Provocation of Freezing of Gait in Parkinson's Disease
Study Details
Study Description
Brief Summary
Sample Size N= 10 Parkinson's disease patients with self-reported freezing of gait and 10 without self-reported freezing of gait (in total, 20 Parkinson's disease patients)
Accrual Period Single visit for 2 hours
Study Design This is a cross-sectional study with an intervention to provoke freezing of gait using split-belt treadmill in Parkinson's disease patients with a randomized cross-over design.
After baseline evaluation (a), interventions to induce freezing of gait will be performed in a randomized order to avoid a practice/fatigue effect in the following conditions using combination of 4 interventions: walking speed (fast walking vs. natural walking), visual loading (passing through narrow pathway), cognitive loading (dual task), and asymmetry (best side reduction).
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Natural and fast walking with self-paced mode to access gait parameters and decide the speed for evaluation (3 mins X2) remaining assessment will be randomized and performed on the treadmill:
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Natural and fast walking passing through narrow pathway (2 mins X2)
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Natural and fast walking with dual task (2 mins X2)
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Natural and fast walking passing through narrow pathway and during cognitive dual task (2 mins X2)
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Natural and fast walking reducing the best side (2 mins X2)
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Natural and fast walking reducing the best side passing through narrow pathway (2 mins X2)
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Natural and fast walking reducing the best side with cognitive dual task (2 mins X2)
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Natural and fast walking reducing the best side passing through narrow pathway and during cognitive dual task (2 mins X2)
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Conditions b-h will be carried out on a split-belt treadmill (Grail systems®, by Motek, Netherlands).
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(b-i) freezing of gait episodes will be identified with synchronized videorecordings (screening done by two independent observers). Episodes identified by both observers will be confirmed and measured by comparing the relative height of metatarsal and heel markers of each foot, in keeping with a previous study evaluating freezing of gait episode on a treadmill.
Study Duration
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(Baselines evaluation) Enrolment and assessment (Montreal cognitive assessment, Movement Disorders Society-unified Parkinson's disease rating scale part 2, 3 and 4, Activities-Specific Balance Confidence Scale, Parkinson's disease questionnaire-39, and New freezing of gait questionnaire)
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(a) Formal gait analysis using split-belt treadmill (Grail systems®, by Motek, Netherlands) will be done for baseline assessment (normal walking) and to test patient's ability for fast walking (25% of the normal speed).
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(b-h) Provocation of freezing of gait at split-belt treadmill (Grail systems®, by Motek, Netherlands) with natural and fast walking with/without additional loading or interventions on the asymmetry
Total time= 2 hours
Study Intervention Freezing of gait will be provoked based on the situations combined among 4 conditions; (1) interventions on asymmetry, (2) cognitive dual task, (3) visual loading - passing through narrow pathway, and (4) walking speed at a split-belt treadmill.
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Fast walking will be defined as walking 25% faster than the normal comfortable walking. Subjects who cannot reach this speed, will be asked to walk at their safest maximum speed.
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Passing narrow pathway will be done by walking in a "rope bridge" scene in virtual reality (VR).
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Dual cognitive task will be carried out with serial subtraction prompted on the screen in VR.
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Best side reduction will be defined as 25% slower speed on the best side based on the speed during the initial natural walking with tied configuration setting based on a previous study.3
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Condition b-h will be randomized.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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No Intervention: Natural walking
|
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Experimental: fast walking
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Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
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Experimental: normal walking passing through narrow pathway
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Other: visual loading
visual loading (walking through narrow pathway using VR)
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Experimental: fast walking passing through narrow pathway
|
Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
Other: visual loading
visual loading (walking through narrow pathway using VR)
|
Experimental: Natural walking with dual task
|
Other: dual task
dual task (serial subtraction using VR)
|
Experimental: fast walking with dual task
|
Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
Other: dual task
dual task (serial subtraction using VR)
|
Experimental: Natural walking passing through narrow pathway and during cognitive dual task
|
Other: visual loading
visual loading (walking through narrow pathway using VR)
Other: dual task
dual task (serial subtraction using VR)
|
Experimental: fast walking passing through narrow pathway and during cognitive dual task
|
Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
Other: visual loading
visual loading (walking through narrow pathway using VR)
Other: dual task
dual task (serial subtraction using VR)
|
Experimental: Natural walking reducing the best side
|
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Experimental: fast walking reducing the best side
|
Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Experimental: Natural walking reducing the best side passing through narrow pathway
|
Other: visual loading
visual loading (walking through narrow pathway using VR)
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Experimental: fast walking reducing the best side passing through narrow pathway
|
Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
Other: visual loading
visual loading (walking through narrow pathway using VR)
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Experimental: Natural walking reducing the best side with cognitive dual task
|
Other: dual task
dual task (serial subtraction using VR)
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Experimental: fast walking reducing the best side with cognitive dual task
|
Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
Other: dual task
dual task (serial subtraction using VR)
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Experimental: Natural walking reducing the best side passing through narrow pathway and during cognitive dual task
|
Other: visual loading
visual loading (walking through narrow pathway using VR)
Other: dual task
dual task (serial subtraction using VR)
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Experimental: fast walking reducing the best side passing through narrow pathway and during cognitive dual task
|
Other: walking speed
walking speed (normal speed vs. fast speed). fast speed was 25% faster than normal speed
Other: visual loading
visual loading (walking through narrow pathway using VR)
Other: dual task
dual task (serial subtraction using VR)
Other: best side reduction
best side reduction (split belt mode, the speed of best side was reduced by 25% compared to the other side)
|
Outcome Measures
Primary Outcome Measures
- number of freezing of gait [Within intervention (2mins for each situation)]
provoked freezing of gait during each situation
Secondary Outcome Measures
- Correlation with Montreal cognitive assessment, Movement Disorders Society-unified Parkinson's disease rating scale part 2 and 3, Activities-Specific Balance Confidence Scale, Parkinson's disease questionnaire-39, and New freezing of gait questionnaire [Within intervention (2mins for each situation)]
Correlation of detected number of freezing of gait with clinical scales
- Comparison of number/duration of provoked freezing of gait among the situations between Parkinson's disease patients with and without freezing of gait [Within intervention (2mins for each situation)]
Comparison between two groups
Eligibility Criteria
Criteria
Inclusion Criteria:
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Idiopathic Parkinson's disease
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Hoehn & Yahr Stage 1-3
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Ten with self-reported freezing of gait (score of 1 in part 1 of new freezing of gait questionnaire), and 10 without FOG..
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Sequence effect on feet (as score of at least 2 in the leg agility (item#3.8) of Movement Disorders Society-Unified Parkinson's disease rating scale part 3)
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Stable clinical response to medications or stimulation parameters for at least 1 months
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Able to walk on a motor-driven treadmill
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Ability to provide informed consent
Exclusion Criteria:
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Severe imbalance that limits ambulation (Hoehn &Yahr score above 4)
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Orthostatic hypotension
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Orthopedic conditions and other systemic disease affecting locomotion
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Shortness of breath and cardiac disease
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Psychiatric disorders needing medication
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Dementia
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Presence of other neurological disorder
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Toronto Western Hospital | Toronto | Ontario | Canada | M5T 2S8 |
Sponsors and Collaborators
- University of Toronto
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Barbe MT, Amarell M, Snijders AH, Florin E, Quatuor EL, Schönau E, Fink GR, Bloem BR, Timmermann L. Gait and upper limb variability in Parkinson's disease patients with and without freezing of gait. J Neurol. 2014 Feb;261(2):330-42. doi: 10.1007/s00415-013-7199-1. Epub 2013 Dec 4.
- Berardelli A, Rothwell JC, Thompson PD, Hallett M. Pathophysiology of bradykinesia in Parkinson's disease. Brain. 2001 Nov;124(Pt 11):2131-46. Review.
- Bologna M, Guerra A, Paparella G, Giordo L, Alunni Fegatelli D, Vestri AR, Rothwell JC, Berardelli A. Neurophysiological correlates of bradykinesia in Parkinson's disease. Brain. 2018 Aug 1;141(8):2432-2444. doi: 10.1093/brain/awy155.
- Chee R, Murphy A, Danoudis M, Georgiou-Karistianis N, Iansek R. Gait freezing in Parkinson's disease and the stride length sequence effect interaction. Brain. 2009 Aug;132(Pt 8):2151-60. doi: 10.1093/brain/awp053. Epub 2009 May 11.
- D'Cruz N, Seuthe J, Ginis P, Hulzinga F, Schlenstedt C, Nieuwboer A. Short-Term Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in Parkinson's Disease and Healthy Elderly. Front Neurol. 2020 Sep 30;11:560084. doi: 10.3389/fneur.2020.560084. eCollection 2020.
- Fasano A, Herzog J, Seifert E, Stolze H, Falk D, Reese R, Volkmann J, Deuschl G. Modulation of gait coordination by subthalamic stimulation improves freezing of gait. Mov Disord. 2011 Apr;26(5):844-51. doi: 10.1002/mds.23583. Epub 2011 Mar 2.
- Fasano A, Schlenstedt C, Herzog J, Plotnik M, Rose FEM, Volkmann J, Deuschl G. Split-belt locomotion in Parkinson's disease links asymmetry, dyscoordination and sequence effect. Gait Posture. 2016 Jul;48:6-12. doi: 10.1016/j.gaitpost.2016.04.020. Epub 2016 Apr 27.
- Giladi N, Kao R, Fahn S. Freezing phenomenon in patients with parkinsonian syndromes. Mov Disord. 1997 May;12(3):302-5.
- Giladi N, Treves TA, Simon ES, Shabtai H, Orlov Y, Kandinov B, Paleacu D, Korczyn AD. Freezing of gait in patients with advanced Parkinson's disease. J Neural Transm (Vienna). 2001;108(1):53-61.
- Giladi N. Medical treatment of freezing of gait. Mov Disord. 2008;23 Suppl 2:S482-8. doi: 10.1002/mds.21914. Review. Erratum in: Mov Disord. 2008 Aug 15;23(11):1639-40.
- Ginis P, Nackaerts E, Nieuwboer A, Heremans E. Cueing for people with Parkinson's disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives. Ann Phys Rehabil Med. 2018 Nov;61(6):407-413. doi: 10.1016/j.rehab.2017.08.002. Epub 2017 Sep 7. Review.
- Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N; Movement Disorder Society UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008 Nov 15;23(15):2129-70. doi: 10.1002/mds.22340.
- Hausdorff JM, Schaafsma JD, Balash Y, Bartels AL, Gurevich T, Giladi N. Impaired regulation of stride variability in Parkinson's disease subjects with freezing of gait. Exp Brain Res. 2003 Mar;149(2):187-94. Epub 2003 Jan 22.
- Iansek R, Huxham F, McGinley J. The sequence effect and gait festination in Parkinson disease: contributors to freezing of gait? Mov Disord. 2006 Sep;21(9):1419-24.
- Lu C, Amundsen Huffmaster SL, Tuite PJ, Vachon JM, MacKinnon CD. Effect of Cue Timing and Modality on Gait Initiation in Parkinson Disease With Freezing of Gait. Arch Phys Med Rehabil. 2017 Jul;98(7):1291-1299.e1. doi: 10.1016/j.apmr.2017.01.009. Epub 2017 Feb 4.
- Morris M, Iansek R, Matyas T, Summers J. Abnormalities in the stride length-cadence relation in parkinsonian gait. Mov Disord. 1998 Jan;13(1):61-9.
- Nanhoe-Mahabier W, Snijders AH, Delval A, Weerdesteyn V, Duysens J, Overeem S, Bloem BR. Split-belt locomotion in Parkinson's disease with and without freezing of gait. Neuroscience. 2013 Apr 16;236:110-6. doi: 10.1016/j.neuroscience.2013.01.038. Epub 2013 Jan 29.
- Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. Erratum in: J Am Geriatr Soc. 2019 Sep;67(9):1991.
- Nieuwboer A, Rochester L, Herman T, Vandenberghe W, Emil GE, Thomaes T, Giladi N. Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson's disease and their carers. Gait Posture. 2009 Nov;30(4):459-63. doi: 10.1016/j.gaitpost.2009.07.108. Epub 2009 Aug 5.
- Nonnekes J, Bloem BR. Biphasic Levodopa-Induced Freezing of Gait in Parkinson's Disease. J Parkinsons Dis. 2020;10(3):1245-1248. doi: 10.3233/JPD-201997.
- Nonnekes J, Janssen AM, Mensink SH, Oude Nijhuis LB, Bloem BR, Snijders AH. Short rapid steps to provoke freezing of gait in Parkinson's disease. J Neurol. 2014 Sep;261(9):1763-7. doi: 10.1007/s00415-014-7422-8. Epub 2014 Jun 24.
- Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A. Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol. 2011 Aug;10(8):734-44. doi: 10.1016/S1474-4422(11)70143-0. Review.
- Peterson DS, Fling BW, Mancini M, Cohen RG, Nutt JG, Horak FB. Dual-task interference and brain structural connectivity in people with Parkinson's disease who freeze. J Neurol Neurosurg Psychiatry. 2015 Jul;86(7):786-92. doi: 10.1136/jnnp-2014-308840. Epub 2014 Sep 15.
- Peto V, Jenkinson C, Fitzpatrick R, Greenhall R. The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease. Qual Life Res. 1995 Jun;4(3):241-8.
- Plotnik M, Giladi N, Balash Y, Peretz C, Hausdorff JM. Is freezing of gait in Parkinson's disease related to asymmetric motor function? Ann Neurol. 2005 May;57(5):656-63.
- Plotnik M, Giladi N, Hausdorff JM. Is freezing of gait in Parkinson's disease a result of multiple gait impairments? Implications for treatment. Parkinsons Dis. 2012;2012:459321. doi: 10.1155/2012/459321. Epub 2012 Jan 12.
- Ricciardi L, Ricciardi D, Lena F, Plotnik M, Petracca M, Barricella S, Bentivoglio AR, Modugno N, Bernabei R, Fasano A. Working on asymmetry in Parkinson's disease: randomized, controlled pilot study. Neurol Sci. 2015 Aug;36(8):1337-43. doi: 10.1007/s10072-015-2082-8. Epub 2015 Feb 13.
- Sawada M, Wada-Isoe K, Hanajima R, Nakashima K. Clinical features of freezing of gait in Parkinson's disease patients. Brain Behav. 2019 Apr;9(4):e01244. doi: 10.1002/brb3.1244. Epub 2019 Mar 9.
- Seuthe J, D'Cruz N, Ginis P, Becktepe JS, Weisser B, Nieuwboer A, Schlenstedt C. The Effect of One Session Split-Belt Treadmill Training on Gait Adaptation in People With Parkinson's Disease and Freezing of Gait. Neurorehabil Neural Repair. 2020 Oct;34(10):954-963. doi: 10.1177/1545968320953144. Epub 2020 Sep 17.
- Snijders AH, Weerdesteyn V, Hagen YJ, Duysens J, Giladi N, Bloem BR. Obstacle avoidance to elicit freezing of gait during treadmill walking. Mov Disord. 2010 Jan 15;25(1):57-63. doi: 10.1002/mds.22894.
- Spildooren J, Vercruysse S, Desloovere K, Vandenberghe W, Kerckhofs E, Nieuwboer A. Freezing of gait in Parkinson's disease: the impact of dual-tasking and turning. Mov Disord. 2010 Nov 15;25(15):2563-70. doi: 10.1002/mds.23327.
- Youn J, Okuma Y, Hwang M, Kim D, Cho JW. Falling Direction can Predict the Mechanism of Recurrent Falls in Advanced Parkinson's Disease. Sci Rep. 2017 Jun 20;7(1):3921. doi: 10.1038/s41598-017-04302-7.
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