CuPiD, a smartphone app designed by researchers, uses sensors to provide personalized rehab for patients with Parkinson’s disease experiencing freezing of gait, according to a news release. After a pilot program recently was completed, the app is being updated for widespread use.

PT_news-01Many patients in the latter stage of Parkinson’s disease are at high risk of dangerous, sometimes fatal, falls, according to the release, and a major reason is freezing of gait, or the brief episodes in which the person is unable to step forward. These episodes often occur during gait initiation or when turning while walking, the release said. Patients who experience freezing of gait often lose their independence, which has a direct effect on their already degenerating quality of life.

An eight-member European Union-funded consortium of researchers, including physical therapists, has been working on CuPiD for three years. The consortium, which is led by the University of Bologna in Italy, includes teams from Italy, Spain, Switzerland, Belgium, Israel and the U.K. The app’s goal is to provide home-based, personalized rehab for patients with Parkinson’s disease who experience freezing or other gait disturbances. The results are monitored remotely by healthcare professionals.

The CuPiD app uses small sensors placed on a patient’s shoes that measure the person’s gait in real-time. If certain deviations from a preset norm emerge, an audio message alerts the patient to change walking pattern immediately to avoid a dangerous situation.

“[Freezing of gait] is a leading cause of disability in patients with Parkinson’s disease,” researcher Jeffrey Hausdorff, PhD, said in the release. Hausdorff, an associate professor with Tel Aviv University’s Sackler Faculty of Medicine, and laboratory director of the Center for Movement, Cognition, and Mobility at Tel Aviv Sourasky Medical Center, is the lead investigator on the Israeli team.

“[Freezing] often occurs during walking transitions associated with turning, starting, stopping and moving in open spaces,” Hausdorff said in the release. “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.”

Hausdorff and his team at Tel Aviv Medical Center conducted a pilot study with 40 participants: 20 patients with Parkinson’s disease who used the CuPid app and 20 patients with Parkinson’s who completed conventional exercises and did not use the app. The results were promising, according to the release, and the investigators are exploring the possibility of a larger follow-up study.

Repairing a short circuit

Anat Mirelman, PhD, also of TAU and TASMC, co-directed the project. Freezing of gait 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, Mirelman said in the release. The app is designed to help patients get around that difficulty.

“There are two modes to the app,” Mirelman said in the release. “The first improves the overall gait pattern — ‘keep it up, you are walking well,’ says a virtual physical therapist — and the positive feedback while walking actually helps the patient emotionally as well as functionally. If the gait pattern needs adjustments, the app will let the user know. The second mode helps patients avoid and free themselves of [freezing of gait] if they are already stuck. We believe, and we have already seen in clinical trials here at the hospital, that this has the potential to improve the quality of life for these patients quite dramatically.

“FoG reduces patients’ independence. Patients become afraid of walking by themselves and this leads to self-imposed restrictions in mobility,” she said in the release. “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.”

According to Hausdorff, the app incorporates the knowledge of the patient’s physical therapist, who determines the person’s normal or strong walking pattern.

“It’s unobtrusive and has the potential to reduce dependence on Parkinson’s medication that has detrimental side effects,” Hausdorff said in the release. “How much or how often the app is used depends on how advanced the disease is, but since the system is so small and noninvasive, it can be used just about anywhere. It’s exciting to think of the potential of long-term use.”

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