Objective: To determine feasibility of Google Glass (GG) technology to improve freezing of gait (FOG) in parkinsonism

Background: FOG is a motor block often resistant to medical and surgical therapies, and causes significant morbidity, including falls. Physical therapy remains the best therapy for refractory FOG, but a convenient home-based treatment would allow access for more patients. GG is a lightweight wearable device that provides auditory and visual cues for patients with FOG that improved gait in one study [1], thus suggesting potential benefit in patients with severe gait dysfunction.

Method: Patients with parkinsonism and FOG were trained to use GG programs “Walk with me” and “Unfreeze me.” We recorded ambulation time with and without GG under multiple conditions. FOG and patient experience questionnaires were administered.

Results: Results of 9 subjects were analyzed (1 could not complete tasks due to severe anxiety). Mean age was 70.7 years (range 54-82, SD 10.0), 5/9 female, 8/9 idiopathic Parkinson’s disease, 1/9 primary progressive freezing of gait, mean disease duration 7.4 years (SD 5.1). Reported FOG frequency was about 1x/week (n=2), once daily (n=4), always when walking (n=3). Using GG, average straight walk 25 feet improved by 0.32 seconds (SD 2.12), average 180 degree turn after 25 feet walk worsened by 1.89 seconds (SD 10.66), average dual task of serial 7’s and 25 feet straight walk improved by 1.79 seconds (SD 2.91), and average door passageway walk improved by 0.59 seconds (SD 0.81). 5/9 felt comfortable using GG, but subjects reported difficulties with tap controls, volume, screen size, and possible distractions in public. Three reported improvement with GG, 5 no improvement (1 no survey response).

Conclusion: Mobile smart glass technology like GG shows promise for FOG in parkinsonism and improves some walking tasks. Turning worsened, possibly due to inattention/distraction. Subjects reported a number of issues with the device. Limitations of the study include small sample size and variable causes and frequencies of freezing.  Strengths include multiple tasks attempting to mimic different walking conditions, patient feedback, and video recordings. More investigations are needed to understand how this tool can be improved and how augmented reality can enhance visual and auditory cues for people with gait difficulty.

References: Zhao Y, Nonnekes J, Storcken EJ, et al. Feasibility of external rhythmic cueing with the Google Glass for improving gait in people with Parkinson’s disease. J Neurol. 2016;263(6):1156-65.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-google-glass-improve-freezing-of-gait-in-parkinsonism-a-pilot-study/