Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 6, 2010
   Pages 573 — 582

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

Alberto J. Espay, MD, MSc;1* Yoram Baram, PhD;2 Alok Kumar Dwivedi, PhD;3 Rakesh Shukla, PhD;3 Maureen Gartner, RN, MEd;1 Laura Gaines, BA, CCRC;1 Andrew P. Duker, MD;1 Fredy J. Revilla, MD1

1The Neuroscience Institute, Department of Neurology, Movement Disorders Center, University of Cincinnati, Cincinnati, OH; 2Department of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel; 3Center for Biostatistical Services, Department of Environmental Health, University of Cincinnati, Cincinnati, OH

Abstract — 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.

Key words: cueing device, festination, freezing of gait, gait, gait impairment, Parkinson disease, PD, rehabilitation, virtual reality device, visual feedback.

This article and all supplementary material should be cited as follows:
Espay AJ, Baram Y, Kumar Dwivedi A, Shukla R, Gartner M, Gaines L, Duker AP, Revilla FJ. At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease.
J Rehabil Res Dev. 2010;47(6):573-82
DOI:10.1682/JRRD.2009.10.0165


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Last Reviewed or Updated  Thursday, August 19, 2010 10:59 AM

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