Article

Shuffling and freezing while walking can impair function in patients with
Parkinson disease (PD). Open-loop devices that provide fixed-velocity visual or
auditory cues can improve gait but may be unreliable or exacerbate freezing of
gait in some patients. We examined the efficacy of a closed-loop,
accelerometer-driven, wearable, visual-auditory cueing device in 13 patients with
PD with off-state gait impairment at baseline and after 2 weeks of twice daily
(30 minute duration) at-home use. We measured gait velocity, stride length, and
cadence using a validated electronic gait-analysis system. Subjects underwent
standard motor assessment and completed a self-administered Freezing of Gait
Questionnaire (FOGQ) (range 0-24; lower is better). After training, device use
enhanced walking velocity (61.6 +/- 20.1 cm/s to 72.6 +/- 26.5 cm/s, p = 0.006)
and stride length (74.3 +/- 16.4 cm to 84.0 +/- 18.5 cm, p = 0.004). Upon device
removal, walking velocity (64.5 +/- 21.4 cm/s to 75.4 +/- 21.5 cm/s, p < 0.001)
and stride length (79.0 +/- 20.3 cm to 88.8 +/- 17.7 cm, p = 0.003) exhibited a
greater magnitude of change, suggesting immediate residual benefits. Also upon
device removal, nearly 70 percent of subjects improved by at least 20 percent in
either walking velocity, stride length, or both. An overall improvement in gait
was measured by the FOGQ (14.2 +/-1.9 to 12.4 +/- 2.5, p = 0.02). Although issues
related to compliance and response variability render a definitive interpretation
of study outcome difficult, devices using closed-loop sensory feedback appear to
be effective and desirable nonpharmacologic interventions to improve walking in
selected individuals with PD.

Langue : ANGLAIS