Repetitive stepping in place identifies and measures freezing episodes in subjects with Parkinson's disease (original) (raw)
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Journal of neural transmission (Vienna, Austria : 1996), 2015
Previous studies conducted in laboratory settings suggest that the gait pattern in between freezing of gait (FOG) episodes is abnormal among patients with Parkinson's disease (PD) who suffer from FOG (i.e., "freezers"), compared to those who do not (i.e., "non-freezers"). We evaluated whether long-term recordings also reveal gait alterations in freezers and if these features were related to freezing severity and its impact on daily function. 72 patients with PD wore a 3-D accelerometer for 3 days. Acceleration-derived gait features included quantity (e.g., the amount of walking) and quality measures (e.g., gait variability). The New FOG-Questionnaire evaluated the subject's perceptions of FOG severity and its impact. Age, gender, and disease duration were similar (p > 0.19) in the 28 freezers and 44 non-freezers. Walking quantity was similar in the two groups, while freezers walked with higher gait variability (i.e., larger anterior-posterior power spe...
Increased foot strike variability in Parkinson's disease patients with freezing of gait
Parkinsonism & related disorders, 2018
Freezing of gait (FOG) is a debilitating, late motor complication of Parkinson's disease (PD) that occurs in 50-80% of patients. Gait freezing significantly worsens quality of life by decreasing mobility and increasing falls. Studies have shown that patients with episodic freezing episodes also have deficits in continuous gait. We evaluated whether there was an objective gait correlate to the increased stumbling reported by many patients with gait freezing. PD subjects and healthy controls (HC) were enrolled after IRB approval. Subjects with more than 1 fall/day or a Montreal Cognitive Assessment score <10 were excluded. Subjects walked at their normal pace, 8 lengths of a 20 × 4 foot pressure-sensor mat. Data was collected and analyzed using PKMAS software (Protokinetics) and statistical analysis performed using SPSS 22 (IBM). 72 age matched subjects (22 PD FOG, 27 PD no-FOG, and 23 HC) were enrolled. Disease duration and Hoehn & Yahr scores were not significantly different ...
Freezing of Gait in Parkinson’s Disease: Implications for Dual-Task Walking
Journal of Parkinson's Disease
Background: The simultaneous completion of multiple tasks (dual-tasking, DT) often leads to poorer task performance (DT cost, DTC). People with Parkinson’s disease (PwPD) exhibit difficulty with DT, and DTC may be particularly pronounced in PwPD with freezing of gait (FOG). Objective: This study assessed the relationship between FOG status and DTC during gait. Methods: Gait parameters were collected using inertial sensors in 106 PwPD (off-medication), including definite-freezers (dFOG; n = 25), possible-freezers (pFOG; n = 16), and non-freezers (nFOG; n = 65) during single (ST)-and DT walking. Results: PwPD with dFOG had larger (worse) DTC than nFOG for foot-strike angle, stride length, toe-off angle, variability of foot-strike angle, and arm range of motion (ROM). After accounting for covariates, the toe-off angle and stride length remained worse in PwPD who freeze. Worse cognition predicted larger DTC for stride length, gait cycle duration, gait speed, and step duration across gro...
Clinical indicators of gait freezing in Parkinson's disease
2020
Background: Freezing of gait is a common (FOG) episodic gait disorder in advanced Parkinson's disease (PD). FOG is one of the main risk factors for falls; therefore FOG's consequences can be devastating. This symptom is difficult to study in a research laboratory because of its unpredictability which makes it difficult to select patients for clinical testing and make the right treatment decisions. Thus, clinical indicators may be useful to distinguish between patients with and without FOG. The aim of this study was to compare the number of steps and the time to perform a 180-degree turn in patients with Parkinson's disease with and without FOG. Material and methods: The study was performed on 56 PD patients. Subjects were divided into 2 groups: a total of 28 patients with PD and FOG were compared with 28 patients with PD without FOG, according to item number 14, from the Unified Parkinson's Disease Rating Scale (UPDRS). The 2 subgroups were homogeneous in terms of age and disease severity. Results: Significant differences were found between the two groups both in steps number (P <0.0001) and in the time required to perform a 180-degree turn (P <0.0001). Conclusions: Performing more steps and more seconds to turn 180 degrees may be a useful indicator to distinguish the characteristics of PD patients with FOG. A PD patient which turns at 180-degree with more than 5 steps is most likely a patient with FOG.
Assessing the utility of Freezing of Gait Questionnaires in Parkinson’s Disease
Parkinsonism & Related Disorders, 2012
There are currently two validated questionnaires, the Freezing of Gait Questionnaire and the New Freezing of Gait Questionnaire, that are intended to assess the degree of freezing of gait in patients with Parkinson's disease. However, to date no study has attempted to determine whether ratings on these questionnaires accurately reflect the severity (frequency and duration) of actual freezing episodes experienced by patients. We studied twenty-four patients with Parkinson's disease who self-reported significant freezing while in their practically-defined 'off' state. Prior to clinical assessment they completed both freezing of gait questionnaires before being video-recorded while performing a series of timed up-and-go tasks, which incorporated turning, rotating and passing through narrow gaps. The rating of video recordings by two independent observers identified a total of 530 freezing events. The frequency and duration of freezing episodes for each patient were calculated and correlated with questionnaire ratings. Scores on either questionnaire did not correlate with either the frequency or duration of freezing episodes experienced by patients during objective assessment. These results suggest the need to re-evaluate the utility of questionnaires in the assessment of freezing of gait. Furthermore, these results highlight the need for accurate objective methods of identifying freezing events when assessing future clinical interventions aimed at reducing this potentially disabling symptom of Parkinson's disease.
Walking patterns in Parkinson's disease with and without freezing of gait
Neuroscience, 2011
The pathophysiology underlying freezing of gait (FOG) in Parkinson's disease remains incompletely understood. Patients with FOG ("freezers") have a higher temporal variability and asymmetry of strides compared to patients without FOG ("non-freezers"). We aimed to extend this view, by assessing spatial variability and asymmetry of steps and interlimb coordination between the upper and lower limbs during gait. Twelve freezers, 15 non-freezers, and 15 agematched controls were instructed to walk overground and on a treadmill. Kinematic data were recorded with a motion analysis system. Both freezers and non-freezers showed an increased spatial variability of leg movements compared to controls. In addition, both patient groups had a deficit in interlimb coordination, not only between ipsilateral arms and legs, but also between diagonally positioned limbs. The only difference between freezers and non-freezers was a decreased step length during treadmill walking. We conclude that parkinsonian gait-regardless of FOG-is irregular, not only in the legs, but also with respect to interlimb coordination between the arms and legs. FOG is reflected by abnormal treadmill walking, presumably because this provides a greater challenge to the defective supraspinal control than overground walking, hampering the ability of freezers to increase their stride length when necessary.
Quantifying freezing of gait in Parkinson's disease during the instrumented timed up and go test
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2012
Over half of patients with PD eventually develop freezing of gait (FoG), an intermittent failure to initiate or maintain walking that is often associated with trembling of the legs. We tested 21 PD with FoG, 27 PD without FoG, and 21 healthy elderly people in a clinic with the Intrumented Timed Up and Go test (ITUG). FoG was quantified from the power spectral density of the antero-posterior shank acceleration from which a Frequency Ratio was calculated as the square of the total power in the 3-8 Hz band, divided by the square of the total power in the .5-3 Hz band. Spatiotemporal gait parameters calculated from synchronized gyroscopes on the two legs were also measured in these subjects. The Frequency Ratio was significantly larger in freezers than in non-freezers or control subjects. It better differentiated gait disorders between PD subjects with and without FoG than traditional gait measures such as stride length, stride velocity and double support time. The Frequency Ratio was v...
Gait initiation impairment in patients with Parkinson’s disease and freezing of gait
ObjectiveFreezing of gait (FOG) is a sudden episodic inability to produce effective stepping despite the intention to walk. It typically occurs during gait initiation or modulation and may lead to falls and loss of independence. We assessed gait initiation (GI) changes in parkinsonian patients suffering from FOG when off dopaminergic medications, removing correlations with anthropometric measurements, the base of support, and initial stance posture. We also addressed the temporal pattern of segmental body movements subserving gait initiation.MethodsWe studied 23 subjects with Parkinson’s disease (PD) and FOG (PDF), 20 patients with PD and no previous history of FOG (PDNF), and 20 healthy controls (HC). Kinematic and dynamic analysis of anticipatory postural adjustments (imbalance, unloading, stepping phase) was performed while patients were starting gait from upright standing after a self-selected period, to avoid any effect of cueing on gait initiation.ResultsThe center of pressure...
Neuroimaging and neuropsychological assessment of freezing of gait in Parkinson's disease
Alzheimer's & Dementia: Translational Research & Clinical Interventions
Introduction: Freezing of gait (FOG) is a disabling phenomenon characterized by a brief, episodic absence or reduction of forward progression of the feet despite the intention to walk. It is a common cause of falls and mortality in cases with Parkinson's disease (PD). This article reviews neuropsychological and neuroimaging studies to date and introduces a new study of multimodal imaging and cognition in PD-FOG. Methods: A comprehensive literature search identified studies using neuropsychological evaluation and/or neuroimaging to evaluate PD-FOG. Results: Several studies have evaluated PD-FOG, but few have combined neuropsychological and comprehensive neuroimaging and none longitudinally. Discussion: A study using a combined approach longitudinally evaluating cognitive dysfunction and underlying neural networks in FOG is needed. We introduce the framework of a study which demonstrates the use of establishing an infrastructure for studying neurodegenerative disorders using the