On‐Demand Cueing for Freezing of Gait in Parkinson's Disease: A Randomized Controlled Trial

Movement Disorders, Journal Year: 2024, Volume and Issue: 39(5), P. 876 - 886

Published: March 14, 2024

Abstract Background Cueing can alleviate freezing of gait (FOG) in people with Parkinson's disease (PD), but using the same cues continuously daily life may compromise effectiveness. Therefore, we developed DeFOG‐system to deliver personalized auditory on detection a FOG episode. Objectives We aimed evaluate effects DeFOG during FOG‐provoking protocol: (1) after 4 weeks DeFOG‐use against an active control group; (2) immediate (within‐group) different medication states. Method In this randomized controlled trial, 63 PD and were allocated or group. Both groups received feedback their living step counts device, group also on‐demand cueing. Video‐rated severity was compared pre‐ post‐intervention through protocol administered at home off ‐medication, without DeFOG. Within‐group tested by comparing Results similar between groups, found no between‐group differences FOG‐severity. However, within‐group analysis showed that alleviated (effect size d = 0.57), regardless state. Combining yielded effect 0.67. Conclusions reduced considerably population severe freezers both medication. Nonetheless, did not ameliorate unless worn. These findings suggest cueing is only effective when used, other walking aids. © 2024 International Parkinson Movement Disorder Society.

Language: Английский

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A Pilot Interventional Study on Feasibility and Effectiveness of the CUE1 device in Parkinson’s disease.

Parkinsonism & Related Disorders, Journal Year: 2025, Volume and Issue: 133, P. 107349 - 107349

Published: Feb. 22, 2025

Language: Английский

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Management of freezing of gait — mechanism-based practical recommendations

Nature Reviews Neurology, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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Role of Exosomes in Parkinson’s and Alzheimer’s Diseases

Published: Jan. 1, 2024

Parkinson's disease (PD), the second most common neurological ailment in world after Alzheimer's (AD), affects about 1% of those over 65 years. Exosomes were first thought to be useless cell debris. It has been discovered that exosomes contain a variety non-coding RNAs, including microRNAs, lncRNAs, and circRNAs, as well other bioactive compounds. A few these compounds are functional messenger RNAs (mRNAs), certain proteins, lipids, chemicals. Our understanding exosome function body improved result this information. physiological activities show important include migration, angiogenesis, intercellular communication, anti-tumor immunity. can help nervous system's cells communicate with one another, get rid waste, keep myelin coating place. Similar this, it is possible development central system illnesses like influenced by brain exosomes. The several neurodegenerative disorders (NDD), mostly attributed extracellular vehicles (EVs) known (EXOs). As result, have attracted attention EVs pathophysiological roles. Because their shown ability transport both pathogenic therapeutic cargo, researchers altered EXOs for use drug delivery.

Language: Английский

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Gait-modifying effects of augmented-reality cueing in people with Parkinson’s disease

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: April 9, 2024

Introduction External cueing can improve gait in people with Parkinson’s disease (PD), but there is a need for wearable, personalized and flexible techniques that exploit the power of action-relevant visual cues. Augmented Reality (AR) involving headsets or glasses represents promising technology those regards. This study examines gait-modifying effects real-world AR PD. Methods 21 PD performed walking tasks augmented either cues, imposing changes speed, step length, crossing height. Two different headsets, differing field view (AR-FOV) size, were used to evaluate potential AR-FOV-size on cues as well head orientation required interacting them. Results Participants modified their length significantly both lengths also being statistically equivalent imposed. Due technical issues, step-height modulation could not be analyzed. AR-FOV size had no significant effect modifications, although small differences observed when nearby objects between headsets. Conclusion People modify effectively state-of-the-art which longer limiting factor. Future studies are warranted explore merit library cue modalities individually-tailored facilitating environments.

Language: Английский

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Comparing the efficacy of therapeutic Thai acupressure on plantar acupoints and laser cane therapy on freezing of gait in Parkinson’s disease: a randomized non-inferiority trial

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: Jan. 29, 2024

Background ON-freezing of gait (ON-FOG) in Parkinson’s disease (PD), often resistant to medication, is linked sensory deficits and proprioceptive impairment, results falls reduced life quality. While visual cues from a laser cane (LC), which rapidly accesses the motor cortex, are commonly used compensate for increased reliance may be affected by progression. Emerging evidence suggests that modulation peripheral processing alleviate ON-FOG, therapeutic Thai acupressure (TTA) solution. This study aims evaluate effect TTA alleviating ON-FOG compare its effectiveness LC patients with PD. Methods open-label, non-inferiority trial randomized 90 PD equally into three arms: plantar nerve stimulation 96 s, cueing, sham control (SC). Stride length was primary endpoint [non-inferiority margin: lower limit 95% confidence interval (CI) above −10 cm mean change difference pre- immediately post-intervention versus (one-sided)]. Secondary outcomes included FOG episodes, double support time, velocity, cadence, step length, timed up go (TUG) test, analog scale (VAS) score. Results showed stride (mean = −0.7 cm; CI: −6.55; 5.15) (one-sided). The improvements SC were comparable between 13.11 7.26; 18.96) 13.8 7.96; 19.65) favored over improved FOG, VAS scores, while only resulted TUG test results. No complications occurred. Conclusion efficacy TTA, improves non-inferior consequently alleviates LC. might enhance function reduce dependence. Therefore, characterized non-invasive, simple, safe techniques, potential non-pharmacological alternative treatment overall quality life. However, further research mechanism, efficacy, utilization essential. Clinical registration https://www.thaiclinicaltrials.org/show/TCTR20200317001 , identifier TCTR20200317001.

Language: Английский

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Cueing-assisted gamified augmented-reality gait-and-balance rehabilitation at home for people with Parkinson’s disease: protocol of a pragmatic randomized controlled trial implemented in the clinical pathway

Frontiers in Neurology, Journal Year: 2025, Volume and Issue: 16

Published: Feb. 24, 2025

Physiotherapy in the clinic is highly recommended for improving gait, balance, and fall risk people with Parkinson's disease. In addition, technology may help boost unsupervised exercise hours at home. Strolll an augmented-reality (AR) neurorehabilitation platform delivering gait-and-balance exercises onto AR glasses that can be performed under direct supervision of therapist clinic, but also independently has option to integrate cueing assist more severe mobility impairments performing exercises. The objective this pragmatic randomized controlled trial (RCT) on examine its clinical feasibility effectiveness indicators falls risk. A secondary evaluate procedures tailoring assistive cues. total 100 disease (Hoehn Yahr stages 1-3) gait and/or balance will participate study. This study a RCT which all participants follow same procedure. After baseline assessment (T0), start 6-week usual care control period, followed by midterm (T1). Subsequently, undergo 2 weeks in-clinic familiarization AR. Then, intervention home, final (T2). primary parameters are (i.e., safety, adherence, performance, user experience) For statistical analyses effectiveness, allocated (using T0-T1 change data) or T1-T2 groups using multiple (n = 20) randomizations. Recruitment started May 2024 last T2 expected February 2025. design particular demonstrate real-world setting representative population. facilitate transition from supervised independent providing individualized treatment, assisted cues when deemed beneficial, https://clinicaltrials.gov/, identifier NCT06590987.

Language: Английский

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Altered Visuomotor Network Dynamics Associated with Freezing of Gait in Parkinson's Disease

Movement Disorders, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 25, 2025

Abstract Background Freezing of gait (FOG) is a common disorder that often accompanies Parkinson's disease (PD). The current understanding brain functional organization in FOG was built on the assumption connectivity (FC) networks static, but FC changes dynamically over time. We aimed to characterize dynamic (DFC) patients with based high temporal‐resolution MRI (fMRI). Methods Eighty‐seven PD patients, including 29 and 58 without FOG, 32 healthy controls underwent resting‐state fMRI. Spatial independent component analysis sliding‐window approach were used estimate DFC. Results Four patterns structured ‘states’ identified: frequent sparsely connected network (State I), less highly synchronized IV), two states opposite connecting directions between visual sensorimotor (positively State II, negatively III). Compared non‐FOG group, spent significantly time II more III. longer dwell III correlated severe symptoms. fractional window tended correlate visual–spatial executive dysfunction FOG. Moreover, fewer transitions lower variability local efficiency observed suggesting relatively ‘rigid’ brain. Conclusions This study highlights how visuomotor dynamics are related presence severity which provides new insights into pathophysiological mechanisms underly © 2025 International Parkinson Movement Disorder Society.

Language: Английский

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Bewegungsblockaden bei Parkinsonsyndromen

Nervenheilkunde, Journal Year: 2025, Volume and Issue: 44(03), P. 98 - 105

Published: March 1, 2025

Zusammenfassung Eine der größten therapeutischen Herausforderungen bei Menschen mit fortgeschrittenen Parkinson-Syndromen sind motorische Blockaden bzw. das Freezing-Phänomen, dessen bekanntester Vertreter wohl Gangfreezing ist. Dabei reicht die Wahrnehmung und Konzeption von motorischen einer Kolibristörung bis hin zum Kardinalsymptom Parkinsonkrankheit. Der vorliegende Artikel macht sich Mühe, diese motorischer zu den ersten Gedanken Parkinson selbst zurück dann im Verlauf Geschichte weiter verfolgen. Es geht uns darum, zeigen ein Verständnis dafür wecken, dass es um einen zentralen Aspekt Phänomenologie handelt. Pathophysiologische Grundlagen werden in ihren anerkannten klinischen Aspekten berührt, ebenso wie klinische forschende Erfassung. Schließlich sowohl wichtigsten pharmakotherapeutischen als auch physiotherapeutischen Ansätze Grundzügen dem Leser vorgestellt.

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Non-invasive device to alleviate symptoms in people living with Parkinson’s: study protocol for a multicentre phase II double-blind randomised controlled trial

BMJ Open, Journal Year: 2025, Volume and Issue: 15(4), P. e096051 - e096051

Published: April 1, 2025

Introduction Existing interventions for people with Parkinson’s disease (PwP) often fall short in addressing gait disturbances and falls, impacting their quality of life. The CUE1 non-invasive medical device, along its updated version, CUE1+, offers vibrotactile stimulation cueing. device shows promise alleviating motor symptoms reducing falls based on early user testing a 9-week pilot study. This study aims to assess the usability, safety, tolerability effectiveness CUE1+ improving compared sham over 12-week period. Methods analysis multicentre, phase II double-blind randomised controlled trial will recruit 50 PwP from Barts Health Homerton NHS Hospitals, enrolling them at Queen Mary University London. Participants, diagnosed idiopathic Parkinson’s, aged 18+ providing written consent, be randomly assigned either experimental group (CUE1+ device) or control (sham device). primary outcome is usability 12 weeks. Measures include recruitment, compliance dropout rates, safety/tolerability which collected through participant clinical diary baseline (week 0) follow-up 13). Effectiveness evaluated same time points using movement tests (MDS-UPDRS Part III, Functional Gait Assessment, Timed Up Go isolation dual tasking two keyboard-based typing tests—Bradykinesia Akinesia Incoordination Digital Finger Tapping), video recordings. Participants wear KinetiGraph wristband monitor home continuously weeks collect real-world data. Patient-reported outcomes MDS-UPDRS I, IV, Activity-specific Balance Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety Depression Fatigue Symptom Scale Disease Questionnaire-39. Ethics dissemination has received ethical approval London-Dulwich Research Committee (reference: 23/PR/1526). Findings submitted peer-reviewed publications. Trial registration number NCT06174948 .

Language: Английский

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