Objective: To evaluate the effects of on-demand auditory cueing on video-rated freezing of gait (FOG) during home-based FOG-provoking tests in people with Parkinson’s disease.
Background: Providing auditory cues on-demand (upon FOG detection) can help patients overcome FOG in daily life. The direct effect of on-demand cueing on percentage time frozen (%TF) during home-based FOG-provoking tests is currently unknown, neither is it clear how it affects different circumstances and types of FOG episodes.
Method: We analyzed the immediate response to cues at the post-test of the larger DeFOG trial, an RCT that aimed to assess the long-term training effects of on-demand in contrast to a control group. Freezers (N=28) performed 5 FOG-provoking tests, including 360° turns in place, navigating a narrow passage and a personal FOG ‘hotspot’. Tests were performed with and without on-demand cueing, delivered through shoe-worn sensors and a smartphone after >12h withdrawal of dopaminergic medication (OFF), and 1 hour after medication intake (ON). The primary outcome was %TF in OFF+ON based on expert video ratings and pooled over the groups.
Results: Patients were 67.0±7.3 years old and had a PD-duration of 13.1±5.6 years. Self-reported FOG severity was 21.4±3.9/28. Overall, the median %TF (interquartile range) was significantly higher for conditions without cueing: %TF=14.5% (IQR: 27.7) than for conditions with cueing: %TF=9.3% (IQR: 16.8). The effect of cueing was significant in OFF (p<0.001) but not in ON after corrections for multiple comparisons (p=0.07). There was a significant difference between %TF OFF+ON of cued and uncued tasks for the 360° turns in place (p=0.04) and narrow passage (p=0.01) only. On-demand cueing significantly lowered %TF trembling FOG (Z=-3.15; p=0.01) and %TF festination (Z=-2.85; p=0.01) but not %TF akinetic FOG (Z=-0.31, p=1.00) in OFF+ON (Table 1).
Conclusion: We show for the first time that automatic on-demand cueing can reduce %TF during home tests that represent daily life challenges, irrespective of training with cues. The largest effects were found for the 360° turns and narrow passage. The results were mainly driven by the OFF tests, indicating that on-demand cueing is most effective when needed most. On-demand cueing had no significant effect on akinetic FOG, suggesting that these episodes are detected less well or that they are more difficult to overcome with auditory cues.
To cite this abstract in AMA style:D. Zoetewei, T. Herman, L. Palmerini, A. Ferrari, J. Hausdorff, A. Nieuwboer, P. Ginis. The effects of on-demand auditory cueing on home-based freezing of gait in people with Parkinson’s disease [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/the-effects-of-on-demand-auditory-cueing-on-home-based-freezing-of-gait-in-people-with-parkinsons-disease/. Accessed September 23, 2023.
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