One of the most prevalent and crippling signs of Parkinson’s disease, a neurodegenerative condition that affects over nine million people globally, is freezing.
Image Credit: SWKStock/Shutterstock.com
When a person with Parkinson’s disease freezes, the patient’s feet frequently stop moving in mid-stride, causing the patient to staccato stutter and take shorter and shorter steps until they stop completely. One of the main causes of falls in Parkinson’s disease patients is these episodes.
Currently, a variety of pharmaceutical, surgical, and behavioral therapies are used to treat freezing, none of which are very successful.
What If There Was a Way to Stop Freezing Altogether?
A soft, wearable robot has been used by researchers from Boston University Sargent College of Health & Rehabilitation Sciences and Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) to assist a person with Parkinson’s disease in walking without freezing.
The patient can walk with a longer stride thanks to the robotic garment, which is worn around the thighs and hips and gently presses the hips as the leg swings.
The wearer is able to walk faster and farther than they could have without the assistance of the garment because the device eliminates the patient’s freezing while the patient is indoors.
We found that just a small amount of mechanical assistance from our soft robotic apparel delivered instantaneous effects and consistently improved walking across a range of conditions for the individual in our study.
Conor J. Walsh, Professor and Co-corresponding Author, John A. Paulson School of Engineering and Applied Sciences
Walsh is also the Chair and Director at the Center for Neurorehabilitation, Physical Therapy Department, Boston University. The study shows how soft robotics may be used to treat this annoying and possibly hazardous Parkinson’s disease symptom, potentially giving affected individuals mobility and independence back.
The study was published in Nature Medicine.
Walsh’s Biodesign Lab at SEAS has been creating assistive and rehabilitative robotic technologies for more than 10 years to help people with ALS and other mobility-impairing diseases, as well as those who have had a stroke. ReWalk Robotics licensed and commercialized some of that technology, including an exosuit for post-stroke gait retraining that is supported by the Wyss Institute for Biologically Inspired Engineering.
The Massachusetts Technology Collaborative awarded a grant to SEAS and Sargent College in 2022 to aid in the advancement and application of wearable and next-generation robotics technologies.
The Move Lab, whose goal is to support advancements in human performance enhancement by providing the R&D infrastructure, funding, collaborative space, and experience needed to transform promising research into mature technologies that can be translated through industry partnerships, serves as the focal point for the research.
This research emerged from that partnership.
Leveraging soft wearable robots to prevent freezing of gait in patients with Parkinson’s required a collaboration between engineers, rehabilitation scientists, physical therapists, biomechanists and apparel designers.
Conor J. Walsh, Professor and Co-Corresponding Author, John A. Paulson School of Engineering and Applied Sciences
Walsh’s team collaborated closely with Terry Ellis, Professor and Physical Therapy Department Chair and Director of the Center for Neurorehabilitation at Boston University.
Despite receiving both surgical and pharmaceutical treatments, the 73-year-old man with Parkinson’s disease experienced significant and incapacitating freezing episodes more than 10 times a day, which led to frequent falls. The team worked with him for six months. Due to these incidents, he was unable to walk around the neighborhood and was forced to rely on a scooter for outside mobility.
In earlier studies, Walsh and colleagues used human-in-the-loop optimization to show that a wearable, soft device could be used to increase hip flexion and help swing the leg forward, offering a practical method of lowering energy expenditure in healthy individuals during walking.
Here, the researchers addressed freezing using the same methodology. The wearable gadget is powered by cables and has sensors and actuators that are worn around the thighs and waist. Algorithms use the motion data gathered by the sensors to estimate the gait’s phase and produce assistive forces in sync with muscle contraction.
The result is immediate. The patient is able to walk without freezing indoors and with only sporadic episodes outdoors without the need for any special training. Without the device, the patient was also able to walk and talk without freezing, which was unusual.
Our team was really excited to see the impact of the technology on the participant’s walking.
Jinsoo Kim, Co-Lead Author and Former Ph.D. Student, SEAS
During the study visits, the participant told researchers: “The suit helps me take longer steps and when it is not active, I notice I drag my feet much more. It has really helped me, and I feel it is a positive step forward. It could help me to walk longer and maintain the quality of my life.”
Walsh adds, “Our study participants who volunteer their time are real partners. Because mobility is difficult, it was a real challenge for this individual to even come into the lab, but we benefited so much from his perspective and feedback.”
Additionally, the device may be used to shed light on the poorly understood mechanisms underlying gait freezing.
Terry D. Ellis notes, “Because we don’t really understand freezing, we don’t really know why this approach works so well. But this work suggests the potential benefits of a ’bottom-up’ rather than ’top-down’ solution to treating gait freezing. We see that restoring almost-normal biomechanics alters the peripheral dynamics of gait and may influence the central processing of gait control.”
Andrew Chin, Teresa Baker, Jinsoo Kim, Franchino Porciuncula, Hee Doo Yang, Nicholas Wendel, and Hee Doo Yang co-authored the study.
Ada Huang, Dorothy Orzel, Asa Eckert-Erdheim, and Sarah Sullivan oversaw the clinical research in addition to contributing to the technology’s design.
The research was funded by the National Science Foundation under grant CMMI-1925085; the National Institutes of Health under grant NIH U01 TR002775; and the Massachusetts Technology Collaborative, Collaborative Research and Development Matching Grant.
Soft robotic device improves walking for individual with Parkinson’s disease
Video Credit: Harvard John A. Paulson School of Engineering and Applied Sciences
Journal Reference:
Kim, J., et al. (2024) Soft robotic apparel to avert freezing of gait in Parkinson’s disease. Nature Medicine. doi.org/10.1038/s41591-023-02731-8.
Source: https://seas.harvard.edu/