What is Parkinsons?

Before we talk about the science of sensory cueing, we think it’s helpful to start with the question, “What is Parkinson’s Disease?” and fortunately, our friends at the Michael J Fox foundation have the perfect video for those who aren’t fully aware of what exactly Parkinson’s Disease is. 

Sometimes you might hear the term ‘Parkinsonism’. This term refers to people who have Parkinsons symptoms such as freezing or festinating gait (short shuffling steps) but who do not respond to Parkinsons medication, meaning their symptoms could be caused by other conditions such as Vascular Dementia, Dementia with Lewy Bodies or MSA. 

While there’s no cure for Parkinsons yet, treatment is available, including medication, physical therapy, and other options available from health care providers around the world. Additionally, there’s other companies and start-ups around the world like us here at strolll, who are working on breakthrough innovations to improvement current treatment today and there's lots to be hopeful for on the horizon!

A strong scientific background

Strolll has a robust foundation in science and technology guided by Dr Melvyn Roerdink PhD, associate professor at VU University in Amsterdam.

Melvyn is one of the founding members behind strolll, having invented Project Holocue at VU University which was acquired by strolll in 2021.

Our approach to science and technology puts users at the heart of the research and innovation we do and we work relentlessly to understand their priorities to create innovations that make a tangible impact on quality of life.

We’re at the beginning of a digital health revolution and here at strolll we have a pipeline of exciting products and features that we believe will truly change lives. 

To learn more about the science of sensory cueing and the working we’re doing in scientific and clinical validation for our products, keep reading.

Gait, balance and falls in Parkinsons.

While most people associate Parkinsons with a hand tremor, gait impairment (walking), balance and falls can actually be one of the most challenging symptoms of the disease, yet there are limited treatment options available.

In a recent survey conducted by Parkinson’s UK of more than 1200 people affected by Parkinson’s Disease, balance and falls were rated the number one priority area for research:

https://www.parkinsons.org.uk/research/improving-life-through-research 

What is sensory cueing?

Cueing is defined as temporal or spatial stimuli, which facilitates repetitive movement usually provided as visual, auditory rhythmic signals or tactile (touch).

In simple terms, cueing can be achieved by placing lines on the floor to guide a person on where to place their foot with each step (visual), playing a metronome beat which a person can sync their step pattern to the beat of (audio) or through vibration/touch which can act as a prompt for movement (tactile). 

It’s often observed that people with Parkinson’s find it easier to climb stairs or step over lines naturally occurring on paved walkways and footpaths, this in fact is an example of visual cues in action. 

These cue's work because they help us to bypass the automatic motor functions which are impaired in Parkinsons and instead engaging other neural pathways related to attention or goal orientated motor control.

By using different types of cue's people with Parkinson's are often able to bypass the impaired part of the brain and overcome mobility limitations that impact daily life.

How do I know if sensory cueing will work?

Sensory cueing is actually a very common compensation strategy among people with Parkinsons, it’s simply that people often don’t realise they’re doing it. In particular, we often hear from people that they find it easier walking upstairs or walking on paved walkways that have naturally occurring lines which they consciously step over or on while walking which improves their gait and in particular reduces freezing of gait in Parkinsons.

Lab studies show that visual cues are the most effective because of a stronger coupling strength, meaning they have a stronger gait modifying ability. This is followed by audio cueing and finally rhythmic tactile sensory cues show the lowest efficacy rates, namely due to a weaker coupling strength between gait and tactile cues resulting in a weaker gait modifying ability.

In order to understand whether cueing could work for you, we recommend trying out some of the 55 detours in this poster, ordering a roll of the cue markers adhesive floor tape or joining the wait list for strolll's Cue X glasses.

Overcoming Heterogeneity & Habituation

Heterogeneity and Habituation barriers have previously limited the wide scale use and impact of sensory cueing in Parkinsons.

Parkinson’s Disease is known to be widely varied across all people with the condition (heterogeneous), meaning that not all types of cueing strategies work for all people, as evidenced in this video (Snijders et al., the Neurologist, 2012) demonstrating the difference between 2D lines and 3D obstacles. Movement disorder specialists famously say; “If you’ve met one person with Parkinson’s Disease, then you’ve met one person with Parkinson’s Disease.”

Less well known is habituation effects. These cueing methods work because they help us to bypass the automatic motor programs that are impaired in Parkinson's, but, as we learn and habituate the the use of cue's our movements become more automatic and the positive effects start to wear off.

This is the breakthrough concept behind the Cue X glasses. With Cue X we're able to overcome heterogeneity and habituation barriers by offering multi-sensory cueing in a single device which can be tailored to personal preference, and adapted overtime to achieve and maintain the bypass effects of automatic motor functions across a varying population.

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