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Neurology. 2018 Jan 9;90(2):e164-e171. doi: 10.1212/WNL.0000000000004795. Epub 2017 Dec 20.

The laser shoes: A new ambulatory device to alleviate freezing of gait in Parkinson disease.

Author information

1
From the Departments of Neurology (C.B., M.v.H., R.H., B.R.B., M.U.F.), Rehabilitation (J.N., V.W.), and Otorhinolaryngology (A.J.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, and Department of Biophysics (R.v.W.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurophysiology (A.D.), Lille University Medical Center, France; Sint Maartenskliniek Research, Development & Education (V.W.), Nijmegen, the Netherlands; Grenoble Alpes University (B.D.); Grenoble Institute of Neurosciences (B.D.), INSERM U1216, France; and Biomedical Signal and Systems Group (J.N., R.v.W., M.U.F.), MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
2
From the Departments of Neurology (C.B., M.v.H., R.H., B.R.B., M.U.F.), Rehabilitation (J.N., V.W.), and Otorhinolaryngology (A.J.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, and Department of Biophysics (R.v.W.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurophysiology (A.D.), Lille University Medical Center, France; Sint Maartenskliniek Research, Development & Education (V.W.), Nijmegen, the Netherlands; Grenoble Alpes University (B.D.); Grenoble Institute of Neurosciences (B.D.), INSERM U1216, France; and Biomedical Signal and Systems Group (J.N., R.v.W., M.U.F.), MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands. m.u.ferraye@utwente.nl murielle.ferraye@gmail.com.

Abstract

OBJECTIVE:

To assess, in a cross-sectional study, the feasibility and immediate efficacy of laser shoes, a new ambulatory visual cueing device with practical applicability for use in daily life, on freezing of gait (FOG) and gait measures in Parkinson disease (PD).

METHODS:

We tested 21 patients with PD and FOG, both "off" and "on" medication. In a controlled gait laboratory, we measured the number of FOG episodes and the percent time frozen occurring during a standardized walking protocol that included FOG provoking circumstances. Participants performed 10 trials with and 10 trials without cueing. FOG was assessed using offline video analysis by an independent rater. Gait measures were recorded in between FOG episodes with the use of accelerometry.

RESULTS:

Cueing using laser shoes was associated with a significant reduction in the number of FOG episodes, both "off" (45.9%) and "on" (37.7%) medication. Moreover, laser shoes significantly reduced the percent time frozen by 56.5% (95% confidence interval [CI] 32.5-85.8; p = 0.004) when "off" medication. The reduction while "on" medication was slightly smaller (51.4%, 95% CI -41.8 to 91.5; p = 0.075). These effects were paralleled by patients' positive subjective experience on laser shoes' efficacy. There were no clinically meaningful changes in the gait measures.

CONCLUSIONS:

These findings demonstrate the immediate efficacy of laser shoes in a controlled gait laboratory, and offer a promising intervention with potential to deliver in-home cueing for patients with FOG.

CLASSIFICATION OF EVIDENCE:

This study provides Class III evidence that for patients with PD, laser shoes significantly reduce FOG severity (both number and duration of FOG episodes).

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