# Ankle Bracelet Laser as a Novel Portable Device to Improve Walking in Patients With Parkinsonism: Randomized Crossover Controlled Trial

## TL;DR

A new ankle-worn laser device improved walking in Parkinson's patients by reducing freezing of gait during a controlled trial.

## Contribution

The ankle bracelet laser is a novel, portable, and hands-free visual cueing device for gait improvement in parkinsonism.

## Key findings

- Gait speed and stride length improved significantly with the laser-on condition.
- The timed up and go test duration decreased by nearly 8 seconds when using the laser.
- The device showed no adverse effects and improved the locomotor rehabilitation index.

## Abstract

Freezing of gait (FOG) is a common and debilitating symptom of parkinsonism. Although visual cues have proven efficacy in alleviating FOG, most current visual cues are fixed in place, restricting their use to controlled environments such as clinics or homes. Mobile open-loop cueing devices have been developed to address this limitation; however, they typically require manual activation to deliver the visual cues, which can be particularly challenging for patients with attention or cognitive impairments, leading to equivocal results in improving gait performance.

The aim of the study is to assess the efficacy of an ankle bracelet laser, a new mobile visual cue designed for practical use, in improving gait performance in patients with parkinsonism and FOG.

A randomized controlled 2-period crossover trial was conducted from June 15, 2020, to October 1, 2020, at Ramathibodi Hospital. In total, 10 patients with parkinsonism and FOG were enrolled in 2 conditions: walking with laser-off first and walking with laser-on first. Gait speed, the timed up and go test, stride length, and the locomotor rehabilitation index were assessed twice in each trial with a 10-minute washout period.

The results showed favorable improvement in all parameters. Gait speed and stride length improved by 0.07 m/s (95% CI 0.04-0.09 m/s; P<.001) and 0.17 m (95% CI 0.11-0.23 m; P<.001), respectively, with laser-on. The timed up and go test duration was reduced by 7.69 seconds (95% CI 2.82-12.55 seconds; P=.002). The locomotor rehabilitation index improved by 4.46% (95% CI 2.56%-6.36%; P<.001). When using the device, there were no adverse effects, such as dizziness or blurred vision.

The ankle bracelet laser cue produced immediate improvements in gait speed, stride length, and balance in patients with parkinsonism and FOG, suggesting that the device can acutely enhance gait performance. Further research is needed to determine whether these benefits are sustained and applicable to daily life activities.

Thai Clinical Trials Registry TCTR20210511001; https://www.thaiclinicaltrials.org/show/TCTR20210511001