Recurrent falls are a major cause of disability in patients with Parkinson’s disease (PD). A reduced minimum toe clearance (mTC) is primarily responsible for these recurrent falls in PD patients. Preventing such falls by enhancing toe clearance has become one of the most important goals in gait training among PD patients. However, in the past, manual gait training for improving mTC has not been proven effective in a real-life environment outside laboratory settings. Thus, in this paper, we propose an automated cueing-based novel gait training intervention in anticipation of improved mTC. The cueing scheme records the foot strike angle (FSA) and cues the participants if the FSA is observed above a threshold. The patients with PD (n = 8) were recruited and asked to walk under two conditions: a) with cue and b) without cue at a self-selected speed during the ON medication state. Kinetic and kinematic gait parameters such as vertical ground reaction force, the center of pressure, toe clearance, and FSA were recorded using indigenously developed wearable instrumentation. A Mann-Whitney U test showed a significant increase (p<0.001) in the minimal toe clearance and FSA with cue compared to without cue walking except in one subject. This finding provides evidence favoring the potential incorporation of an FSA-based cueing device for gait rehabilitation among PD patients. In addition, the wearable setup supports the present cueing scheme applicable outside laboratory and home settings.

Objective: Auditory and visual cues have been shown to be efficacious in laboratory-based freezing of gait (FoG) mitigation in Parkinson’s disease (PD). However, the real-life applications of these cues are restricted due to inconvenience to the users and lower social acceptance. Recently developed closed loop vibrotactile cues based on temporal gait events have overcome the shortcomings of auditory and visual cueing. However, spatial gait parameter driven vibrotactile cueing has not been explored yet. Previous studies have suggested spatial gait parameter driven cueing to be more effective than temporal cueing based on FoG pathophysiology. Therefore, we developed and validated a novel cueing scheme in which foot to ground angle at heel strike (FGA_HS) is estimated using indigenous instrumented shoes to drive vibrotactile cueing. Methods: Eight PD freezers underwent a 6-meter timed walk test including reverse counting and hurdles to induce FoG. PD freezers underwent the protocol in the off-medication state with and without cue, and after medication without cue. Indigenous instrumented shoes were used for objective gait assessment. Results: Freezing severity, quantified by the ratio of time spent freezing to the total walking time, reduced with the cue in the off-medication state. The reduced freezing severity was accompanied by increased antero-posterior stance center of pressure excursion (CoP_AP) and FGA_HS.  Conclusion: The novel spatial gait parameter-based cue was effective in mitigating FoG through improvement in associated gait parameters. Significance: With a future comprehensive validation on a larger number of participants, the novel cueing method has significant potential for practical use and commercialization.