Objective: To assess the effect of cueing with vibrotactile stimulation on the duration of ON and OFF state and freezing of gait (FOG) in patients with Parkinson’s disease (PwP) by using wearable sensor technology in real-time and patient home environment.

Background: Approximately 60% of PwP encounter at least one fall annually[1]. OFF state and FOG[2] are common risk factors for falls in PwP and do not necessarily respond well to dopaminergic medication[3]. Tactile cues including focused vibrotactile stimulation delivered via non-invasive medical devices that can be used in home settings by patients, have shown promise in improving motor symptoms, gait, and FOG, and decreasing falls in PwP[4,5]. Wearable technology is increasingly utilized to objectively monitor outcomes[6].

Method: A patient with idiopathic Parkinson’s disease (PD) voluntarily participated and was instructed to use the STAT-ON^TM, a single wearable device positioned around the waist, for 12 hours a day, starting from the morning, for 5 consecutive days without (pre) and then 5 consecutive days with (post) the CUE1 non-invasive medical device. The STAT-ON^TM can quantify the time per day that PwP might spend in ON and OFF state and with dyskinesia, the number of steps and minutes of walking per day, and number of FOG episodes as well as provide a bradykinesia index. The CUE1 is designed for PwP, worn on the sternum and delivers low frequency auditory cueing with high frequency vibrotactile stimulation. Data are presented as mean± standard deviation or mean and percentage (%).

Results: After wearing the CUE1 for 5 days, an 87-year-old male with PD duration 5 years showed a notable decrease in average FoG episodes (26.8± 35.2 versus 10.6± 5.1) and duration of OFF state (13.5 hours; 22.3% versus 8.5 hours; 12.6%) and increase in duration of ON state (13.5 hours; 22.3% versus 20 hours; 29.6%) per day.

Conclusion: STAT-ON^TM appears to be a reliable method to monitor a patient’s symptoms and enhancing understanding of treatment effects of tactile cueing. In this case, the CUE1 was able to decrease FOG episodes and time spent in OFF state and increase time spent in ON state. This could prove beneficial in reducing the frequency of falls among PwP. Further studies to replicate these results are needed.

References: 1. Allen, N. E., Schwarzel, A. K., & Canning, C. G. (2013). Recurrent falls in Parkinson’s disease: a systematic review. Parkinson’s disease, 2013, 906274. https://doi.org/10.1155/2013/906274
2. Williams-Gray, C. H., Mason, S. L., Evans, J. R., Foltynie, T., Brayne, C., Robbins, T. W., & Barker, R. A. (2013). The CamPaIGN study of Parkinson’s disease: 10-year outlook in an incident population-based cohort. Journal of neurology, neurosurgery, and psychiatry, 84(11), 1258–1264. https://doi.org/10.1136/jnnp-2013-30
3. Smulders, K., Dale, M. L., Carlson-Kuhta, P., Nutt, J. G., & Horak, F. B. (2016). Pharmacological treatment in Parkinson’s disease: Effects on gait. Parkinsonism & related disorders, 31, 3–13. https://doi.org/10.1016/j.parkreldis.2016.07.006
4. Muthukrishnan, N., Abbas, J. J., Shill, H. A., & Krishnamurthi, N. (2019). Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review. Sensors (Basel, Switzerland), 19(24), 5468. https://doi.org/10.3390/s19245468
5. Sweeney, D., Quinlan, L. R., Browne, P., Richardson, M., Meskell, P., & ÓLaighin, G. (2019). A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson’s Disease. Sensors (Basel, Switzerland), 19(6), 1277. https://doi.org/10.3390/s19061277
6. Moreau, C., Rouaud, T., Grabli, D., Benatru, I., Remy, P., Marques, A. R., Drapier, S., Mariani, L. L., Roze, E., Devos, D., Dupont, G., Bereau, M., & Fabbri, M. (2023). Overview on wearable sensors for the management of Parkinson’s disease. NPJ Parkinson’s disease, 9(1), 153. https://doi.org/10.1038/s41531-023-00585-y

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-non-invasive-wearable-devices-in-home-settings-for-assessment-and-treatment-of-the-duration-of-on-and-off-state-and-freezing-of-gait-in-parkinsons-disease-a-case-study/