Turn around freezing: Community-living turning behavior in people with Parkinson's disease

Difficulty in turning while walking is common among patients with Parkinson's disease (PD). This difficulty often leads to significant disability, falls, and loss of function; moreover, turning is a common trigger for freezing of gait (FoG). We hypothesized that the quantity and quality of turning mobility while walking during daily life would be different among subjects with PD with and without FoG. Here, we investigated, for the first time, the turning quality during daily life as it relates to FoG in people with PD using a single inertial sensor. Ninety-four subjects with PD (among whom 25 had FoG) wore an inertial sensor attached by a belt on the lower back during normal daily activity consecutively for 3 days. An algorithm identified periods of walking and calculated the number and quality metrics of turning. Quality, but not the quantity, of turning at home was different in freezers compared to the non-freezers. The number of turns (19.3 ± 9.2/30 min in freezers, 22.4 ± 12.9/30 min non-freezers; p = 0.194) was similar in the two groups. Some aspects of quality of turns, specifically mean jerkiness, mean and variability of medio-lateral jerkiness were significantly higher (p < 0.05) in the freezers, compared to non-freezers. Interestingly, subjects with FoG showed specific turning differences in the turns with larger angles compared to those without FoG. These findings suggest that turning during daily activities among patients with PD is impaired in subjects with FoG, compared to subject without freezing. As such, clinical decision-making and rehabilitation assessment may benefit from measuring the quality of turning mobility during daily activities in PD.