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).

[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.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effects-of-on-demand-auditory-cueing-on-home-based-freezing-of-gait-in-people-with-parkinsons-disease/