Wearable device prevents freezing of gait in Parkinson’s patient

https://parkinsonsnewstoday.com/news/soft-robotic-apparel-to-avert-freezing-of-gait-in-parkinsons-disease/?utm_source=PAR&utm_campaign=ff78228b04-PAR_ENL_3.0_US&utm_medium=email&utm_term=0_62dd4fb5e3-ff78228b04-75100205: Wearable device prevents freezing of gait in Parkinson’s patient

Researchers at Harvard and Boston universities have adapted a soft, robotic wearable device to help mitigate the effects of gait freezing, a potentially disabling Parkinson’s disease symptom marked by patients feeling like their feet are stuck to the floor, and they’re unable to take another step.

The device or exosuit, which they initially designed to help adults with walking difficulties due to a stroke or other conditions, “instantaneously eliminated” freezing of gait while walking indoors for a 73-year-old Parkinson’s patient in tests done across six months, the scientists reported. The man was reported to have daily and “incapacitating” episodes of gait freezing, a fairly common disease motor symptom.

Use of this “soft robotic apparel that augments hip flexion” also permitted the patient to walk faster and for a greater distance, the researchers wrote.

An article describing the device and its use, “Soft robotic apparel to avert freezing of gait in Parkinson’s disease,” was published in the journal Nature Medicine.

Freezing of gait can be common with Parkinson’s disease

“We found that just a small amount of mechanical assistance from our soft robotic apparel delivered instantaneous effects and consistently improved walking across a range of conditions for the individual in our study,” Conor Walsh, a study co-lead author and a professor of engineering and applied sciences at the John A. Paulson School of Engineering and Applied Sciences at Harvard, where the study was conducted, said in university news story.

Walking difficulties, problems with balance, and freezing of gait affect most Parkinson’s patients, particularly in its more advanced stages. While disease treatments, ranging from pharmaceutical medications to deep brain stimulation surgery, can help with a variety of motor and nonmotor Parkinson’s symptoms, those for freezing of gait have “modest and transient effects,” the scientists wrote.

The soft exosuit was tested over six months in the man with Parkinson’s, who was experiencing freezing episodes more than 10 times daily despite medications and surgical treatment. He had frequent falls due to frozen gait, and used a scooter to get around outdoors.

Worn around the hips and thighs, the garment is designed to give a gentle push to the hips with each stride.

Using the device, the patient increased walking distance by 55%, and showed better gait quality, as noted by a 25% decline in gait variability, the scientists reported. Gait difficulties occasionally were noted with outdoor use.

“This suit helps me take longer steps and when it is not active, I notice I drag my feet much more,” the man said. “It has really helped me … to walk longer and maintain the quality of my life.”

It was tested in a variety of environmental contexts and conditions over multiple days to demonstrate its potential for “community use,” the scientists wrote.

Walsh’s Biodesign lab at the Harvard school has been developing assistive and rehabilitative devices for more than a decade to improve mobility after a stroke or for people with amyotrophic lateral sclerosis  and similar disorders.

Device uses sensors that help to propel leg movement

Previously, he and his team employed human-in-the-loop optimization to show that a wearable robotic device could be used to augment hip flexion in healthy people, helping the leg to move forward while reducing the amount of energy used to walk. That approach then was applied to gait freeze.

The device uses cable-driven actuators and sensors worn around the waist and thighs. Algorithms, using motion data collected by the sensors, estimate the gait’s phase and generate forces to assist leg muscle movement. Walking tests conducted with the patient required no special training for the exosuit’s use, the scientists noted, adding that the patient was able to walk and talk without freezing using the device, something he otherwise rarely tried to do.

“This study demonstrated that [freezing of gait] was averted using soft robotic apparel in an individual with Parkinson’s disease, serving as an impetus for technological advancements in response to this serious yet unmet need,” the scientists concluded.

The device also may help in better understanding the mechanics of gait freeze, which might explain exactly why the equipment works, said Terry Ellis, the study’s other co-lead author, and a professor, physical therapy department chair, and director of the Center for Neurorehabilitation at Boston University.

“We see that restoring almost-normal biomechanics alters the peripheral dynamics of gait and may influence the central processing of gait control,” Ellis said.

The work was supported by grants from the National Science Foundation, the National Institutes of Health, and the Massachusetts Technology Collaborative.

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