Sensory Electrical Stimulation Cueing May Reduce Freezing of Gait Episodes in Parkinson’s Disease

Abstract

Introduction Freezing of gait (FoG) is a movement abnormality that presents with advancing Parkinson's disease (PD) and is one of the most debilitating symptoms of the disease. The mainstay of nonpharmacological management of FoG is typically through external cueing techniques designed to relieve or prevent the freezing episode. Previous work shows that electrical stimulation may prove useful as a gait guidance technique, but further evidence is required. The main objective of this study was to determine whether a “fixed” rhythmic sensory electrical stimulation (sES) cueing strategy would significantly (i) reduce the time taken to complete a walking task and (ii) reduce the number of FoG episodes occurring when performing the task. Methods 9 participants with idiopathic PD performed a self-identified walking task during both control (no cue) and cueing conditions. The self-identified walking task was a home-based daily walking activity, which was known to result in FoG for that person. A trained physiotherapist recorded the time taken to complete the walking task and the number of FoG episodes which occurred during the task. Data were analyzed by paired t-tests for both the time to complete a walking task and the number of FoG episodes occurring. Results sES cueing resulted in a reduction in the time taken to complete a walking task and in the number of FoG episodes occurring during performance of this task by 14.23 ± 11.15% (p=0.009) and 58.28 ± 33.89% (p=0.002), respectively. Conclusions This study shows a positive effect of “fixed” rhythmic sES on the time taken to complete a walking task and on the number of FoG episodes occurring during the task. Our results provide evidence that sES cueing delivered in a “fixed” rhythmic manner has the potential to be an effective cueing mechanism for FoG prevention.

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

“…In 2018, Rosenthal et al proposed the use of sensory electrical stimulation to provide somatosensory cueing [54]. In this paper, Rosenthal et al hypothesized that somatosensory cueing delivered at a fixed tempo would modify the users walking patterns and help to alleviate On-FoG.…”

“…Visual cueing has been shown to ameliorate Off-FoG episodes [42,43,45,51] and On-FoG episodes [42,43,49,51,55]. The effect of somatosensory cueing has also been shown to ameliorate Off-FoG episodes [45,94] and On-FoG episodes [54]. However, due to the limited number of studies [45,48] that directly compared different cueing modalities, further investigation will be required to establish which modality is the most effective in different circumstances.…”

“…These studies can be grouped into two categories. Immediate cueing: the majority of studies have investigated the immediate effect of cueing on FoG [36,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59]. These studies predominantly evaluated the effect of cueing over a single session of use, with the objective of the cueing being to provide an immediate benefit in terms a reduction in the number/duration of FoG episodes.Therapeutic cueing: a number of studies have investigated the therapeutic effect of cueing [60,61,62,63,64,65,66,67,68,69,70].…”

“…These different approaches to ameliorate FoG have provided various technical challenges that led to the development of novel cueing systems. Examples of these cueing systems are custom-built metronomes [44], laser light canes [42], optical head-mounted displays [56], custom-built vibratory units [36] and electrical stimulation systems [54]. The effectiveness of these systems to ameliorate FoG has been suggested to be strongly dependent on the cueing modality adopted and the specific information that the cue provides [35].…”

Nonpharmacological, Nonsurgical Treatments for Freezing of Gait in Parkinson's Disease: A Systematic Review

“…In order to avoid studies with lower statistical power, 15 studies reporting samples with <10 patients were excluded. The therapies evaluated in those studies included visual cueing (laser light, staircase climbing) auditory cueing, tactile cueing, cueing exercise program, cognitive training, physical training, rTMS, and tDCS . All these approaches have been covered as well in the articles included in our review.…”