Parkinson’s disease (PD) frequently disrupts walking and balance. Walking speed slows, steps grow shorter, turning becomes difficult, and feet get momentarily “stuck” to the ground, a condition called freezing of gait. Parkinson’s scientists often refer to these symptoms collectively as gait impairments.
Tests for gait impairments can be useful in diagnosing PD, detecting the effects of treatments and monitoring PD progression, even in early disease. But researchers use different approaches when assessing gait, resulting in inconsistencies in data collection, difficulties with interpretation across studies and limitations in understanding gait changes in PD and using gait outcomes in clinical trials.
Recognizing the critical need for a standardized, sensitive protocol for assessing gait in PD, 20 experts in the field, including representatives from six PD nonprofits, worked together to develop one. Their resulting proposed protocol, published in February by the Journal of Parkinson’s Disease, moves the field toward a uniform approach for assessing gait in people with PD.
The Gait Advisors Leading Outcomes for Parkinson’s (GALOP) advisory committee at The Michael J. Fox Foundation for Parkinson’s Research (MJFF) drafted the initial protocol, integrating expert consensus on best practices. GALOP then refined the protocol and achieved consensus on it through several rounds of discussions with representatives from a range of academic institutions and the following organizations:
- Parkinson’s UK
- Cure Parkinson’s
- Shake It Up Australia Foundation
- Parkinson Canada
- Critical Path Institute
To support widespread adoption across clinics and research settings, MJFF and these other organizations will require that their funded gait studies collect the information outlined in the protocol. Funded studies also will need to report their findings in an open access platform, so that other researchers can access them. These requirements are designed to increase adoption of the protocol and make it easier for researchers to learn the links between changes in gait and progression of PD.
The paper concludes: Standardizing gait protocols and outcomes in PD has the potential of accelerating research and clinical trials, harmonizing protocols across study sites, fostering collaborations, and in the long run, improving patient care and quality of life.
How MJFF is Prioritizing Treatment for Gait Impairments
Therapies that improve walking and reducing falls rank among the highest priorities for people with Parkinson’s, especially as the disease advances. The GALOP-led publication in Journal of Parkinson’s Disease publication is just on one of the ways MJFF is working to find better treatments for PD’s gait-related symptoms. Other initiatives include the following.
Open Calls to the Community
MJFF has launched a variety of open calls to the community to propose novel approaches to treating gait issues in PD. Recently supported projects include a range of efforts to treat freezing of gait through pharmacological approaches, physical therapy, wearable technology and optimizations to currently available deep brain stimulation. A newly launched call focuses on exploring personalized approaches to better understand, assess and improve gait in PD, and through this we hope to find additional, more individualized approaches.
Searchable Library
MJFF sponsors an interactive, searchable living library of PD digital measures, measurement tools and datasets so that qualified researchers worldwide can find available resources to support their independent gait and mobility studies.
Digital Data Collection
A variety of MJFF-backed research efforts seek to define PD’s impact on gait at different stages of the disease, in order to uncover the pathophysiological underpinnings of gait symptoms. Related to this work, MJFF sponsors and supports data collection through digital tools like smartwatches to capture information about daily life in PD, including data on gait changes and the risk for falls. These digital tools are capable of collecting vast amounts of information, and so we also fund research teams to analyze this data for insights into the progression and experience of PD.