DetectFoG : Detection of Gait Freezing Episodes in Parkinsonian Patients Using Inertial Measurement Units (DetectFoG)

DetectFoG : Detection of Gait Freezing Episodes in Parkinsonian Patients Using Inertial Measurement Units

Parkinson's disease is the second most common neurodegenerative disease in the world. One of these manifestations is the freezing of gait (FOG) which affects 50 to 80% of Parkinsonian patients. It is defined as a brief and episodic absence or marked reduction in the forward progression of the feet despite the intention to walk. FOG is one of the most disabling symptoms causing a greater risk of falling and a loss of autonomy for these patients. This symptom is little or not dopamine-sensitive and little improved by surgery (deep brain stimulation). Although this symptom is common and debilitating, it is difficult to assess clinically. The objective assessment of the presence and severity of FOG episodes can be done with tests such as the New-Freezing of Gait Questionnaire (N-FOGQ) with however limitations. Indeed, this filmed examination is scored a posteriori and the accumulation of the administration times which makes it difficult to use in routine clinical practice. To overcome these limitations, the use of a diary completed by the patient himself is a simple alternative to assess this symptom, but studies show that patients abandon this practice in the long term and that it is not used by patients with cognitive impairment. Recent advances in miniaturization have made it possible to create light and compact sensors to assess these events objectively. Inertial measurement units have been widely used in the literature to detect FOG episodes. The choice of the detection algorithms are a major issue in the scientific community. To date, due to the heterogeneity of the protocols, no method is currently required as a reference. The objective is to evaluate the accuracy of a new algorithm to detect the number of FOG episodes in Parkinsonian patients. This evaluation will be done on the freeze-inducing walking path.

Patients will be evaluated in the "ON" state phase and in the "OFF" state phase. For each visit, the patient will be asked to walk at a comfortable speed under the following 3 conditions: motor task, verbal, normal.

Each patient will have 2 visits : First visit in the "ON" state phase, i.e. when their oral treatment allows the maximum improvement of dopamine-responsive parkinsonian symptoms. A second visit in the "OFF" phase after having stopped taking their antiparkinsonian medications for at least 12 hours before the start of the visit, in order to promote episodes of FOG For each visit, the patient will be asked to walk at a comfortable speed under the following 3 conditions: Normal condition without additional physical and verbal tasks Condition with added physical tasks: The physical task of holding a tray with a plastic cup filled with water Condition with added verbal tasks: The verbal task of saying as many words as possible starting with a specific letter. Passing conditions will be randomized. Each condition will be fulfilled a maximum of 5 times. A rest period will be respected

Each patient will have 2 visits : First visit in the "ON" state phase, i.e. when their oral treatment allows the maximum improvement of dopamine-responsive parkinsonian symptoms. A second visit will be scheduled 15 +/- 7 days from the first. Patients will then be assessed in the "OFF" phase after having stopped taking their antiparkinsonian medications for at least 12 hours before the start of the visit, in order to promote episodes of FOG For each visit, the patient will be asked to walk at a comfortable speed under the following 3 conditions: Normal condition without addition of additional physical and verbal tasks Condition with added physical tasks: The physical task of holding a tray with a plastic cup filled with water Condition with added verbal tasks: The verbal task of saying as many words as possible starting with a specific letter. Passing conditions will be randomized. Each condition will be fulfilled a maximum of 5 times. A rest period will be respected

The precision will be calculated as the ratio of the number of true positives and the number of true negatives. The reference identification of FOG episodes will be carried out on video by two expert neurologists.

Sensitivity will be calculated as the ratio of true positives divided by the sum of true positives and false negatives.

Accuracy will be calculated as the ratio of true positives divided by the sum of true positives and false positives.

The specificity will be calculated as the ratio of true negatives divided by the sum of true negatives and false positives.

Average of the temporal difference between the beginning of the episode detected with video and that detected with the algorithm

Temporal difference between the beginning of the episode detected with video and that detected with the algorithm

Comparison of the performance of the algorithm (precision, sensitivity, accuracy, specificity) depending on the ON/OFF state and 3 path conditions, with a repeated measures ANOVA.

Inclusion Criteria: Patient over 18 years old With Parkinson's disease according to the United Kingdom Brain Bank criteria Presenting episodes of freezing of gait assessed on the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS II - question 13 with a score between 1 and 3 in order to have a patient walking without technical assistance) produced by the neurologist Able to walk 30 meters independently Affiliated to a social security scheme or beneficiary of such a scheme Having signed a free and informed consent in writing Exclusion Criteria: Montreal Cognitive Assessment (MOCA) < 20/30 Other neurological or orthopedic history that interferes with walking Pregnant, parturient or breastfeeding women Adults subject to legal protection (safeguard of justice, curatorship, guardianship), persons deprived of liberty Persons undergoing psychiatric care, persons admitted to a health or social establishment for purposes other than research Minors Persons unable to express their consent Simultaneous participation in another research related to balance and/or walking