Blog: harnessing new technology to overcome the frustration of freezing

Lois Rosenthal describes how her fascination with rhythmic cues for freezing of gait led to research testing an innovative sensory electrical stimulation device, and reflects on her experience as a first-time researcher.

Lois Rosenthal is a highly specialised physiotherapist in rehabilitation and movement disorder based at Stobhill Day Hospital, Glasgow. In March 2019, she embarked on a Parkinson’s UK funded secondment as a Parkinson’s clinical specialist physiotherapist.

Here she describes how her fascination with rhythmic cues for freezing of gait led to research testing an innovative sensory electrical stimulation device, and reflects on her experience as a first-time researcher.

I’ve found as a physiotherapist working with people with Parkinson’s, freezing of gait (FoG) is one of the most frustrating symptoms to manage. It’s not responsive to Parkinson’s medication and inconsistently responds to traditional cueing techniques. It has a huge impact on quality of life and is a big contributor to falls, social isolation, and depression.

Attentional strategies work well in the early stages, but can you imagine the mental workload of having to think about every step you take? Add in a busy environment, uneven surface, and a chatty friend, and it all goes pear-shaped.

In my student days, I was left amazed by a video of the difference a metronome in action made to a person’s mobility within their home; but I knew that method would not transfer well to daily situations outside of the home. Still, I loved the idea of a rhythmic cue and, as I progressed through my career, it kept me thinking about what else could work.

Sensory electrical stimulation

At one of our movement disorder service development meetings at Stobhill Day Hospital, I asked my colleagues if they had heard of functional or sensory electrical stimulation as a cue for freezing. None had but were intrigued and pushed me to explore it further.

A brainstorming session with Gill Alexander (stroke physiotherapist guru) followed and my husband – a willing guinea pig - was subjected to several exploratory attempts at functional electrical stimulation while mimicking freezing. No piece of kit that I had access to did what I was looking for.

This changed when I came across a PhD title involving sensory electrical stimulation (sES) and FoG at NUI Galway. The sES method involves using enough of a current to elicit a sensory response, but not enough to cause a motor response.

Initial contact with Professor Gearoid O Laighin at NUI Galway revealed that the team had invented a device but needed a clinician for further testing. With the support of my colleague, Dr Anne Louise Cunnington, a partnership was established between our two organisations, leading to the sES research.

The study

The objective of the research was to investigate whether a ‘fixed’ rhythmic sES cueing strategy would (i) reduce the time take to complete a walking task and (ii) reduce the number of freezing episodes occurring when performing the task. Participants were visited at home and asked to carry out a walking task known to elicit FoG with no cue; background sES cue; and self-activated sES cue (order randomised).

Positive results

Results showed that background sES, set at the same rate as a metronome, caused significantly fewer freezing episodes, and a significant reduction in time taken to complete the walking task. One participant who did not freeze on the day of the task still experienced an improvement in speed and quality of gait. No adverse effects were experienced, and the device – worn under clothing - was subtle, well tolerated and easy to apply.

Reflections on the research process

As a novice researcher, I had no idea how long research takes to get approved, and there were quite a few bumps along the road. In fact, we finally got the go-ahead from the ethics committee just 2 weeks before I went off on maternity leave. As this project had been ‘my baby’ for a year prior to the arrival of the real one, I felt determined to stay involved and I was able to use keep-in-touch days to see it through! I have found it really fulfilling to be able to explore a question I have had for so long, and actually find something that could be an innovative solution, which could improve the quality of life for many people with Parkinson’s.

Future research

The sES research results were very exciting for all the team and we are keen to carry out further testing. With 9 participants in the initial study, we now need a larger scale study. The groundwork is done, the device is ready to go… could your service get involved?

If so, contact Professor Gearoid O Laighin at NUI Galway: [email protected]

Read the full study in the Journal of Healthcare Engineering.