Vibratory and plantar pressure stimulation: Steps to improve freezing of gait in Parkinson's disease

Self-treatment of freezing of gait in Parkinson’s disease patients using silicone pads to apply Thai acupressure to plantar acupoints: A randomised, controlled trial

“…The present study demonstrated that self-treatment using acupressure with silicone pads to stimulate designated plantar acupoints could effectively alleviate FOG during ON-state by increasing stride length, gait velocity, and cadence and decreasing the number of FOG episodes, FOG duration, and %FOG, which is consistent with previously reported findings using other mechanical stimuli of the designated plantar regions [11] , [13] , [14] , [15] , [16] , [17] . The treatment in which patients repeatedly leaned their seated body weight forward to stimulate acupoints at the head of the big toe and the first metatarsal bone, as targeted by silicone pads placed under the plantar surface, was easy for the patients to perform and can be considered an option for self-treatment outside clinical settings for mildly affected PD patients with ON-FOG.…”

“…The participants were instructed to perform self-acupressure by pushing their body weight against the silicone pads at the four designated acupoints separately and in succession: at two points per foot, the head of the big toe and the base of the first metatarsal bone, which influences the monosynaptic reflex in the tibialis anterior muscle, in the active-treatment group [11] , [12] , [13] , [14] . These locations were selected because they have the highest sensitivity threshold for vibratory and touch pressure in patients with PD [10] , [11] and have been used in previous studies [11] , [12] , [13] , [14] , [15] , [16] , [17] . Moreover, these locations correspond to standard therapeutic Thai acupoints on the foot that influence motor function in the lower extremities [23] .…”

“…The primary outcome was stride length. The secondary outcomes centred on the evaluation of FOG, including the number of FOG episodes, FOG duration, the ratio of the total duration of FOG to the total gait duration as a percentage (%FOG) [15] , gait velocity, cadence, double-support time, and the coefficients of variation (CV, which represent gait rhythm variation) of stride length, velocity, double-support time, and stride velocity. To be consistent with a previous study, we defined FOG episodes as those with a double-support time ≥ 1.65 standard deviations above the mean and velocity ≤ 90 % below the mean [17] , [24] .…”

“…Patients with PD exhibit notable denervation of cutaneous Aβ fibers, including mechanoreceptors [9] . Stimulus of mechanoreceptors in the foot that have the highest sensitivity thresholds in the plantar region for vibratory and touch pressure [10] , [11] and modulate somatosensory processing from the plantar nerves [12] might effectively alleviate FOG [13] , [14] , [15] , [16] . This pressure stimulus can be achieved using metallic mechanical stimulators [11] , [12] , [13] , [14] or silicone pads [15] , [16] applied to the plantar mechanoreceptors to increase peripheral afferent sensory input and proprioceptive feedback from the plantar nerves to central pattern generators and enhance sensorimotor function, which may improve gait parameters and alleviate FOG.…”

Dynamic evaluation of spine kinematics in individuals with Parkinson’s disease and freezing of gait

“…We assessed barefoot walking as footwear modify gait characteristics in patients with PD [33]. There is also evidence of the effect of plantar stimulation on parkinsonian gait [34] and specifically on FoG [35].…”