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The CuePed Trial: How Does Environmental Complexity Impact Cue Effectiveness? A Comparison of Tonic and Phasic Visual Cueing in Simple and Complex Environments in a Parkinson's Disease Population with Freezing of Gait.
Parkinson's Disease ( IF 3.2 ) Pub Date : 2019-07-24 , DOI: 10.1155/2019/2478980
Rodney Marsh 1, 2 , Michael H Cole 3 , Nadeeka N W Dissanayaka 4, 5 , Tiffany R Au 4 , Sandra Clewett 6 , John D O'Sullivan 1, 5 , Peter A Silburn 1, 7
Affiliation  

Background. The optimal prescription of cueing for the treatment of freezing of gait (FoG) in Parkinson’s disease (PD) is currently a difficult problem for clinicians due to the heterogeneity of cueing modalities, devices, and the limited comparative trial evidence. There has been a rise in the development of motion-sensitive, wearable cueing devices for the treatment of FoG in PD. These devices generally produce cues after signature gait or electroencephalographic antecedents of FoG episodes are detected (phasic cues). It is not known whether these devices offer benefit over simple (tonic) cueing devices. Methods. We assembled 20 participants with PD and FoG and familiarized them with a belt-worn, laser-light cueing device (Agilitas™). The device was designed with 2 cueing modalities—gait-dependent or “phasic” cueing and gait-independent or “tonic” cueing. Participants used the device sequentially in the off, phasic, or tonic modes, across 2 tasks—a 2-minute walk and an obstacle course. Results. A significant improvement in mean distance walked during the 2-minute walk test was observed for the tonic mode (127.3 m) compared with the off (111.4 m) and phasic (116.1 m) conditions. In contrast, there was a nonsignificant trend toward improvement in FoG frequency, duration, and course time when the device was switched from off to tonic and to phasic modes for the obstacle course. Conclusions. Parkinson’s disease patients with FoG demonstrated an improvement in distance walked during the two-minute walk test when a cueing device was switched from off to phasic and to tonic modes of operation. However, this benefit was lost when patients negotiated an obstacle course.

中文翻译:

CuePed 试验:环境复杂性如何影响提示效果?帕金森病人群在简单和复杂环境中的强直和相位视觉提示与步态冻结的比较。

背景。由于提示方式、设备的异质性和有限的比较试验证据,提示治疗帕金森病 (PD) 步态冻结 (FoG) 的最佳处方是目前临床医生面临的难题。用于治疗 PD 中的 FoG 的运动敏感、可穿戴提示设备的开发有所增加。这些设备通常在检测到 FoG 事件的特征步态或脑电图先决条件后产生提示(相位提示)。目前尚不清楚这些设备是否比简单的(补品)提示设备更有优势。方法. 我们召集了 20 名患有 PD 和 FoG 的参与者,并让他们熟悉了一种佩戴在腰带上的激光提示设备 (Agilitas™)。该设备设计有 2 种提示方式——步态相关或“阶段性”提示和步态无关或“强直”提示。参与者在 2 项任务(2 分钟步行和障碍训练)中按顺序在关闭、阶段或强直模式下使用该设备。结果。与关闭 (111.4 m) 和阶段 (116.1 m) 条件相比,强直模式 (127.3 m) 在 2 分钟步行测试期间的平均步行距离有显着改善。相比之下,当设备从关闭切换到强直和障碍训练阶段模式时,FoG 频率、持续时间和课程时间的改善趋势并不显着。结论. 患有 FoG 的帕金森病患者在两分钟步行测试中表现出步行距离的改善,当提示装置从关闭切换到相位和强直操作模式时。然而,当患者通过障碍课程时,这种益处就消失了。
更新日期:2019-07-24
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