Objective: To explore the effect of combined vibratory and pressure stimulations in PD patients with unresponsive FOG and develop the innovative PD shoe.

Background: Freezing of gait (FOG) is one of the most devastating symptoms in advanced Parkinson’ disease (PD) and often unresponsive to pharmacological interventions. Dysfunction of the plantar peripheral sensory systems was recently proposed as a part of the underlying mechanisms of FOG, however, the effect of combined plantar peripheral sensory stimulations has never been explored. As a result, a novel PD shoe is being developed based on the proposed effect of combined plantar sensory stimulations.

Method: PD patients with FOG were randomised into combined vibratory and pressure stimulation, vibratory stimulation only, pressure stimulation only or no stimulation groups. Vibratory stimulation was performed with frequency of 100 Hz at the bilateral Achilles tendon while pressure stimulation was performed with pressure of 10 N/m²at the bilateral first halluxes, first metatarsal bones and soles simultaneously. In the combined group, vibratory and pressure stimulations were operated concurrently. All stimulations were completed 5 minutes prior to objective gait measurement. All patients were instructed to walk on a gait mat with sensors. Outcomes were compared pre- and post- stimulation.

Results: Sixty patients participated in the study. There were no significant differences in baseline clinical characteristics and gait parameters amongst the four groups. The combined vibratory and pressure stimulation group showed significantly decreased number of freezing episodes (p = 0.019), increased stride length (p <0.001), stride velocity (p <0.001) and stride length in the three strides before freezing episodes (p-value <0.001) when compared to vibration only, pressure only or control groups. A prototype of the innovative PD shoe, which consists of vibratory stimulation, internal soft silicone pads pressured at plantar areas and a switched battery circuit, has been developed and is being tested in PD patients with FOG.

Conclusion: Our study shows that combining vibratory and pressure stimulations has significant benefit on FOG. A prototype PD shoe combining vibratory and pressure plantar stimulators has been developed as a potential novel treatment of unresponsive FOG in PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/combined-plantar-stimulations-using-a-novel-parkinson-shoe-benefit-parkinsons-disease-patients-with-unresponsive-freezing-of-gait/