Photo Credit: Sydney.edu.au
Over half of Parkinson's disease patients experience a walking problem known as freezing of gait.

Many patients in the latter stage of Parkinson’s disease are at high risk of dangerous, sometimes fatal, falls. One major reason is the disabling symptom referred to as Freezing of Gait (FoG) — brief episodes of an inability to step forward that typically occurs during gait initiation or when turning while walking.

Patients who experience FoG often lose their independence, which has a direct effect on their already degenerating quality of life. In the absence of effective pharmacological therapies for FoG, technology-based solutions to alleviate the symptom and prolong the patients’ ability to live independently are desperately being sought.

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CuPID is a project three years in the making and the product of an eight-member European Union-funded consortium including researchers at Tel Aviv University. It strives to provide personalized rehabilitation for patients with Parkinson’s disease who experience FoG or other gait disturbances.

CuPID is a home-based, personalized rehabilitation tool in the form of a Smartphone app that harnesses wearable sensors, audio biofeedback, and external cueing to provide intense motivational training tailored to each patient. The results are monitored remotely by medical professionals, who provide quality care while enhancing patient compliance.

The CuPID app just completed its pilot run and is being fine-tuned for more widespread use. It utilizes small sensors placed on a patient’s shoes that measure a person’s gait in “real-time.” If certain deviations from a pre-set norm emerge, an audio message alerts the patient to change his or her walking pattern immediately to avoid a dangerous situation.

Tel Aviv University Prof. Jeffrey Hausdorff said:

FoG is a leading cause of disability in patients with Parkinson’s disease. It often occurs during ‘walking transitions’ associated with turning, starting, stopping, and moving in open spaces. It can also occur when people approach narrow spaces, such as doors or elevators, and in crowded places. Recognizing such situations is a very powerful key for prevention — and this is one of the features of this program.

Prof. Hausdorff and his team at Tel Aviv Medical Center conducted a pilot study on 40 subjects: 20 patients with Parkinson’s disease who used the CuPID app and 20 patients who carried out conventional exercises and did not use the app. The results are promising and the investigators are currently exploring the possibility of a larger follow-up study to further demonstrate the app’s efficacy. Tel Aviv University Dr. Anat Mirelman, who co-directed the project, explained that FoG episodes resemble a short-circuit in the brain, rendering it unable to generate the appropriate stepping pattern, often leaving the patient in an untenable and frustrating situation. The app is designed to circumvent that difficulty. She said:

FoG reduces patients’ independence. Patients become afraid of walking by themselves and this leads to self-imposed restrictions in mobility. When their feet get stuck to the ground, their bodies lunge forward — it’s very frightening. People often end up in wheelchairs, and this is a vicious cycle, as it places more reliance on the assisted-living infrastructure.

“The program now integrates the expertise of a patient’s physical therapist, who establishes what is considered a patient’s ‘normal’ or ‘strong’ walking pattern,” said Prof. Hausdorff. “It’s unobtrusive and has the potential to reduce dependence on Parkinson’s medication that has detrimental side effects. How much or how often the app is used depends on how advanced the disease is, but since the system is so small and non-invasive, it can be used just about anywhere.”

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