Dealing with the heterogeneous presentations of freezing of gait: how reliable are the freezing index and heart rate for freezing detection?
Helena Cockx, Jorik Nonnekes, Bastiaan R Bloem and 3 others
PMID 37106388WHAT IT FOUND
The freezing index fails to separate freezing from voluntary stops and misfires on turns.
Heart rate reliably distinguishes freezing from stops across all types. Combining a simple forward-motion metric with heart rate monitoring may improve home detection of freezing in Parkinson's disease.
Key findings
01The freezing index increased during voluntary stops and normal turns, making it unable to distinguish these from freezing episodes.
02Heart rate change significantly differentiated freezing from voluntary stops for all freezing types and triggering situations.
03Heart rate did not significantly increase during freezing when participants carried a tray (motor dual-task), though it still distinguished freezing from stops in that condition.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study analysed group-level averages, so it cannot predict how well these signals work for an individual patient's specific freezing patterns. Data on akinetic freezing (total absence of movement) was limited, requiring cautious interpretation of findings for this subtype. Participants performed tasks in a laboratory setting with specific instructions (e.g., turning with small steps), which may not fully replicate real-world variability. One participant with Multiple System Atrophy was analysed separately and showed different responses, highlighting that findings may not generalise to other parkinsonian disorders.
Declared interests
Funded by the Netherlands Organisation for Scientific Research and the European Regional Development Fund. No commercial conflicts declared.
The easy way to misread this
Do not assume heart rate alone can detect all freezing episodes. It failed to significantly increase during freezing when participants carried a tray (motor dual-task), and it could not distinguish freezing from normal turning or narrow passages. It only reliably separated freezing from voluntary stops.