Sensory and Cognitive Processing in Freezing of Gait

Dr Conor Fearon, Dr Tudor Munteanu, Ella Baird, Dr John Butler Prof Tim Lynch, Prof Richard Reilly

 

Freezing of gait (FOG) is a paroxysmal motor symptom which manifests as “brief, episodic absence or marked reduction in forward progression of the feet despite the intention to walk” (Nutt et al., 2011). Attempts to properly define FOG implicitly highlight many of the issues which surround research in this area. In clinical practice, the patient describes the feeling their feet are “stuck” or “glued” to the floor and it frequently occurs in the context of severe gait festination (where step length and stride time shorten progressively until complete cessation of locomotion occurs). Freezing affects up to 60% of patients with advanced Parkinson’s Disease (PD) (Giladi & Nieuwboer, 2008) but can also occur in early PD, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism, normal pressure hydrocephalus and alone as a “pure freezing syndrome” (Giladi, Kao, & Fahn, 7AD). It most commonly occurs during turning, initiation of gait, in narrow spaces, while performing a second task simultaneously (dual-tasking) and stressful or emotional situations.

Despite advances in pharmacological therapy for Parkinson’s disease, freezing of gait remains a significant problem for those patients prone to it. Furthermore, there is a close association with falls and placement in nursing homes (Bloem, Hausdorff, Visser, & Giladi, 2004). In particular, dual-tasking is a significant contributor to falls in this population (Jacobs, Nutt, Carlson-Kuhta, Allen, & Horak, 2014). This highlights the importance of FOG, not only as a disturbing and disabling symptom for patients with PD, but also as a considerable cost to the healthcare system (Grimbergen, Munneke, & Bloem, 2004) .

The process of freezing is not an episodic phenomenon as FOG patients have been shown gait abnormalities in between episodes of freezing, including reduced step amplitude increased stride variability and disordered bilateral coordination (Frazzitta, Pezzoli, Bertotti, & Maestri, 2012; Hausdorff, Schaafsma, Balash, Bartels, et al., 2003b; Plotnik & Hausdorff, 2008). Moreover, patients with FOG demonstrate lack of control of bimanual upper limb movements (Nieuwboer, Vercruysse, et al., 2009b; Vercruysse et al., 2012) pointing to a more general impairment of internal timing and motor control. One might therefore suspect that the underlying changes which cause freezing episodes to occur would be detectable, to some degree, at all times, rather than simply when freezing episodes occur. In addition, circumstances which tend to induce freezing in those who experience it (such as stress or dual-tasking), might make these changes more easily detectable.

The main aims of this research:

  • To examine whether true sensory processing differences exist between patients with and without FOG
  • To develop a virtual reality based paradigm which reliably provokes FOG in an experimental setting
  • To use this paradigm in order to examine behavioural and neurophysiological cognitive differences between patients with and without FOG while dual-tasking
  • To examine whether motor learning and goal directed behaviour performance is different between patients with and without FOG

 

International Peer-Reviewed Journal Papers

  • C. Fearon*, J.S. Butler*, L. Newman, T. Lynch, R.B. Reilly. Audiovisual Processing is Abnormal in Parkinson’s Disease and Correlates with Freezing of Gait and Disease Duration, Journal of Parkinson’s Disease. 2015 Oct 17;5(4):925-36.
  • C. Fearon*, I. Killane*, L. Newman, C. McDonnell, S. Waechter, K. Sons, T. Lynch, R.B. Reilly. Dual Motor-Cognitive Virtual Reality Training Impacts Dual-Task Performance in Freezing of Gait. IEEE Journal of Biomedical and Health Informatics, 2015 Nov;19(6):1855-61.
  • C. Fearon*, J.S. Butler*, I Killane, S. Waechter, R.B. Reilly, T. Lynch. Getting Ready to Freeze: Motor Preparation Rather Than Decision Making Differentiates Parkinson’s Disease Patients with and without Freezing of Gait. Manuscript in Review

 Conference Publications/ Presentations / Published Abstracts

  • C. Fearon, J.S. Butler, I Killane, S. Waechter, L. Newman, R.B. Reilly, T. Lynch. Motor Preparation and Decision-Making in Parkinson’s Disease Patients With And Without Freezing of Gait: An Event-Related Potential Study. Irish Neurological Association Meeting. Limerick Ireland, May 2016.
  • C. Fearon, J.S. Butler, L. Newman, R.B. Reilly, T. Lynch. Differential Audiovisual Processing in Parkinson’s disease. Movement Disorder Society International Congress of Parkinson’s Disease and Movement Disorders. San Diego, USA, June 2015.
  • I. Killane, C. Fearon , C. McDonnell , K. Sons, R.B. Reilly. Results from a Dual Motor Cognitive Virtual Reality Intervention. International Society for Posture and Gait Research World Congress. Seville, Spain, June 2015.
  • S. Wächter, C. Fearon, C. McDonnell, J. Gallego, B. Quinlivan, I. Killane, J.S. Butler, T. Lynch, R.B. Reilly. The Impact of Dual Tasking on Cognitive Performance in a Parkinson’s Disease Cohort with and without Freezing of Gait: An EEG and Behavioral Based Approach. Proceedings of 7th International IEEE EMBS Conference on Neural Engineering. Montpelier, France. April 2015.
  • C. Fearon, L. Newman, J.S. Butler, B. Quinlivan, R.B. Reilly, T. Lynch. Motor Learning in Parkinson’s Disease using an Action Acquisition Task. Irish Neurological Association Meeting. Galway, Ireland, May 2015.
  • C. Fearon, L. Newman, B. Quinlivan, J.S. Butler, T. Lynch, R.B. Reilly, “Investigation of Motor Learning in Parkinson’s Disease using an Action Acquisition Task”. Association of British Neurologists Meeting. Harrogate, UK, May 2015.
  • C. Fearon, S. Wächter, J.S. Butler, C. McDonnell, I. Killane, S. Stoneman, B. Magennis, T. Lynch, R.B. Reilly. Attention and Motor Preparation in Freezing of Gait: An Evoked Potential Perspective”. Irish Institute of Clinical Neuroscience Registrar's Prize in Clinical Neuroscience. Dublin, November 2014. Winner, Research Prize.
  • C. Fearon, T. Lynch, R.B. Reilly. Attention and Motor Preparation in Freezing of Gait. Global Engagement of Doctoral Education Health Science Initiative, Ann Arbor, MI, USA, October 2014.
  • S. Wächter, C. Fearon, C. McDonnell, J.S. Butler, J. Gallego, B. Quinlivan, I. Killane, T. Lynch, R.B. Reilly. The Role of Cognitive Load on Freezing of Gait in Parkinson’s Disease: an Approach Based on EEG and Gait Analysis using a Virtual Reality Environment. Poster presentation, Neuroscience Ireland Young Neuroscientists Symposium. Trinity College Dublin, September, 2014.
  • C. Fearon, S. Wächter, N. McDevitt, E. Harrington, J. S. Butler, T. Lynch, R.B. Reilly. Electroencephalography in Parkinson’s Disease Patients with Freezing of Gait while Stepping in Place. International Society for Posture and Gait Research World Congress. Vancouver, Canada, July 2014.
  • C. Fearon, S. Wächter, R.B. Beck, J.S. Butler, J. Williams, S. Kelly, B. Magennis, T. Lynch, R.B. Reilly. Ambulatory Electroencephalography and Virtual Reality Environments in Freezing of Gait in Parkinson's Disease. Irish Neurological Association Meeting. Belfast, UK, May 2014.
  • C. Fearon, N. McDevitt, B. Magennis, E. Harrington, R.B. Reilly, T. Lynch. Electroencephalography and Gait Analysis using Virtual Reality Environments in Freezing of Gait. 1st Freezing of Gait Congress. Dead Sea, Israel, Feb 2014.
  • C. Fearon, B. Quinlivan, R. Cheshire, B. Magennis, E. Harrington, R.B. Reilly, T. Lynch. Gait analysis and Electroencephalography using Virtual Reality Environments in Freezing of Gait in Parkinson's Disease. Registrar's Prize in Clinical Neuroscience. Dublin, November 2013.
  • C. Fearon, E. Roudaia, H. Nolan, J. Gallego, B. Quinlivan, C. O’Leary, R.B. Reilly, T. Lynch. Gait analysis and Wii Balance Board Use in Freezing of Gait in Parkinson’s Disease. Movement Disorder Society International Congress of Parkinson’s Disease and Movement Disorders. Sydney, Australia, June 2013.
  • E. Roudaia, J. Gallego, H. Nolan, C. Fearon, F. Newell, R. Reilly. Sensorimotor synchronization to auditory and visual cues in ageing and Parkinson’s Disease. TIMELY school on “Timing and Time Perception: Procedures, Measures & Applications. Corfu, Greece, February 2013.