A comparison of clinical and objective measures of freezing of gait in Parkinson's disease
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Freezing of gait, a paroxysmal motor block, is common in the latter stages of Parkinson's disease. The current 'gold standard' of assessing the severity of freezing is based on clinical identification (by up to 3 raters) of the number of episodes from video. The aims of this study were to systematically assess this 'gold standard' across multiple Parkinson's disease centers, and to compare these clinical ratings with objective measures derived from lower limb acceleration data. Video recordings were acquired during a timed up-and-go task from 10 Parkinson's disease patients (with a clinical history of freezing) in the 'off' state. Patients were instrumented with accelerometers on the lateral aspect of each shank. Ten experienced clinicians were recruited from four Parkinson's disease centers to independently assess the videos for number and duration of freezing events. The reliability of clinical video assessment for number of freezing events was moderate (intraclass correlation coefficient 0.63). Percent time frozen (cumulative duration of freezing episodes/total duration of the walking task) demonstrated stronger agreement between raters (0.73). Agreement of accelerometry-derived measures of freezing severity with mean clinician ratings was strong for number of episodes (0.78) and very strong for percent time frozen (0.93). The results demonstrate the viability of objective measures of freezing, and that percent time frozen is a more reliable metric of severity than number of freezing events for both clinical and objective measures. The large variability between clinicians suggests that caution should be used when comparing subjective ratings across centers.
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Wearables were also used in Parkinson's disease to quantify sleep disturbances, gait measures, freezing of gait, missteps and falls, and physical activity levels.
“Wearables were also used to quantify sleep disturbances [30], gait measures [31, 32], freezing of gait [33, 34], missteps and fall [35, 36], and physical activity levels [37–39].”
From Wearable sensors for clinical applications in epilepsy, Parkinson’s disease, and stroke: A mixed-methods systematic review (2018) · cites this paper as [34]
Wearables showed good agreement with video-based ratings regarding the number of freezing episodes and the percentage of time with freezing of gait.
“Wearables showed good agreement with video-based ratings regarding the number of freezing episodes and the percentage of time with freezing of gait [34].”
From Wearable sensors for clinical applications in epilepsy, Parkinson’s disease, and stroke: A mixed-methods systematic review (2018) · cites this paper as [34]
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- Authors
- Morris, T. R., Cho, C., Dilda, V., Shine, J. M., Naismith, S. L., Lewis, S. J. G., & Moore, S. T.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- The University of Sydney (AU)
- Corresponding author
- Moore, Steven T.
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2012-06
- Volume
- 18
- Issue
- 5
- Pages
- 572-577
- ISSN
- 1353-8020 (ISSN-L)
- OpenAlex
- W2160698760
- Cited by
- 114
- References
- 31
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 10 · 2023: 4 · 2022: 13 · 2021: 15 · 2020: 8 · 2019: 8 · 2018: 6 · 2017: 11 · 2016: 3 · 2015: 6 · 2014: 7 · 2013: 10 · 2012: 1
- FWCI
- 19.10
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Parkinsonism & Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Acquire (CQUniversity) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute on Deafness and Other Communication Disorders (R01DC007658)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Keywords
- freezing of gait, Parkinson's disease
- MeSH terms
- Aged, Female, Humans, Kinetocardiography, Locomotion, Male, Middle Aged, Parkinson Disease, Severity of Illness Index, Video Recording, Reproducibility of Results, Gait Disorders, Neurologic, Freezing Reaction, Cataleptic, Self Report
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