Objective: To increase the speed and objectivity of decision making for patients with Parkinson’s disease and gait impairments, undergoing deep brain stimulation (DBS), using the quantified timed up and go (QTUG) device.

Background: Deep Brain Stimulation (DBS) provides an effective treatment to alleviate motor symptoms of Parkinson’s disease (PD). However, DBS is less efficacious in treating gait and balance impairments for patients with PD and can have a negative effect on balance (1).There is disagreement within the literature regarding optimal DBS parameters and targets for patient with gait and balance problems (2), specifically around high or low frequency stimulation. Although lower frequency stimulation can assist with some forms of gait impairment, other therapeutic benefits of DBS can be lost (3).The lack of homogeneity in the measurement of gait and postural control, alongside the challenges of timely and cost efficient sensitive objective measurement is likely the cause of this debate. More advanced and selective measurements are recommended (4).A new validated wearable device, the Quantitative Timed Up and Go (QTUG) (5) can be used to measure gait parameters, falls risk and underlying frailty in patients with Parkinson’s disease. The device is transportable to the outpatient setting and can deliver instant objective data which can support decision making within clinical practice.We present 3 cases where the QTUG device was used to support decision making and measure outcome for patients with PD and gait impairment undergoing post-operative DBS parameter changes.

Method: 3 patients were seen within a DBS clinic for review of DBS clinical changes. The QTUG device was used to measure gait parameters after each change to monitor efficacy on gait, falls risk and underlying frailty.

Results: We present objective data of 3 patients whose gait parameters, falls risk and underlying frailty were improved using DBS and the QTUG device. The results demonstrate where side effects of overstimulation occur, allowing for real-time clinic changes. An example can be seen within table 1.

Conclusion: The QTUG device can be used in clinical practice to support decision making for DBS patients with gait impairment. The QTUG device could be a valuable tool in future research projects on DBS parameters and gait impairment.

References: 1/ Collomb-Clerc, A and Welter, ML. Effects of deep brain stimulation on balance and gait in patients with Parkinson’s disease: a systematic neurophysiological review. Neurophysiologie Clinique. 2015: 45(4-5) pp. 371–388. 2/ Anderson D, Beecher G, Ba F. Deep Brain Stimulation in Parkinson’s Disease: New and Emerging Targets for Refractory Motor and Nonmotor Symptoms. Parkinsons Dis. 2017;2017:5124328. 3/ Su D, Chen H, Hu W, et al. Frequency-dependent effects of subthalamic deep brain stimulation on motor symptoms in Parkinson’s disease: a meta-analysis of controlled trials. Sci Rep. 2018;8(1):14456. Published 2018 Sep 27. doi:10.1038/s41598-018-32161-3 4/ Lord S, Galna B, Rochester L. Moving forward on gait measurement: toward a more refined approach. Mov Disord. 2013;28:1534–1543. doi:10.1002/mds.25545 5/ Barry R. Greene, Brian Caulfield, Dronacharya Lamichhane, William Bond, Jessica Svendsen, Connie Zurski, Dyveke Pratt, “Prediction of falls in Parkinson’s disease using the Timed Up and Go test and body-worn sensors”, 1st European conference on Falls, Frailty & Fractures, Dublin, November 2017

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/can-the-quantified-timed-up-and-go-qtug-device-support-decision-making-for-patients-undergoing-deep-brain-stimulation/