By Dr Will Young, Lecturer in Rehabilitation Psychology
19 Jan 2019
A BBC World Hacks documentary shows how lasers mounted on shoes can help people with Parkinson's disease overcome freezing episodes that would otherwise leave them unable to walk. But can we pin our hopes on this technology working for everyone? Brunel rehabilitation psychology expert Dr Will Young, who appears in the documentary, explains that such technologies form part of much larger endeavour to develop a range of strategies that could offer solutions for people with different preferences.
The visual appeal is instant. Laser units strapped to your shoes, resting above your toes, project bright green lines in front of your feet, giving your brain visual cues to walk.
And for people with Parkinson's – such as Mel, who features in the BBC documentary – this simple idea has helped her overcome 'freezing of gait', effectively bypassing a disconnect between her brain and her body. Episodes such as standing immobilised in a Tube station for over an hour have been replaced by Mel shopping with freedom and refreshing fluidity.
Would everyone benefit?
It looks and sounds wonderful, and a welcome break from one of Parkinson's most disabling symptoms. But could this technology benefit everyone?
As I mention in the BBC documentary, my sense from talking to people is that this kind of visual cueing strategy works for some but not others. Indeed, it is unrealistic to expect that one strategy might be used universally and deliver benefits to all.
Through research projects and public engagement activities, I speak to many people who experience freezing and I commonly see that people create their own solutions to ‘cue’ a step from a freeze.
Some people sing a song, count in time or tap their leg/foot and move to the beat. Some attach a laser pointer to a walking stick, while others imagine themselves stepping over an obstacle. Many people intuitively experiment with various ideas to find out what works best for them – and often people’s preferred strategies are unique, highly personalised and effective in helping them step.
These self-generated strategies may be particularly beneficial because they do not generally rely on equipment/gadgets that must be transported and set up. Instead, people can recall them at a moment's notice, adjusting the timing, and so on, to suit their particular situation.
Improving available options
While many people will benefit from their preferred strategy, we still have an opportunity to improve the options available.
Due to recent advances in neuroscientific research, we know more about how Parkinson’s can affect specific parts of the brain. This means that we can potentially design cues that rely more on other, less-affected brain areas and improve the ability to walk as a result. With such developments in mind, I anticipate that the research community will continue to develop new strategies that are free/low-cost, readily portable and adaptable to different scenarios.
At Brunel University London, we are one of a relatively small number of laboratories that excel in developing innovative, low-cost strategies, and later this year will be publishing data showing a pronounced increase in the number of successful steps made from a freeze when using a specific mental imagery technique. However, like laser shoes, all alternative strategies (especially those involving mental imagery) also have practical limitations. For example, recalling mental cues can be problematic for people with cognitive decline, or those who are particularly anxious and potentially distracted.
There is currently very little information available to people with Parkinson’s about the range of cueing options available and what the current scientific evidence suggests regarding their effectiveness. This means that people will often find it difficult to make an informed decision about strategies that they should try and equipment that they might purchase. At Brunel University London, it is our ambition to work with other leading institutions to contribute to an online database containing such information.
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