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. 2025 Apr 29:12:100332.
doi: 10.1016/j.prdoa.2025.100332. eCollection 2025.

Effects of augmented reality cueing strategies on freezing of gait: The ELIMINATE FoG trial

Affiliations

Effects of augmented reality cueing strategies on freezing of gait: The ELIMINATE FoG trial

Brendan Baugher et al. Clin Park Relat Disord. .

Abstract

Background: Freezing of gait (FoG) is a treatment-resistant symptom of Parkinson disease (PD). Augmented reality (AR) cues have been investigated as a therapy for FoG, with inconclusive results from a limited array of AR constructs.

Objectives: Compare four modalities of a novel AR cue to physical and no-cue controls.

Methods: Presence of FoG in PD was required; exclusion criteria included dementia, severe vision loss, and significant gait-disrupting comorbidities. Participants completed six walking tasks, featuring different cueing conditions in a crossover fashion, in a holographic hallway displayed by an AR headset. A conventional physical cue was presented first, followed by other conditions in randomized order (hand-controlled AR cue, observer-controlled AR cue, eye-controlled AR cue, constant AR cue, no-cue control). Primary outcomes were FoG duration and incidence, manually annotated. Secondary outcomes included survey questions and gait parameters derived from IMUs.

Results: Thirty-six participants completed testing. The observer-controlled AR cue produced lower FoG duration than the no-cue, physical, and hand-controlled AR cue conditions (N = 36, p ≤ 0.006, Wilcoxon effect size (WES) ≥ 0.46). The constant cue reduced FoG incidence compared to all other conditions (N = 36, p ≤ 0.016, WES ≥ 0.40). Participants' preferred AR cues decreased FoG duration (N = 28, p ≤ 0.004, WES ≥ 0.48) and incidence (N = 28, p ≤ 0.022, WES ≥ 0.38) compared to controls. Differences in kinematic outcomes were negligible. Survey results indicated receptiveness toward AR cueing, with diversity in preferred cue activation modalities. No significant adverse events occurred.

Conclusions: AR cueing decreased FoG incidence and duration compared to controls. Efficacy of discrete cueing modalities likely depends on user intrinsic factors, such as preference.

Keywords: Augmented reality; Cue; FoG; Gait freezing; Parkinson’s disease.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: James Liao reports financial support was provided by American Parkinson Disease Association. Brendan Baugher reports financial support was provided by American Parkinson Disease Association. Brendan Baugher reports financial support was provided by Ohio University Russ College of Engineering and Technology. Brendan Baugher reports financial support was provided by Ohio University Graduate College. Active licensing agreement with Strolll Limited for the techniques described in the manuscript – BB, JL; Editor-in-chief of Parkinsonism and Related Disorders – HHF; Scientific advisory board member for Strolll Limited – JLA If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Aerial (A) and lateral (B) views of the novel AR cue, and 3D models of course Level 1, 2 (C) and 3 (D) from aerial view. Green traces represent the paths of two participants throughout all six conditions. Thick black traces indicate FoG episodes. Blue circles represent the pivot circle. Columns and tall walls were 2.5 m high. Short walls were 0.5 m high. The interior width of the doorways was 0.55 m, and the distance between columns was 0.5 m. The hallway itself was 7.5 m long and 2.2 m wide.
Fig. 2
Fig. 2
Percent time frozen (top) and freeze rates (bottom), per condition, ordered by descending medians. Significant differences in the conditions are denoted with brackets, with significance based on Wilcoxon signed-rank tests.

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