To improve gait of freezing in patients with Parkinson′s disease by electrical stimulation to common peroneal nerve delivered by wearable stimulator / 中华神经科杂志

ABSTRACT

Objective To explore whether the proprioceptive sensory cueing delivered by electrical stimulator to common peroneal nerve can improve the freezing of gait of parkinsonian patients. Methods Thirty patients with Parkinson′s disease experiencing freezing of gait (FOG) admitted to the First Affiliated Hospital of Anhui Medical University from January to December 2018 were included in the trial. Proprioceptive sensory cueing was provided by alternating electrical stimuli to bilateral common peroneal nerves delivered through the wearable electrical stimulator automatically triggered by walking. The modified 12 meters Timed Walking Test, six items of the modified Parkinson Activity Scale (PSA?6), and FOG score were used to test the gait function respectively when the stimulator was turned on and off. Results Compared to the off status, time duration for two 360°turns (T360), initiating (T1) and the turning (T2) was reduced with statistical significance when the stimulator was turned on in the three trial situations which were walking with no extra task (17.49 (13.55, 23.48) s vs 14.73 (10.31, 21.71) s, 2.16 (1.78, 2.68) s vs 1.70 (1.38, 2.29) s, 6.37 (4.10, 7.45) s vs 4.77 (3.40, 6.85) s; Z=-3.219,-4.206,-2.910, P<0.05), walking with cognitive task (21.35 (16.30, 30.72) s vs 18.36 (13.83, 27.98) s, 2.80 (2.05, 3.75) s vs 2.04 (1.64, 3.00) s, 6.58 (5.23, 8.96) s vs 5.75 (4.59, 7.76) s; Z=-3.486,-4.206,-3.363, P<0.05) and walking with motor task (25.34 (17.79, 30.30) s vs 22.24 (14.11, 29.33) s, 2.46 (2.19, 3.18) s vs 2.35 (1.66, 2.59) s, 7.77 (4.75, 9.93) s vs 6.45 (3.81, 7.66) s; Z=-3.468,-3.983,-3.570, P<0.05). In all the three exercise modes, the maintaining time (T3) was not significantly different. With the stimulator turned on, the total walking time (Tt) was not significantly different when the patients walked without extra task and with cognitive task but obviously improved with motor task (29.26 (20.11, 33.21) s vs 27.66 (17.70, 32.73) s, Z=-2.644, P=0.008). Compared to the off status, patients showed higher PAS?6 scores (18.99±2.55 vs 16.82±2.92, t=-6.617, P=0.000) and lower FOG scores (14.10 ± 5.02 vs 10.61 ± 5.05, t=6.151, P=0.000) with statistical significance when the stimulator was turned on. Conclusion The wearable electrical stimulator can alleviate FOG in patients with Parkinson′s disease by improving rotation, gait initiation and turning and may be used as a new rehabilitative therapy for patients with FOG.