Pavement patterns can be designed to improve gait in Parkinson's disease patients

Abstract

Background Public spaces are usually designed with respect to various patient populations, but not Parkinson's disease. The objective of this study was to explore what type of easily applicable visual cueing might be used in public spaces and some interiors to improve gait in people with Parkinson's disease. Methods Thirty‐two patients with freezing of gait walked an 8‐meter track on 6 different floor patterns in single‐ and dual‐task conditions in random sequence. The reference pattern was a virtual large transverse chessboard, and the other patterns differed either in size (small floor stones), orientation (diagonal), nature (real paving), regularity (irregular), or no pattern. Time, number of steps, velocity, step length, cadence, and dual‐task effect were calculated. The number and total duration of freezing episodes were analyzed. Results Virtual, large, transverse floor stones improve time (P = 0.0101), velocity (P = 0.0029), number of steps (P = 0.0291), and step length (P = 0.0254) in Parkinson's disease patients compared with walking on no pattern. Virtual floor stones were superior in time and velocity to the real ones. Transverse floor stones were better than diagonal, whereas regular pattern stones were superior to irregular in some gait parameters. Subjectively, the reference pattern was preferred to the irregular one and to no pattern. No direct effect on freezing of gait was observed. Conclusions Parkinson's disease patients may benefit from floor patterns incorporating transverse oriented large rectangular visual cues. Because public space can be regulated with respect to people with medical conditions, the relevant legislative documents should be extended to allow for parkinsonian gait disorder. © 2019 International Parkinson and Movement Disorder Society

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

“…Increasing background step length would make the SE less significant, thereby reducing the likelihood of freezing (11,14). Transverse lines on floor are well-known strategies to reduce FOG (25)(26)(27). In recent years, wearable laser lights have been designed to deal with FOG in PD patients.…”

“…Strips on the floor may be more suitable for indoor FOG rehabilitation, while wearable laser lights offer the potential for alleviating freezing in daily activities. A recent research showed that pavement patterns designed in the form of large transversal visual cues could help improve gait in PD patients (27), and this may be a feasible strategy.…”

The Role of Architecture and Design in the Management of Parkinson’s Disease: A Systematic Review

“…Because pavement characteristics have been implicated several times in the risk of falling, fear of falling and gait disturbances, it should be one of the main intervention areas for people with PD. For instance, it was recently suggested that PD patients may benefit from floor patterns incorporating transverse oriented large rectangular visual cues [58], although no further details on floor adaptations were obtained. In addition, visual and auditory cueing techniques, e.g., transverse lines on the walkway, have been used as an effective component of locomotor therapy for people with PD [68][69][70][71] and are recommended at Hoehn-Yahr stage II [72].…”

“…To survey the circumstances surrounding falls, Stack et al [30,34] developed two cross-sectional design studies where questionnaires were used, and found trip hazards to be the main driver of sudden falls or near falling, namely uneven pavements, curbs, steps, skirting boards, doorways, and carpets. In addi- [57]; 2010 [46] Doorways/Lights Ashburn et al [32] Floor surface/Stair rails/Height of shelves Cole et al 2011 [33] Floor surface Floor surface Cowie et al 2010 [47]; 2011 [49] Doorways Ehgoetz et al 2013 [56] Doorways/Confined spaces/Open space/Lights Gál et al [58] Floor surface Galna, et al 2013 [13] Obstacle course Gazibara et al 2014 [35]; 2016 [36] Floor surface/Obstacle Giladi et al 1992 [41] Narrow spaces Gray et al 2000 [31] Floor [44] Narrow spaces Slaug et al 2013 [62] Housing accessibility Stack et al 1999 [30]; 2013 [34] Floor surface/Steps/Confined spaces/Doorways Stegemöller et al 2012 [51] Obstacle course tion, steps and doorways were reported to be the primary locations of such events within the home. Similarly, in a prospective-cohort study where fall diaries were used to assess fall related characteristics, Gray et al [31] found carpets to be the most common location of falls, referring further confined spaces to be also important fall locations.…”

“…They found that people who fell adapt differently to walking on unstable surfaces than age-matched controls, and that PD patients may alter their gait kinetic when walking on a slippery surface. Recently, an experimental study developed by Gál et al [58] assessed gait under six floor patterns, with the reference pattern being a virtual large transverse chessboard, and the other patterns differing either in size (small floor stones), orientation (diagonal), nature (real paving), regularity (irregular), or no pattern. They observed no direct effect on FOG in overall and no differences in gait parameters between large and small floor stones.…”