Objective: Investigate the efficacy of augmented three-dimensional (3D) visual cues delivered via smart glasses on improving freezing of gait (FOG) and gait stability in patients with Parkinson’s Disease (PD) and FOG (PD-FOG).

Background: FOG is characterized by paroxysmal gait arrests preventing effective forward movement. The timing and scaling impairments involved in FOG extend to gait in between FOG episodes. External cues like transverse lines on the floor reduce FOG and improve gait parameters in a subset of patients, but their use in daily life is limited by practical constraints. Smart glasses could deliver portable, personalized cues, but their efficacy has yet to be established.

Methods: 25 patients with PD-FOG performed a walking trajectory aimed at eliciting FOG while wearing customized smart glasses that could provide augmented cues in the central visual field. Five different cueing conditions (‘no cue’, ‘transverse bars on the floor’, ‘metronome’, ‘augmented bars’ and ‘augmented staircase’) were compared. FOG episodes were scored from video recordings; motion data was recorded from inertial sensors attached to all four limbs, the trunk and head.

Results: Out of 25 participants [19 males, mean age 72 years, Hoehn&Yahr 2-3], 20 participants walked each cue-trajectory combination twice, 5 participants once. A total of 300 FOG episodes (222 during turning) occurred in 19 out of 25 participants. The Friedman test showed a statistically significant difference amongst all conditions for the number of FOG episodes (χ²(4) = 9.936, p = 0.042) and total duration of FOG (χ²(4) = 11.414, p = 0.022), but pairwise comparisons yielded no statistically significant difference between cues. Results were similar when imputing missing second sessions from first sessions, and when analyzing FOG during turning and non-turning separately. Participants preferred the metronome most, then the bars on the floor, the augmented bars via the smart glasses, no cue, and the augmented staircase the least.

Conclusions: Our study shows no beneficial effect of augmented 3D visual cues delivered via customized smart glasses on number and duration of FOG. Currently available smart glasses which are able to project cues in the central visual field are rather bulky and heavy. Indeed, participants considered the smart glasses uncomfortable, which might have caused distraction, interfering with the effect of all cues.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-three-dimensional-visual-cues-delivered-via-smart-glasses-reduce-freezing-of-gait-in-patients-with-parkinsons-disease/