An objective assessment to investigate the impact of turning angle on freezing of gait in Parkinson's disease

Abstract

Freezing of gait (FoG) is often described in subjects with Parkinson's disease (PD) as a sudden inability to continue the forward walking progression. FoG occurs most often during turning, especially at sharp angles. Here, we investigated 180 and 360 degrees turns in two groups: PD subjects reporting FoG (FoG+), and PD subjects without FoG (FoG-). Forty-three subjects (25 FoG+, 18 FoG-) wore an inertial sensor on their back while walking back and forth continuously for 2 min (reversing direction with a 180° turn), and while turning in place for 1 min (alternating 360° turning in opposite directions). Objective measures (turn duration, peak velocity, jerkiness and range of acceleration) were computed during the turns and compared across FoG+ and FoG-groups. Results showed that FoG+ compared to FoG-took significantly a longer time to complete 360° turns than 180° turns. A significant lower turn peak velocity, higher jerkiness and an increased range of medio-lateral acceleration was also found in FoG+. Significant differences between the two groups across the two turning tasks validated the hypothesis that sharper turns might cause higher instability in FoG+ compared to FoG-.

A Novel Physical Mobility Task to Assess Freezers in Parkinson’s Disease

“…The papers considered to compose this study are listed in Table 1. [14] X BECK (2015) [15] X X HANDOJOSENO (2015) [20] X X KILLANE (2015) [21] X X WAECHTER (2015) [22] X X CANDO (2016) [23] X X X X TARD (2016) [24] X BERTOLI (2017) [1] X X MURALIDHARAN (2017) [25] X…”

“…The following combinations of terms were used to maximize the scope and type of material referred in the search: FOG is usually triggered by postural transitions [1], the triggers considered to be a possible manner of causing FOG, according to the literature review, are to sit and stand up from a chair, walk through a doorway, reach a destination, turn 180° and 360°, and carry out a dual task. The triggers considered in each study included in the literature review are shown in Table 1.…”

“…The volunteers were able to walk independently for 10 m and reported experiencing FOG in the prior month. FOG severity was rated using the New Freezing of Gait Questionnaire (new FOG-Q) [1,2,5,27,31,32]. All the participants had a FOG history with different severity and frequency [20].…”

“…Freezing of gait (FOG) is one of the most disabling features of Parkinson's disease (PD) [1]. FOG motor disorder represents an intermittent failure to initiate or maintain locomotion [2].…”

“…FOG episodes last more than one second and can be triggered by postural transitions [1]. An FOG trigger can be a movement, e.g., a turn while walking (turning hesitation), the beginning of walking (starting hesitation), and just before reaching a destination (destination hesitation); an environmental constraint, e.g., doors, narrow passages, public transportation, and small or messy spaces; a dual task, either motor dual task or motor-cognitive dual task; or a negative emotion, such as anxiety, stress, anger, fear, or distress [7,[13][14][15].…”