Vibrating socks for Parkinson’s Disease

Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson’s disease (PD). Non-pharmacological approaches, including external cueing, are generating growing interest. However, it remains difficult to translate such cueing strategies into an efficient ambulatory device that is effective, but at the same time socially acceptable (i.e. ‘invisible’ to outsiders). In this regard, tactile cueing holds great promise. Here, we propose rhythmically vibrating socks as a new ambulatory device to improve gait and alleviate FOG in PD. The vibrating socks can offer tactile cueing in an open-loop (fixed frequency) or closed-loop manner (vibration is activated when 80% of body weight is placed on the sock. We expect both types of tactile cueing to be feasible and effective, with tactile cueing being preferential over auditory cueing.

Using a within-subject design, we will test the ability of vibrating socks, a new tactile cueing device for the management of FOG in patients with PD. We will include 40 PD patients with a recent history of disabling/regular FOG in two medical centres (Medisch Spectrum Twente and Radboud UMC).

Measurements will be conducted during two separate mornings (max. 4 hours per session), one while ON dopaminergic medication and one while OFF dopaminergic medication (>12 hours after intake of the last dose of medication). During both sessions motor (MDS-UPDRS part III) and cognitive status (FAB and MMSE) will be tested. Additionally, patients will perform four different walking tasks ((1) walking at preferred speed for 10 m, (2) turning while walking, (3) gait trajectory with narrow passages, (4) rapid full turns) in four different conditions ((1) tactile cueing in a closed-loop manner; (2) tactile cueing in an open-loop manner; (3) auditory cueing; or (4) no cueing). Each walking test will be performed three times, and recorded on video.

Primary outcome measure will be the presence and percent time of FOG (total FOG duration divided by the total walking duration). The presence and percent time of FOG will be determined via offline visual analysis of the videos by experienced raters.

Secondary outcome parameters are the spatiotemporal gait parameters as obtained by instrumented gait analysis (Xsense), including velocity, step length, cadence and relative durations of the single and double limb support phases). In addition, patients’ experience will be evaluated using standardized questionnaires.

All outcome parameters will be compared between the four conditions (tactile closed loop cuing, tactile open loop cueing, auditory cueing and no cueing).

We expect both types of tactile cueing (open- and closed loop) to be feasible and effective, with tactile cueing being preferential over auditory cueing.

24 months

Vibrating socks, a new tactile cueing device