C-Gait for Detecting Freezing of Gait in the Early to Middle Stages of Parkinson's Disease: A Model Prediction Study

Abstract

Objective: Efficient methods for assessing walking adaptability in individuals with Parkinson's disease (PD) are urgently needed. Therefore, this study aimed to assess C-Gait for detecting freezing of gait (FOG) in patients with early- to middle-stage PD.

Method: People with PD (PWP) diagnosis (Hoehn and Yahr stages 1-3) were recruited from April 2019 to November 2019 in Beijing Rehabilitation Hospital. The participants performed six items of walking adaptability on an instrumented treadmill augmented with visual targets and obstacles (C-Mill). The patient's walking adaptability was evaluated by C-Gait assessment and traditional walking tests, and FOG-related indexes were collected as outcome measures. Two discriminant models were established by stepwise discriminant analysis; area under the receiver operating characteristic (ROC) curve (AUC) was used to validate the models.

Result: In total, 53 patients were included in this study. Most C-Gait assessment items had no or low correlations with traditional walking tests. The obstacle avoidance (r = -0.639, P = 0.003) and speed of adaptation (r = -0.486, P = 0.035) items could lead to FOG with high sensitivity. In addition, the C-Gait assessment model (AUC = 0.755) had slightly better discrimination of freezers from non-freezers compared with traditional walking test models (AUC = 0.672); specifically, obstacle avoidance and speed of adaptation have uniquely discriminant potential.

Conclusion: C-gait assessment could provide additional value to the traditional walking tests for PD. Gait adaptability assessment, as measured by C-Gait, may be able to help identify freezers in a PD population.

Keywords: C-Gait assessment; Parkinson’s disease; freezing of gait; rehabilitation; walking adaptability.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Chen, Yan, Qi, Zhen, Liu, Wang, Liu, Wang, Liu, Fang, Su, Yan, Liu, Xi and Fang.

Figures

FIGURE 1

Spearman’s correlation coefficients between C-Gait assessment scores. In this study, correlation coefficients of 0–0.25, 0.25–0.50, 0.50–0.75, and 0.75–1.00 were considered to indicate very low, low, moderate, and high correlations, respectively. Slalom walking (SW), tandem walking (TW), obstacle avoidance (OA), visually guided stepping (VGS), reaction to unexpected perturbation (RUP), and speed of adaptation (SA) were on the x-axis, while traditional walking test measures were on the y-axis, i.e., The New Freezing of Gait Questionnaire (NFOG-Q), Unified Parkinson’s Disease Rating Scale Part III, item 11, and Freezing of Gait (UPDRS 3.11 FOG). Color types and shades provide a visualization of the direction and strength of the correlations, respectively. The numbers shown in each square correspond to different colors, indicating the Spearman’s correlation coefficient (rs) from Spearman’s rank correlation analysis of each pair. * Correlation is statistically significant at the P < 0.05 level; ** Correlation is statistically significant at the P < 0.01 level.

FIGURE 2

Receiver operating characteristic (ROC) curves of two discriminant models for freezing of gait (FOG). The areas under the ROC curves (AUCs) for DM1 and DM2 were 0.672 and 0.755, respectively. DM1, discriminant model 1 (traditional walking tests); DM2, discriminant model 2 (C-Gait assessment).