. 2019

Sensors

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“…Thus, ARTI should cause more activation of MITG, which includes visual temporal areas 41,42 . Visual temporal areas are important for freezers because of their increased reliance on visual and sensory information to walk 43,44 ; however, they have an inadequate integration of sensory input, proprioceptive deficits, and visual information during walking 45,46 . Thus, increased activation in MITG of the right hemisphere after ARTI (Fig.…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait

et al. 2020

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Background Exercises with motor complexity induce neuroplasticity in individuals with Parkinson's disease (PD), but its effects on freezing of gait are unknown. The objective of this study was to verify if adapted resistance training with instability — exercises with motor complexity will be more effective than traditional motor rehabilitation — exercises without motor complexity in improving freezing‐of‐gait severity, outcomes linked to freezing of gait, and brain function. Methods Freezers were randomized either to the adapted resistance training with instability group (n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. The primary outcome was the New Freezing of Gait Questionnaire. Secondary outcomes were freezing of gait ratio (turning task), cognitive inhibition (Stroop‐III test), motor signs (Unified Parkinson's Disease Rating Scale part‐III [UPDRS‐III]), quality of life (PD Questionnaire 39), anticipatory postural adjustment (leg‐lifting task) and brain activation during a functional magnetic resonance imaging protocol of simulated anticipatory postural adjustment task. Outcomes were evaluated before and after interventions. Results Only adapted resistance training with instability improved all the outcomes (P < 0.05). Adapted resistance training with instability was more effective than traditional motor rehabilitation (in improving freezing‐of‐gait ratio, motor signs, quality of life, anticipatory postural adjustment amplitude, and brain activation; P < 0.05). Our results are clinically relevant because improvement in the New Freezing of Gait Questionnaire (−4.4 points) and UPDRS‐III (−7.4 points) scores exceeded the minimally detectable change (traditional motor rehabilitation group data) and the moderate clinically important difference suggested for PD, respectively. The changes in mesencephalic locomotor region activation and in anticipatory postural adjustment amplitude explained the changes in New Freezing of Gait Questionnaire scores and in freezing‐of‐gait ratio following adapted resistance training with instability, respectively. Conclusions Adapted resistance training with instability is able to cause significant clinical improvement and brain plasticity in freezers. © 2020 International Parkinson and Movement Disorder Society

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“…3,11,22 The ARTI program incorporates complex motor exercises with dual-task conditions, which require high attentional, motor control, and sensorimotor demands. These primary characteristics of ARTI are very important to restore gait automaticity in freezers because they present an inadequate integration of sensory inputs and proprioceptive deficits, 52 as external somatosensory cues can mitigate freezing events while walking 53 as well as DTC on gait speed and stride length. 54 Second, freezers present worse attentional control to perform dual-task walking than nonfreezers, as gait attentiondirected cues (visual external information) improve dual-task walking.…”

Section: Arti Restores Gait Automaticity In Freezersmentioning

confidence: 99%

The Adapted Resistance Training with Instability Randomized Controlled Trial for Gait Automaticity

et al. 2020

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Background Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set‐shifting. We also verified associations between gait automaticity change and CLR activation change previously published. Methods Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual‐task and dual‐task cost [DTC] on gait speed and stride length), single‐task gait speed and stride length, attentional set‐shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. Results Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual‐task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set‐shifting at posttraining (P < 0.05). Conclusions ARTI restores gait automaticity and improves attentional set‐shifting in freezers attributed to the usage of exercises with high motor complexity. © 2020 International Parkinson and Movement Disorder Society

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Alleviating freezing of gait using phase-dependent tactile biofeedback

Cited by 18 publications

References 16 publications

A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease

A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease

A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait

The Adapted Resistance Training with Instability Randomized Controlled Trial for Gait Automaticity

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