SCH: Context-aware Freezing of Gait mitigation in real-world setting

该项目旨在减轻步态冻结(雾)的负担，超过50%的帕金森氏病(PD)患者患有这种疾病。雾是帕金森病的一种常见的破坏性表现，目前尚无治愈或足够的内科或外科治疗方法。雾被定义为“尽管有行走的意图，但脚的前进速度出现短暂的间歇性消失或明显减慢”。众所周知，雾事件往往是由各种环境和心理因素引发的。最常见的触发因素包括起步犹豫(步态开始时僵住)、在狭小的四分之三中行走、转弯犹豫(改变方向时冻结)、接近视觉目标、双重任务以及压力大、时间敏感的情况 就像在电梯门关上之前进入电梯一样。每一个帕金森病患者对这些不同的触发因素的敏感性是独特的，这强调了定制治疗方法的必要性。治疗雾的一个有希望的选择是使用触觉刺激，然而，到目前为止，还没有一项技术可以提供定制的治疗方法，以适应特定触发场景的个人需求。在这个拟议的项目中，弗吉尼亚联邦大学和William&Mary团队将共同开发新技术，根据个人需求部署特定背景的振动刺激，以防止或减轻雾气。在任务1中，我们将设计和开发一个可穿戴的自动雾系统 使用现有技术(Ultiegure UG运动传感器、PDVibe3和智能手机)进行检测和振动交付。该设备将能够在出现雾时立即检测到雾。在任务2中，我们将确定在受控环境中(在临床实验室)引起雾的五种最常见的环境和心理触发因素的振动频率和振幅的最佳剂量。在任务3中，我们将在可穿戴系统中集成全球定位机制，以便设备能够识别雾气的环境触发因素。 我们将对任务2中确定的最优振动参数(针对五个触发器中的每一个)进行编程，以响应相应的环境和心理触发器进行部署，并将在真实环境中(公共场所)进行测试。在这个项目完成后，我们将创建并测试一个闭环系统，该系统将在防止或缓解雾发作所需的准确时刻为帕金森氏症患者提供定制的振动治疗。该项目直接与NINDS使命保持一致，以减轻帕金森病等神经系统疾病的负担。

This project seeks to reduce the burden of freezing of gait (FoG), which is suffered by over 50% of people living with Parkinson’s disease (PD). FoG is a common, devastating manifestation of PD for which there is no cure or adequate medical or surgical treatment. FoG has been defined as a “brief, episodic absence or marked reduction of forward progression of the feet, despite the intention to walk”. It is widely known that FoG episodes are frequently triggered by various environmental and psychological factors. The most commonly recognized triggers include start hesitation (freezing upon gait initiation), walking through tight quarters, turn hesitation (freezing when changing directions), approaching a visual target, dual tasking, and stressful, time sensitive situations such as entering an elevator before the doors close. Each individual with PD is unique with regard to how sensitive they are to these various triggers, underscoring the need for customized therapeutic approaches. A promising option for treating FoG is the use of tactile stimulation, however, no technology to date can provide customized therapy that adapts to the individual’s needs with regard to the specific triggering scenarios. In this proposed project, the Virginia Commonwealth University and William & Mary teams will work together to develop novel technology that deploys context-specific vibration stimuli tailored to the individual’s needs, with the goal of preventing or mitigating FoG. In Task 1, we will design and develop a wearable system for automatic FoG detection and vibration delivery using existing technology (Ultigesture UG motion sensors, PDVibe3, and a smartphone). The device will be able to detect FoG immediately upon occurrence. In Task 2, we will determine the optimum dose of vibration frequency and amplitude for the five most common environmental and psychological triggers for FoG in a controlled environment (in the clinical lab). In Task 3, we will integrate a global positioning mechanism into the wearable system so that the device can recognize environmental triggers of FoG. We will program the optimal parameters of vibration determined in Task 2 (for each of the five triggers) to deploy in response to corresponding environmental and psychological triggers and will test it in a real-world setting (a public place). Upon completion of this project we will have created and tested a closed-loop system that will deliver customized vibration therapy to people with PD at the precise moment it is needed to prevent or mitigate FoG episodes. This project aligns directly with the NINDS mission to reduce the burden of neurological diseases such as PD.