Skip to main content
Download PDF

Carpets with visual cues can improve gait in Parkinson’s disease patients: may be independent of executive function

European Journal of Medical Research volume 28, Article number: 530 (2023) Cite this article

Abstract

Background

Gait impairment is common in Parkinson’s disease (PD) patients, which greatly reduces their quality of life. Executive dysfunction is associated with gait impairment. Compensatory strategies, including visual cues, have been shown to be effective in improving PD gait. In this study, we aimed to understand whether carpets with visual cues could improve PD gait, and how the improvement varies across patients with different executive function state.

Methods

We designed carpets with chessboard and stripe cues. A total of 65 Chinese PD patients were recruited. Movement Disorder Society Unified Parkinson’s Disease Rating Scale, L-dopa equivalent daily dosage, Hoehn & Yahr stage, Frontal Assessment Battery, Mini Mental State Examination Scale, Hamilton Anxiety Scale, and Hamilton Depression Scale were evaluated. Gait parameters including stride length, gait speed and fall risk were recorded by a wearable electronic device.

Results

The stride length and gait speed were significantly improved and the fall risk was significantly mitigated when PD patients walked on carpets with chessboard and stripe patterns. Further analysis showed the amelioration of gait parameters was independent of executive dysfunction.

Conclusions

Our study demonstrates that carpets with visual cues can improve the gait of PD patients even in those with mild executive dysfunction.

Background

Parkinson’s disease (PD) is a common neurodegenerative disease, whose prevalence rises rapidly with age [1]. The cardinal motor manifestations of PD include bradykinesia, rigidity, rest tremor, and gait impairment [2]. Gait disturbance runs through the course of PD and greatly affects their quality of life [3].

The characteristics of gait impairment in PD patients vary widely, including decreased speed, reduced stride length, reduced arm swing amplitude, increased interlimb asymmetry, larger gait variability, impaired complex locomotor tasks, reduced axial rotation, stooped posture, impaired motor automaticity, freezing of gait (FOG), and increased risk of falling [3,4,5]. It has been believed that gait impairment in PD patients is not only related to deficit of motor activity, but also closely related to higher-level cognitive impairments such as executive dysfunction [6, 7]. Accurate assessment and treatment of gait impairment in PD patients is very important.

Several observational and quantitative scales such as Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) [8], Freezing of Gait Questionnaire [9], Timed Up-and-Go [10], and 6-min walk test [11] have been widely used to assess PD gait. However, these methods obtain relatively simple metrics and are susceptible to tester bias [3, 12]. Sensor-based wearable electronic devices enable gait measures more detailed and can be performed in home and community settings.

Similar to bradykinesia, tremor, and rigidity, gait impairment in PD can be clearly relieved by dopaminergic drugs, especially in the early stage. However, these drugs are not always effective and might lead to sedation, orthostatic hypotension, behavioral and psychiatric symptoms [13, 14]. Motor fluctuation and dyskinesia associated with long-term use of levodopa can even lead to worsening of gait [15]. Therefore, non-pharmacological interventions to treat PD gait are receiving increasing attention. Numerous studies have shown that various aspects of gait in PD patients can be improved by different rhythmical visual and auditory cues [16,17,18,19,20]. A previous study showed that public space floors with visual cues can improve gait in PD patients [21].

In this study, we designed carpets with visual cues, and aimed to explore whether they could improve gait in PD patients using wearable electronic device. We also want to test if executive dysfunction affects the gait improvement.

Methods

Patients

A total of 65 PD patients of Han Chinese ethnicity were recruited from Department of Neurology, the Second Affiliated Hospital and Yuying Children’s Hospital from February 2021 to March 2023. All patients were diagnosed by two movement disorder neurologists according to the movement disorder society clinical diagnostic criteria for PD [22]. Most of them were de novo PD patients. Excluded participants were those with severe cognitive impairment, uncorrectable visual disorders, neuromusculoskeletal disorders that affect gait, and severe gait disorder that prevents independent walking. Since the automated device cannot distinguish FOG, we also excluded patients with FOG based on Freezing of Gait Questionnaire.

Clinical evaluations

Clinical information including age, disease duration, MDS-UPDRS, L-dopa equivalent daily dosage (LEDD), Hoehn & Yahr stage, Frontal Assessment Battery (FAB), Mini Mental State Examination Scale (MMSE), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) were assessed by face-to-face interview and physical examinations in the off medication state, which is defined as at least 12 h after stopping antiparkinsonian medication [23]. All the patients were evaluated with FAB [24] and they were divided into PD with executive dysfunction group (FAB score < 13) and PD without executive dysfunction group (FAB score ≥ 13) based on the FAB score, as previously described [25].

Gait analysis

The 5-m-long and 1-m-wide carpet is designed into 3 patterns (Fig. 1A): (1) No pattern (blank carpet); (2) Chessboard pattern (50 × 50 cm black-white chessboard); (3) Stripe pattern (50 cm black and 25 cm white spaced stripes). To better reflect daily life, patients were asked to walk three times at a natural speed on each pattern of carpet in their habitual on medication state, when they felt as comfortable as usual. Gait performance of the patients was evaluated by a wearable electronic device (Dalian Qianhan Technology Co., Limited, China), which was widely used in PD gait evaluation [26, 27]. Participants were asked to wear five sensor transmission modules on the waist, both thighs, and calves (Fig. 1B). Parameters including stride length, gait speed were calculated according to the acceleration data automatically. Fall risk was calculated by the system according to the gait parameters as previously described [28, 29].

Fig. 1
figure 1

Three patterns of carpets and position of wearable sensor modules. A (1) No pattern; (2) Chessboard pattern; (3) Stripe pattern. B Participants wore five sensor modules on the waist, both thighs, and calves

Full size image

Statistical analysis

The data were analyzed using IBM SPSS Statistics 19.0 for windows. The normal distribution of the data was assessed by Kolmogorov–Smirnov test. Variables were described as mean ± standard deviation (SD) when the data are normally distributed. Otherwise, they were described as the median and interquartile range (IR). Difference in gender between PD with executive dysfunction and PD without executive dysfunction groups was assessed by Chi square test. Differences in age, MDS-UPDRS total score, and MDS-UPDRS III score were analyzed by unpaired two-tailed t-test. Differences in disease duration, LEDD, Hoehn & Yahr stage, FAB score, MMSE score, HAMA score, and HAMD score were analyzed by Mann–Whitney U test. Differences in stride length and gait speed when patients walked on three patterned carpets were analyzed by One-way repeated measures ANOVA. Two-way repeated measures ANOVA test was used to analyze the interaction between executive function and visual cues on gait parameters. Difference in fall risk when patients walked on three patterned carpets was analyzed by Friedman test. A two-tailed P < 0.05 was considered statistically significant.

Results

Demographic and clinical characteristics of PD patients

According to the FAB score, there were 24 cases in PD with executive dysfunction group and 41 cases in PD without executive dysfunction group. The two groups were comparable in gender, age, disease duration, MDS-UPDRS total score, MDS-UPDRS III score, LEDD, Hoehn & Yahr stage, HAMA score and HAMD score (P > 0.05; Table 1). In contrast, FAB score and MMSE score were significantly lower in PD with executive dysfunction group (P < 0.001 and P = 0.001 respectively; Table 1).

Table 1 Demographic and clinical characteristics of PD patients
Full size table

Carpets with chessboard and striped patterns improve PD gait

Stride length, gait speed and fall risk of the 65 PD patients were recorded and analyzed when they walked on carpets with three patterns. The stride length was 0.905 ± 0.029 m when they walked on carpet with no pattern, which was significantly shorter than the stride length when they walked on carpets with chessboard and stripe patterns (0.927 ± 0.029 m, P = 0.001 and 0.938 ± 0.029 m, P < 0.001 respectively; Fig. 2A). Gait speed was also significantly faster when they walked on chessboard and stripe patterned carpets than on carpet with no pattern (0.836 ± 0.030 m/s vs. 0.809 ± 0.031 m/s, P = 0.008 and 0.842 ± 0.032 m/s vs. 0.809 ± 0.031 m/s, P < 0.001 respectively; Fig. 2B). The fall risk on carpets with no pattern, chessboard and stripe patterns was 5.300% (interquartile range, 3.767–10.667%), 5.133% (interquartile range, 3.567–9.782%), and 4.500% (interquartile range, 3.619–9.300%) respectively. Both chessboard and stripe patterns were statistically different from no pattern (P = 0.037 and P = 0.001 respectively; Fig. 2C). However, no significant differences were found between the gait parameters on the 2 patterned carpets (P > 0.05).

Fig. 2
figure 2

Comparison of gait parameters among three patterned carpets. A Stride length. B Gait speed. C Fall risk. n = 65. Values are expressed as means ± SE for stride length and gait speed. Data of fall risk is expressed as median and interquartile range. *P < 0.05; **P < 0.01; ***P < 0.001

Full size image

Analysis of executive function on gait improvement

In the further analysis, patients were divided into PD with executive dysfunction group and PD without executive dysfunction group according to their FAB scores. PD patients without executive dysfunction showed significant stride length improvement on chessboard and stripe patterned carpets (P = 0.003 and P < 0.001 respectively; Fig. 3A). Similar results were found in gait speed (P = 0.004 and P < 0.001 respectively; Fig. 3B). Significant amelioration of fall risk was found in both groups of PD patients with and without executive dysfunction when they walked on carpet with stripe pattern (P = 0.035 and P = 0.020 respectively; Fig. 3C). To further explore the effect of executive function on stride length and gait speed improvements, a two-way repeated measures ANOVA was performed. As presented in Table 2, both stride length and gait speed were significantly benefited from visual cues (P < 0.001 and P < 0.001 respectively). However, there was no significant interaction between visual cues and executive dysfunction (P = 0.359 and P = 0.270 respectively; Table 2), or significant main effect of executive dysfunction (P = 0.982 and P = 0.694 respectively; Table 2).

Fig. 3
figure 3

Change of gait parameters induced by the designed carpets in PD patients with and without executive dysfunction. A Stride length. B Gait speed. C Fall risk. n = 24 for PD patients with executive dysfunction; n = 41 for PD patients without executive dysfunction. Values are expressed as means ± SE for stride length and gait speed. Data of fall risk is expressed as median and interquartile range. *P < 0.05; **P < 0.01; ***P < 0.001

Full size image
Table 2 Results of two-way repeated measures ANOVA
Full size table

Discussion

Gait impairment is very common and heterogeneous in PD patients. In this study, we designed two kinds of carpets with visual cues (chessboard pattern and stripe pattern), and found that carpets with the two patterns are effective in improving gait in PD patients without FOG. Further analysis suggested that this improvement may be independent of executive function.

Gait impairment is a major concern for PD patients, causing falls and recurrent falls in 68.3% and 39% of the patients [30,31,32]. Treatment for PD gait impairment is diverse. Although their therapeutic targets are different, levodopa, dopamine agonists, inhibitors of amine oxidase B, and acetylcholinesterase inhibitors have all been reported to be effective in improving PD gait [13, 33,34,35,36]. However, the side effects of long-term use and the uncertainty of efficacy are their limitations [13]. Non-pharmacological interventions make up for these deficiencies and bring additional benefits. Compensation strategies developed spontaneously or trained by doctors can alleviate PD gait impairment by bypassing the basal ganglia pathway, among which, external cues are known to be the most widely applied strategy [37, 38]. External cues refer to a series of rhythmically visual, auditory, or proprioceptive stimuli that provide a gait reference. To better apply visual cue strategies to home and community settings, we designed carpets with chessboard and striped cues in the current study. Based on wearable device recordings and subsequent analysis, our results showed that the two patterned carpets can improve stride length, gait speed and fall risk in PD patients. A previous study designed a chessboard floor and tested it in 32 PD patients with FOG. The results showed that it can improve several parameters of gait [21]. Our study, with a larger sample size, showed that even PD patients without FOG would benefit from carpets with visual cues.

The underlying mechanism of gait impairments in PD patients is not clear. Relevant studies are mainly carried out in cross-sectional studies, focusing on brain functional MRI, risk factors, and neurotransmitters. In addition to the nigrostriatal dopamine system, non-motor symptoms, non-dopaminergic systems, and frontal-striatal connections have also been shown to be associated with gait impairment in PD [39,40,41]. Executive dysfunction plays an important role in gait impairment [7]. A previous study showed that both mild and marked executive dysfunctions are independent risk factors for falls in PD patients [25]. What’s more, rivastigmine and donepezil, which are used to improve executive function, have been shown to be effective in improving PD gait [35, 36].

Highlighted should be that we firstly evaluated the gait improvement by visual cues in PD patients with or without executive dysfunction respectively. The results showed that the benefits in stride length and gait speed are significant in those without executive dysfunction. However, further analysis showed that this improvement was not significantly different between the patients with and without executive dysfunction. It may be due to the fact that executive dysfunction is not extremely severe in our cohort, as we have excluded those who could not follow the instructions when recruiting patients. Our results suggest that the gait-improving effect of visual cues is also valuable in PD patients with mild executive dysfunction.

It is worth noting that a short walk (in the absence of habituation) on a patterned carpet may raise attention, and further boost the gait performance. The habits of walking on such patterns may induce habituation, lower attention and eventually lose the benefit observed on gait in such a research setting. Therefore, whether such patterned carpets can permanently improve PD gait needs further study. Meanwhile, we have to acknowledge certain limitations. The turns, narrow spaces and obstacles that exist in real home and community settings are not reflected in our research. In addition, our study has a relatively small sample size and lacks longitudinal observation, the presence of which would otherwise enhance the reliability of the conclusions.

Conclusions

In summary, the current study provides further evidence that carpets with visual cues can improve the gait of PD patients even in those with mild executive dysfunction. Further study in larger population is needed to confirm our findings.

Availability of data and materials

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding authors.

Abbreviations

ED:

Executive dysfunction

F:

Female

FOG:

Freezing of gait

HAMA:

Hamilton Anxiety Scale

HAMD:

Hamilton Depression Scale

IR:

Interquartile range

LEDD:

L-dopa equivalent daily dosage

M:

Male

MDS-UPDRS:

Movement Disorder Society-Unified Parkinson’s disease Rating Scale

MMSE:

Mini Mental State Examination Scale

PD:

Parkinson’s disease

SD:

Standard deviation

VC:

Visual cues

References

  1. Cui L, Hou NN, Wu HM, Zuo X, Lian YZ, Zhang CN, et al. Prevalence of Alzheimer’s disease and Parkinson’s disease in China: an updated systematical analysis. Front Aging Neurosci. 2020;12: 603854.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kalia LV, Lang AE. Parkinson’s disease. Lancet. 2015;386:896–912.

    Article  CAS  PubMed  Google Scholar 

  3. Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, et al. Gait impairments in Parkinson’s disease. Lancet Neurol. 2019;18:697–708.

    Article  PubMed  Google Scholar 

  4. Palmerini L, Rocchi L, Mazilu S, Gazit E, Hausdorff JM, Chiari L. Identification of characteristic motor patterns preceding freezing of gait in Parkinson’s disease using wearable sensors. Front Neurol. 2017;8:394.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shah J, Pillai L, Williams DK, Doerhoff SM, Larson-Prior L, Garcia-Rill E, et al. Increased foot strike variability in Parkinson’s disease patients with freezing of gait. Parkinsonism Relat Disord. 2018;53:58–63.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Giladi N, Hausdorff JM. The role of mental function in the pathogenesis of freezing of gait in Parkinson’s disease. J Neurol Sci. 2006;248:173–6.

    Article  PubMed  Google Scholar 

  7. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord. 2008;23:329–42 (quiz 472).

    Article  PubMed  Google Scholar 

  8. Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008;23:2129–70.

    Article  PubMed  Google Scholar 

  9. Giladi N, Shabtai H, Simon ES, Biran S, Tal J, Korczyn AD. Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord. 2000;6:165–70.

    Article  CAS  PubMed  Google Scholar 

  10. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.

    Article  CAS  PubMed  Google Scholar 

  11. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985;132:919–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B, et al. Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: critique and recommendations. Mov Disord. 2016;31:1342–55.

    Article  PubMed  Google Scholar 

  13. Curtze C, Nutt JG, Carlson-Kuhta P, Mancini M, Horak FB. Levodopa is a double-edged sword for balance and gait in people with Parkinson’s disease. Mov Disord. 2015;30:1361–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sterling NW, Cusumano JP, Shaham N, Piazza SJ, Liu G, Kong L, et al. Dopaminergic modulation of arm swing during gait among Parkinson’s disease patients. J Parkinsons Dis. 2015;5:141–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Okuma Y, Silva de Lima AL, Fukae J, Bloem BR, Snijders AH. A prospective study of falls in relation to freezing of gait and response fluctuations in Parkinson’s disease. Parkinsonism Relat Disord. 2018;46:30–5.

    Article  PubMed  Google Scholar 

  16. Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems AM, Kwakkel G, et al. The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease. Arch Phys Med Rehabil. 2005;86:999–1006.

    Article  PubMed  Google Scholar 

  17. Barthel C, Nonnekes J, van Helvert M, Haan R, Janssen A, Delval A, et al. The laser shoes: a new ambulatory device to alleviate freezing of gait in Parkinson disease. Neurology. 2018;90:e164–71.

    Article  PubMed  Google Scholar 

  18. Warlop T, Detrembleur C, Buxes Lopez M, Stoquart G, Lejeune T, Jeanjean A. Does Nordic walking restore the temporal organization of gait variability in Parkinson’s disease? J Neuroeng Rehabil. 2017;14:17.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rutz DG, Benninger DH. Physical therapy for freezing of gait and gait impairments in Parkinson disease: a systematic review. PM R. 2020;12:1140–56.

    Article  PubMed  Google Scholar 

  20. Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, et al. Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis. BMJ. 2012;345: e5004.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gal O, Polakova K, Hoskovcova M, Tomandl J, Capek V, Berka R, et al. Pavement patterns can be designed to improve gait in Parkinson’s disease patients. Mov Disord. 2019;34:1831–8.

    Article  PubMed  Google Scholar 

  22. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30:1591–601.

    Article  PubMed  Google Scholar 

  23. Bordelon YM, Hays RD, Vassar SD, Diaz N, Bronstein J, Vickrey BG. Medication responsiveness of motor symptoms in a population-based study of Parkinson disease. Parkinsons Dis. 2011;2011: 967839.

    PubMed  PubMed Central  Google Scholar 

  24. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a frontal assessment battery at bedside. Neurology. 2000;55:1621–6.

    Article  CAS  PubMed  Google Scholar 

  25. Pelicioni PHS, Menant JC, Henderson EJ, Latt MD, Brodie MA, Lord SR. Mild and marked executive dysfunction and falls in people with Parkinson’s disease. Braz J Phys Ther. 2021;25:437–43.

    Article  PubMed  Google Scholar 

  26. Zhu S, Zhong M, Bai Y, Wu Z, Gu R, Jiang X, et al. The Association between clinical characteristics and motor symptom laterality in patients with Parkinson’s disease. Front Neurol. 2021;12: 663232.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wu Z, Jiang X, Zhong M, Shen B, Zhu J, Pan Y, et al. Wearable sensors measure ankle joint changes of patients with Parkinson’s disease before and after acute levodopa challenge. Parkinsons Dis. 2020;2020:2976535.

    PubMed  PubMed Central  Google Scholar 

  28. Taylor ME, Delbaere K, Mikolaizak AS, Lord SR, Close JC. Gait parameter risk factors for falls under simple and dual task conditions in cognitively impaired older people. Gait Posture. 2013;37:126–30.

    Article  PubMed  Google Scholar 

  29. Cheng Q, Wu M, Wu Y, Hu Y, Kwapong WR, Shi X, et al. Weaker braking force, a new marker of worse gait stability in Alzheimer disease. Front Aging Neurosci. 2020;12: 554168.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wood BH, Bilclough JA, Bowron A, Walker RW. Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry. 2002;72:721–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis. 2013;2013: 906274.

    PubMed  PubMed Central  Google Scholar 

  32. Fasano A, Canning CG, Hausdorff JM, Lord S, Rochester L. Falls in Parkinson’s disease: a complex and evolving picture. Mov Disord. 2017;32:1524–36.

    Article  PubMed  Google Scholar 

  33. Serrao M, Ranavolo A, Conte C, Davassi C, Mari S, Fasano A, et al. Effect of 24-h continuous rotigotine treatment on stationary and non-stationary locomotion in de novo patients with Parkinson disease in an open-label uncontrolled study. J Neurol. 2015;262:2539–47.

    Article  CAS  PubMed  Google Scholar 

  34. Jankovic J, Berkovich E, Eyal E, Tolosa E. Symptomatic efficacy of rasagiline monotherapy in early Parkinson’s disease: post-hoc analyses from the ADAGIO trial. Parkinsonism Relat Disord. 2014;20:640–3.

    Article  PubMed  Google Scholar 

  35. Henderson EJ, Lord SR, Brodie MA, Gaunt DM, Lawrence AD, Close JC, et al. Rivastigmine for gait stability in patients with Parkinson’s disease (ReSPonD): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol. 2016;15:249–58.

    Article  CAS  PubMed  Google Scholar 

  36. Chung KA, Lobb BM, Nutt JG, Horak FB. Effects of a central cholinesterase inhibitor on reducing falls in Parkinson disease. Neurology. 2010;75:1263–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Nonnekes J, Ruzicka E, Nieuwboer A, Hallett M, Fasano A, Bloem BR. Compensation strategies for gait impairments in Parkinson disease: a review. JAMA Neurol. 2019;76:718–25.

    Article  PubMed  Google Scholar 

  38. Tosserams A, Weerdesteyn V, Bal T, Bloem BR, Solis-Escalante T, Nonnekes J. Cortical correlates of gait compensation strategies in Parkinson disease. Ann Neurol. 2022;91:329–41.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Maidan I, Bernad-Elazari H, Gazit E, Giladi N, Hausdorff JM, Mirelman A. Changes in oxygenated hemoglobin link freezing of gait to frontal activation in patients with Parkinson disease: an fNIRS study of transient motor-cognitive failures. J Neurol. 2015;262:899–908.

    Article  CAS  PubMed  Google Scholar 

  40. Arie L, Herman T, Shema-Shiratzky S, Giladi N, Hausdorff JM. Do cognition and other non-motor symptoms decline similarly among patients with Parkinson’s disease motor subtypes? Findings from a 5-year prospective study. J Neurol. 2017;264:2149–57.

    Article  CAS  PubMed  Google Scholar 

  41. Gilat M, Ehgoetz Martens KA, Miranda-Dominguez O, Arpan I, Shine JM, Mancini M, et al. Dysfunctional limbic circuitry underlying freezing of gait in Parkinson’s disease. Neuroscience. 2018;374:119–32.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are thankful to all of the subjects participating in this study.

Funding

The study was supported in part by funding from Zhejiang Provincial Medical Technology Program (2023RC215), Wenzhou Municipal Science and Technology Bureau (Y20220162), Fundamental Research Funds for Wenzhou Medical University (KYYW202030), and Novel Technology Program of the Second Affiliated Hospital and Yuying Children’s Hospital (2022014).

Author information

Author notes

  1. Ze-Di Hu and Shi-Guo Zhu have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China

    Ze-Di Hu, Shi-Guo Zhu, Jie-Fan Huang, Jin-Yu Chen, Shi-Shi Huang, Rong-Pei Liu, Zhu-Ling Chen, Lu-Lu Ma, Xiong Zhang & Jian-Yong Wang

Authors
  1. Ze-Di Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shi-Guo Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jie-Fan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin-Yu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shi-Shi Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rong-Pei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhu-Ling Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lu-Lu Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xiong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jian-Yong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZH, SZ and JW conceived the idea; ZH and SZ assessed gait; ZH, JH, JC, ZC, and LM acquired and analyzed all clinical data; JW, XZ, SH, SZ and RL examined the patients; ZH, SZ and JW wrote the manuscript; XZ and JW supervised the study. All the authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Xiong Zhang or Jian-Yong Wang.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the ethics committee of the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University. All participants signed written informed consents.

Consent for publication

Not applicable.

Competing interests

The authors declare that there is no actual or potential conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hu, ZD., Zhu, SG., Huang, JF. et al. Carpets with visual cues can improve gait in Parkinson’s disease patients: may be independent of executive function. Eur J Med Res 28, 530 (2023). https://doi.org/10.1186/s40001-023-01472-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40001-023-01472-1

Keywords

European Journal of Medical Research

ISSN: 2047-783X

Contact us