Objective: To examine the relationship between freezing of gait (FOG), falls history, and a novel clinical measure in persons with parkinsonism.

Background: Freezing of gait (FOG) is a disabling impairment seen in PD and atypical parkinsonism. This phenomenon often presents as an interruption or full hesitation during walking due to cognitive overstimulation, change in direction, turning, or changes in the environment – such as doorways, escalators, or thresholds.¹ The most specific means of measuring FOG often involve motion capture or wearable systems that are not conducive to quick, clinical screening.^2,3

Method: A modified T-Test, reported as the Freezing of Gait Change in Direction (FOG-COD), represents a novel measurement for FOG. Each direction (forward, lateral, backward) total time within the FOG-COD was differentiated and compared to the TUG. The New Freezing of Gait Questionnaire (NFOG-Q) measured subjective FOG. Patients also reported time in weeks since last fall.

Results: The FOG-COD was repeatedly performed by 53 unique patients for 107 total data points. A significant positive correlation was observed between Lateral FOG-COD time and TUG time (r = 0.57, p < .001, 95% CI = [.42, .68]). This suggests that as Lateral FOG-COD time increases, TUG time tends to increase. A significant positive correlation was observed between Lateral FOG-COD time and patient-reported FOG (r = 0.25, p = .040, 95% CI = [.07, .42]). This suggests that as Lateral FOG-COD time increases, the subjective reporting of FOG tends to increase. A non-significant correlation was noted between the TUG time and patient-reported FOG (r = 0.15, p = 0.53, 95% CI = [-0.4, 33.]. Lateral FOG-COD time significantly predicted FOG (B = 0.02, p < 0.001) such that a one-second increase in Lateral FOG-COD time increased the likelihood of patient-reported FOG by 2%, while TUG time did not have the same effect (B = 0.008, p = 0.226).

Conclusion: The time to perform a self-selected transition from forward walking to sidestepping a total of 20 feet is more closely correlated to reporting of FOG than the 20 feet performed during the TUG. Further studies are necessary to determine if lateral walking speed alone is correlated with FOG and falls reporting. COD places an additional burden on visuospatial processing systems, represents a more complex motor task, and is overall more directly related to FOG and falls than the TUG alone.

References: 1. Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A. Freezing of gait: moving forward on a mysterious clinical phenomenon. The Lancet Neurology. 2011;10(8):734-744. doi:10.1016/s1474-4422(11)70143-0
2. O’Day J, Lee M, Seagers K, et al. Assessing inertial measurement unit locations for freezing of gait detection and patient preference. Journal of NeuroEngineering and Rehabilitation. 2022;19(1)doi:10.1186/s12984-022-00992-x
3. May DS, Tueth LE, Earhart GM, Mazzoni P. Using Wearable Sensors to Assess Freezing of Gait in the Real World. Bioengineering. 2023;10(3):289. doi:10.3390/bioengineering10030289

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-freezing-of-gait-change-of-direction-fog-cod-test-a-novel-measure-to-predict-falls/