Methods Inf Med 2010; 49(01): 88-95
DOI: 10.3414/ME09-02-0003
Special Topic – Original Articles
Schattauer GmbH

A Wearable System to Assist Walking of Parkinson´s Disease Patients

Benefits and Challenges of Context-triggered Acoustic Cueing
M. Bächlin
1   Wearable Computing Lab, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
,
M. Plotnik
2   Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Souransky Medical Center, Tel Aviv, Israel
3   Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
,
D. Roggen
1   Wearable Computing Lab, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
,
N. Giladi
2   Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Souransky Medical Center, Tel Aviv, Israel
4   Dept of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
,
J. M. Hausdorff
2   Laboratory for Gait and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Souransky Medical Center, Tel Aviv, Israel
5   Dept of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
6   Division on Aging, Harvard Medical School, Boston, MA, USA
,
G. Tröster
1   Wearable Computing Lab, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

received: 17 June 2009

accepted: 11 November 2009

Publication Date:
17 January 2018 (online)

Summary

Background: About 50% of the patients with advanced Parkinson’s disease (PD) suffer from freezing of gait (FOG), which is a sudden and transient inability to walk. It often causes falls, interferes with daily activities and significantly impairs quality of life. Because gait deficits in PD patients are often resistant to pharmacologic treatment, effective non-pharmacologic treatments are of special interest.

Objectives: The goal of our study is to evaluate the concept of a wearable device that can obtain real-time gait data, processes them and provides asistance based on pre-determined specifications.

Methods: We developed a real-time wearable FOG detection system that automatically provides a cueing sound when FOG is detected and which stays until the subject resumes walking. We evaluated our wearable assistive technology in a study with 10 PD patients. Over eight hours of data was recorded and a questionnaire was filled out by each patient.

Results: Two hundred and thirty-seven FOG events have been identified by professional physiotherapists in a post-hoc video analysis. The device detected the FOG events online with a sensitivity of 73.1% and a specificity of 81.6% on a 0.5 sec frame-based evaluation.

Conclusions: With this study we show that online assistive feedback for PD patients is possible. We present and discuss the patients’ and physiotherapists’ perspectives on wear-abilty and performance of the wearable assistant as well as their gait performance when using the assistant and point out the next research steps. Our results demonstrate the benefit of such a context-aware system and motivate further studies.

 
  • References

  • 1 Braak H, Ghebremedhin E, Rüb U, Bratzke H, Tredici KD. Stages in the development of Parkinson’s disease-related pathology. Cell and Tissue Research 2004; 318 (01) 121-134.
  • 2 Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008; 79 (04) 368-376.
  • 3 Fahn S. The freezing phenomenon in parkinsonism. Adv Neurol 1995; 67: 53-63.
  • 4 Schaafsma JD, Balash Y, Gurevich T, Bartels AL, Hausdorff JM, Giladi N. Characterization of freezing of gait subtypes and the response of each to levodopa in Parkinson’s disease. European Journal of Neurology 2003; 10 (04) 391-398.
  • 5 Macht M, Kaussner Y, Möller JC, Stiasny-Kolster K, Eggert KM, Krüger HP. et al. Predictors of freezing in Parkinson’s disease: A survey of 6,620 patients. Movement Disorders 2007; 22 (07) 953-956.
  • 6 Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and Freezing of Gait in Parkinson’s Disease: A Review of Two Interconnected, Episodic Phenomena. Movement Disorders 2008; 19 (08) 871-884.
  • 7 de Boer AG, Wijker W, Speelman JD, de Haes JC. Quality of life in patients with Parkinson’s disease: development of a questionnaire. Journal of Neurology, Neurosurgery and Psychiatry 1996; 61 (01) 70-74.
  • 8 Giladi N, McDermott MP, Fahn S, Przedborski S, Jankovic J, Stern M. et al. Freezing of gait in PD: Prospective assessment in the DATATOP cohort. Neurology 2001; 56 (12) 1712-1721.
  • 9 Thaut MH, McIntosh GC, Rice RR, Miller RA, Rathbun J, Brault JM. Rhythmic Auditory Stimulation in Gait Training for Parkinson’s Disease Patients. Movement Disorders 1996; 11 (02) 193-200.
  • 10 van Wegen E, de Goede C, Lim I, Rietberg M, Nieuwboer A, Willems A. et al. The effect of rhythmic somatosensory cueing on gait in patients with Parkinson’s disease. Journal of the Neurological Sciences 2006; 248 1–2 210-214.
  • 11 Lim I, van Wegen E, de Goede C, Deutekom M, Nieuwboer A, Willems A. et al. Effects of external rhythmical cueing on gait in patients with Parkinson’s disease: a systematic review. Clinical Rehabilitation 2005; 19 (07) 695-713.
  • 12 Hausdorff J, Lowenthal J, Herman T, Gruendlinger L, Peretz C, Giladi N. Rhythmic auditory stimulation modulates gait variability in parkinson’s disease. European Journal of Neuroscience 2007; 26 (08) 2369-2375.
  • 13 Nieuwboer A, Kwakkel G, Rochester L, Jones D, van Wegen E, Willems AM. et al. Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. Journal of Neurology, Neurosurgery, and Psychiatry 2007; 78 (02) 134-140.
  • 14 Cubo E, Leurgans S, Goetz C. Short-term and practice effects of metronome pacing in Parkinson’s disease patients with gait freezing while in the ‘on’ state: randomized single blind evaluation. Parkinsonism and related disorders 2004; 10 (08) 507-510.
  • 15 Bächlin M, Roggen D, Tröster G. Context-aware platform for long-term life style management and medical signal analysis. In: Proceeding of the 2nd SENSATION International Conference. Chania, Greece: 2007
  • 16 Moore ST, MacDougall HG, Ondo WG. Ambulatory monitoring of freezing of gait in Parkinson’s disease. Journal of Neuroscience Methods 2008; 167 (02) 340-348.
  • 17 Bächlin M, Roggen D, Plotnik M, Hausdorff J, Tröster G. Online Detection of Freezing of Gait in Parkinson’s Disease Patients: A Performance Characterization. In: Proceedings of the 4th International Conference on Body Area Networks 2009
  • 18 Grant S, Aitchison T, Henderson E, Christie J, Zare S, McMurray J. et al. A Comparison of the Reproducibility and the Sensitivity to Change of Visual Analogue Scales, Borg Scales, and Likert Scales in Normal Subjects During Submaximal Exercise. Chest 1999; 116 (05) 1208-1217.
  • 19 Shelton RC, Keller MB, Gelenberg A, Dunner DL, Hirschfeld R, Thase ME. et al. Effectiveness of St John’s Wort in Major Depression: A Randomized Controlled Trial. Journal of the American Medical Association 2001; 285 (15) 1978-1986.
  • 20 Bächlin M, Plotnik M, Roggen D, Inbar N, Meidan I, Hausdorff J. et al. Parkinson patients’ perspective on context aware wearable technology for auditive assistance. In: Proceedings of the 3rd International Conference on Pervasive Computing Technologies for Healthcare (Pervasive Health); 2009
  • 21 Tajimi K, Konishi T, Sakata N, Sishida S. Stabilization Method for a Hip-mounted Projector Using an Insertial Sensor. In: Advances in Wearable Computing 2009 pp 37-44.
  • 22 Amft O, Lauffer M, Ossevoort S, Macaluso F, Lukowicz P, Tröster G. Design of the QBIC Wearable Computing Platform. In: ASAP ’04: Proceedings of the Application-Specific Systems, Architectures and Processors, 15th IEEE International Conference on (ASAP’04). Washington, DC, USA.: IEEE Computer Society; 2004. pp 398-410.
  • 23 Roggen D, Bharatula NB, Stäger M, Lukowicz P, Tröster G. From Sensors to Miniature Networked Sensor Buttons. In: Proceeding of the 3rd International Conference on Networked Sensing Systems (INSS06); 2006 pp 119-122.
  • 24 Bächlin M, Roggen D, Plotnik M, Inbar N, Meidan I, Herman T. et al. Potentials of enhanced context awareness in wearable assistants for Parkinson’s disease patients with freezing of gait syndrome. In: Proceedings of the 13th International Symposium on Wearable Computers (ISWC); 2009. pp 123-130.