This project seeks to reduce the burden of freezing of gait (FoG), which is suffered by over 50% of people living with Parkinson’s disease (PD). FoG is a common, devastating manifestation of PD for which there is no cure or adequate medical or surgical treatment. FoG has been defined as a “brief, episodic absence or marked reduction of forward progression of the feet, despite the intention to walk”. It is widely known that FoG episodes are frequently triggered by various environmental and psychological factors. The most commonly recognized triggers include start hesitation (freezing upon gait initiation), walking through tight quarters, turn hesitation (freezing when changing directions), approaching a visual target, dual tasking, and stressful, time sensitive situations such as entering an elevator before the doors close. Each individual with PD is unique with regard to how sensitive they are to these various triggers, underscoring the need for customized therapeutic approaches. A promising option for treating FoG is the use of tactile stimulation, however, no technology to date can provide customized therapy that adapts to the individual’s needs with regard to the specific triggering scenarios. In this proposed project, the Virginia Commonwealth University and William & Mary teams will work together to develop novel technology that deploys context-specific vibration stimuli tailored to the individual’s needs, with the goal of preventing or mitigating FoG. In Task 1, we will design and develop a wearable system for automatic FoG detection and vibration delivery using existing technology (Ultigesture UG motion sensors, PDVibe3, and a smartphone). The device will be able to detect FoG immediately upon occurrence. In Task 2, we will determine the optimum dose of vibration frequency and amplitude for the five most common environmental and psychological triggers for FoG in a controlled environment (in the clinical lab). In Task 3, we will integrate a global positioning mechanism into the wearable system so that the device can recognize environmental triggers of FoG. We will program the optimal parameters of vibration determined in Task 2 (for each of the five triggers) to deploy in response to corresponding environmental and psychological triggers and will test it in a real-world setting (a public place). Upon completion of this project we will have created and tested a closed-loop system that will deliver customized vibration therapy to people with PD at the precise moment it is needed to prevent or mitigate FoG episodes. This project aligns directly with the NINDS mission to reduce the burden of neurological diseases such as PD.

No technology to date can provide customized therapy that adapts to the individual’s needs with regard to the specific FoG triggering scenarios. The wearable sensor and smart-phone system proposed has the potential to detect different environmental triggers and deliver an optimized dose of vibration at the precise moment it is needed. For people who are isolated in their homes and at risk for falls due to FoG, this new technology has potential to improve their mobility, independence and quality of life; and have important economic benefits for patients, their families, and for the health-care system as a whole.