Wearing specially designed laser shoes that transmit a beam of light onto the ground ahead had a large benefit on freezing of gait in patients with Parkinson’s disease, in a new study.
“These laser shoes reduced both the number of freezing episodes and the overall duration of freezing by half,” lead author, Murielle Ferraye, PhD, Radboud University, Nijmegen, the Netherlands, told Medscape Medical News. “These results suggest the shoes are the best nonpharmaceutical help yet for freezing in Parkinson’s.”
The study was published online in Neurology on December 20.
Dr Ferraye explained that freezing of gait occurs commonly in advanced Parkinson’s disease. While dopaminergic medication does help, its effects wear off with extended use. Other approaches, such as the use of visual cues, are often then tried.
“External visual cueing is a very simple concept that has been known about for decades as a possible way of treating freezing of gait in Parkinson’s,” she noted.
“Parkinson’s disease affects automatic movements which are coordinated by the basal ganglia, the part of the brain affected by the condition, but conscious movements are controlled by the cortical area of the brain, which remains intact in Parkinson’s,” she added. “By using a visual cue, such as a laser beam directed a step length in front of the patient, this makes the patient actively think about stepping forward to place their foot on the beam. This therefore becomes a conscious movement, which can be undertaken more easily.”
“Several approaches to visual cueing have been tried before, but these have so far been of only limited benefit and there is a large unmet need.”
The laser shoes are a new idea to provide the visual cue in a more user-friendly way. The shoes are designed so that when patients puts their weight on the sole of the foot, this triggers a switch to produce the laser beam in front of the contralateral foot to give the patient a target to aim for. The system can be fine-tuned to each patient’s step length.
Previous approaches to laser cueing have included using a cane where the patient presses a switch with their hands to project the laser. But Dr Ferraye says this could be too complicated for some patients to coordinate because it involves pressing a switch every time they want to take a step.
“With the shoes, the patient’s own body weight automatically triggers the laser so the whole process is much easier, and the intermittent laser signal produced in a rhythmic way, coordinated to a patient’s step, seems to be more efficient.”
For this first proof-of-concept study, 21 patients with Parkinson’s disease and freezing of gait were assessed by using a standardized walking protocol, including freezing triggers, in a controlled gait laboratory. They undertook the walking task both with and without the laser shoes and when on and off dopaminergic medication. In total, each patient performed 10 walking trials with and 10 trials without laser cueing.
Of the 21 patients, 19 demonstrated freezing of gait during the trials and were included in the analysis. Results showed that cueing using the laser shoes was associated with a significant 45.9% reduction in the number of freezing-of-gait episodes when off medication and a 37.7% reduction when on medication.
Moreover, laser shoes significantly reduced the percentage of time frozen by 56.5% when off medication (P = .004) and by 51.4% while on medication (P = .075).
When asked about their impression about laser shoes, 12 patients reported a moderate to large improvement, 4 a small improvement, and 3 no effect. No patient reported a negative impression. Furthermore, 12 patients expressed interest in acquiring laser shoes, 6 were unsure, and 1 was not interested.
Dr Ferraye noted: “The vast majority of patients in this study showed some benefit, although there were a few who did not. It’s not just about wearing the shoes — the patients probably have to have some learning capacity as well.”
But the researchers point out that in this study there was no correlation between degree of improvement afforded by laser shoes and frontal cognitive functioning, “suggesting that (at least in this controlled laboratory setting) patients showed immediate benefits from laser shoes, regardless of their frontal cognitive abilities. This underscores their user-friendliness, and highlights their potential for a possibly broader applicability in a large group of patients with FOG [freezing of gait].”
Dr Ferraye said a second study in patients at home has been completed and has also shown promising results. “Patients normally walk better in the lab, so it is important to study these aids in the home environment too,” she added.
The researchers are now planning a larger confirmatory clinical trial in more than 100 patients.
The shoes were developed by a team at Radboud University, and the researchers are now investigating ways of commercializing them. At present a prototype pair of these laser shows would cost about €200 to €400.
This research was funded by grants from the Hersenstichting and the European Community ‘ s Seventh Framework Programme.
Neurology. Published online December 20, 2017. Abstract
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