At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease

摘要

Shuffling and freezing while walking can impair function in patients with Parkinson disease (PD). Openloop devices that provide fixedvelocity 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 closedloop, accelerometerdriven, wearable, visualauditory cueing device in 13 patients with PD with offstate gait impairment at baseline and after 2 weeks of twice daily (30 minute duration) athome use. We measured gait velocity, stride length, and cadence using a validated electronic gaitanalysis system. Subjects underwent standard motor assessment and completed a selfadministered Freezing of Gait Questionnaire (FOGQ) (range 024; 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 closedloop sensory feedback appear to be effective and desirable nonpharmacologic interventions to improve walking in selected individuals with PD.