Annotated Bibliography. Freezing of Gait: Step by Step closer to a Solution?

Freezing of Gait: Step by Step closer to a Solution?

Patients with Parkinson’s disease oftentimes display freezing of gait (FOG), a movement ailment that appears to be linked to visual perception, hence new treatment options explore intriguing methods and technologies, some of which are described in this paper.

Paper 1

Ferraye, M.U., Fraix, V., Pollak, P., Bloem, B.R. & Debu, B. (2016). The laser-shoe: A new form of continuous ambulatory cueing for patients with Parkinson’s disease. Parkinsonism and Relasted Disorders, 29, 127-128. http://dx.doi.org/10.1016/j.parkreldis.2016.05.004

A paper called ‘Freezing of gait: Promising avenues for future treatment’ by Gilat, Silva, de Lima, Bloem, Shine, Nonnekes and Lewis (2018) mentions the laser-shoe. Entering ‘laser-shoe’ and ‘parkinsons’ in SCU library search field leads to this article.

This paper presents a 79-year-old man suffering from Parkinson’s disease with severe freezing of gait (FOG) and subsequent falls, who was helped by an innovative new creation. To alleviate his FOG the researchers invented the laser- shoe. The laser-shoe is a regular shoe that has been fitted with a laser in the tip of the shoe that gets activated by a switch once the heel contacts the floor at the time the patient experiences FOG. The laser then projects laser lines directly in front of the foot that is about to step forward. This mechanism allows visual cues to be delivered right away and precisely when and where needed.

The paper concisely describes preceding gadgets with lasers (rolling walker and walking stick) and their limitations, and how other visual cues (stripes or lines on the floor) are often restricted to laboratory settings or are stationary. The successful application of a device in a patient’s immediate environment like at home and outside at any time is a useful addition to existing research. In the field of studying new treatments for Parkinson’s disease and FOG every new approach that can add a puzzle piece to the understanding of FOG in Parkinson’s disease is important. As many patients have highly individual courses of the disease and causes of FOG the developers of the laser-shoe seek to trial the shoe on more people to see if it remains an exciting and promising implement.

Paper 2

Janssen, S., Bolte, B., Nonnekes, J., Bittner, M., Bloem, B.R., Heida, T., Zhao, Y. & van Wezel, R.J.A. (2017). Usability of Three-dimensional Augmented Visual Cues Delivered by Smart Glasses on (Freezing of) Gait in Parkinson’s Disease. Frontiers in Neurology, 8:279, 1-10. doi: 10.3389/fneur.2017.00279

Found using the key words ‘parkinson’, ‘FOG’ and ‘augmented reality’ in the SCU library search field and looking for the most recent article published.

The paper describes an unsuccessful trial with 25 Parkinson’s disease patients who are afflicted with freezing of gait (FOG) via the attempt of augmented reality glasses that deliver 3-dimensional visual cues with sound. Considering certain spatial limitations of previous treatment methods, the research team saw great potential in the use of augmented reality glasses, also called smart glasses, to provide a portable device that delivers visual and audio cues on demand, moving through the environment with the patient and thus displays cues over their existing perceptions. The article precisely describes the custom-made glasses, software and methods used to measure movements, selection criteria for the participants and the walking courses. The five cues used in the experiment are specified: 3-dimensional augmented diagonal bars (1), a 3-dimensional augmented staircase (2), parallel bars printed on the floor (3), an auditory metronome rhythm (4) and no cues (5).

The paper contains a sound definition of FOG and earlier studies of external visual and auditory cues (2D patterns, 3D patterns and metronome) are depicted well. The study process is described elaborately and the researchers have reflected to a great degree on their materials and methods, data analysis and the results. The discussion talks in detail about many aspects that might have inhibited a positive outcome of their study, including feedback and improvement suggestions of the participants such as the glasses being uncomfortable and heavy or not enough time to get used to them and familiarise with the cues. The article is highly relevant and useful to contemporary research in this field. It combines many previous ideas and applies revolutionary new technology to find a way to provide FOG relief for patients. The researchers provide an honest and profound discussion of their results. They recommend that future studies allow for more control conditions and should include healthy participants as well. Deeper scientific insight into the efficiency of visual cues for FOG are needed. Hopefully, future pioneering technology will facilitate augmented reality glasses that will turn out to be a successful option to treat FOG in Parkinson’s disease patients.

Paper 3

Janssen, S., Soneji, M., Nonnekes, J. & Bloem, B.R. (2016). A painted staircase illusion to alleviate freezing of gait in Parkinson’s disease. Journal of Neurology, 263(8), 1661-1662. DOI 10.1007/s00415-016-8195-z

Watching a TED talk on https://www.ted.com/talks/mileha_soneji_simple_hacks_for_life_with_parkinson_s, prompted me to search for a peer reviewed paper via the SCU library website using the keywords ‘parkinson’, ‘freezing of gait’ and ‘illusion’.

This article describes the case of a 60-year-old Indian man with Parkinson’s disease who’s freezing of gait (FOG) was alleviated by a 3-dimensional illusionary staircase print on the floor. The man’s FOG was often provoked when he initiated walking or needed to turn - yet fascinatingly, he was capable of descending and climbing stairs without difficulty. This observation inspired his niece to design a 3-dimensional staircase illusion and to print it on the floor in his apartment. Interestingly, the man experienced no improvement by 2-dimensional visual lines on the floor like other patients sometimes do, only a 3-dimensional illusion allowed him to move smoothly across the room. It therefore suggests that the perception of an additional third dimension is crucial to him. The outlined limitations of this kind of intervention are that it is stationary and has great aesthetic impact on a room.

The research team draws interesting and insightful assumptions from this case and refers to previous studies and research to validate their opinions. Although this example is not a scientific study itself, the research team that witnessed the case decided to publish it in the ‘Journal of Neurology’ to complement current research in the field and initiate further exchange of ideas. The article is field relevant, brief, informative and reads effortlessly. It further points to interesting and auspicious avenues to provide visual illusions through augmented and virtual reality. Most notably, the article clearly states the need for more collaboration between clinicians, patients and caregivers and pays homage to relatives and their efforts and creativity to help find treatments for FOG in Parkinson’s disease.