Virtual visual cues: vice or virtue?

Sabine Janssen

    Research output: ThesisPhD Thesis - Research UT, graduation UT

    418 Downloads (Pure)


    ‘Freezing of gait’ is a common, bothersome and potentially hazardous symptom of Parkinson’s disease. Patients describe freezing of gait as the feeling as if their feet are suddenly being ‘glued’ to the floor. Freezing of gait increases the risk of falling, and impedes independence in daily life activities and quality of life. An effective non-pharmaceutical intervention is the application of external cues, e.g. equally spaced bars on the floor or the rhythmic beat of a metronome. Despite the wide variety of cueing devices under investigation, a user-friendly, inconspicuous, wearable device providing visual cues tailored to personal preference and effectivity, is not yet available.
    The overarching aim of this thesis is to explore whether visual cues delivered through augmented reality glasses improve freezing of gait and gait in persons with Parkinson’s disease. The thesis commences with overviews of the position of cueing as a neurorehabilitation strategy in Parkinson’s disease, and of visual and ocular disorders that should be considered when developing visual cues. Next, I report two intriguing cases that point out how heterogeneous cueing strategies can be. Then, as the core of this thesis, I present several studies which explore the effectivity of visual cues delivered through augmented reality glasses to alleviate freezing of gait and improve gait in persons with Parkinson’s disease. This is followed by a study validating a task to increase cognitive load in walking experiments. The final study investigates whether a virtual environment paradigm can be used in neuroimaging and behavioural studies involving cueing.
    In short, this thesis explores whether augmented reality visual cues delivered through smart glasses improve freezing of gait, and gait, in persons with Parkinson’s disease. Various types of visual cues and augmented reality glasses are tested. Unfortunately, none prove sufficiently effective in improving FOG and gait. It is up to future technological developments, and research efforts, to render augmented reality visual cues viable.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Twente
    • van Wezel, Richard J.A., Supervisor
    • Bloem, Bastiaan R., Co-Supervisor, External person
    • Heida, Tjitske, Co-Supervisor
    Award date11 Mar 2020
    Place of PublicationEnschede
    Print ISBNs978-90-365-4967-7
    Publication statusPublished - 11 Mar 2020


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