Clearing the FOG
How an Ohio University Heritage College of Osteopathic Medicine Student is Shaping the Future of Parkinson’s Research By Nick Wood | Staff Writer
Clearing the FOG
How an Ohio University Heritage College of Osteopathic Medicine Student is Shaping the Future of Parkinson’s Research By Nick Wood | Staff Writer
As research participants for Brendan Baugher’s thesis project don their augmented reality goggles and navigate the blue walls of a holographic hallway, they’re overcoming more than the obstacles projected before them–they’re breaking through one of Parkinson disease's most debilitating symptoms: freezing of gait.
“Freezing of gait is a very hard symptom of Parkinson’s to treat, where people literally feel like they’re frozen in place–sometimes mid stride,” Baugher said. “It's a very treatment-resistant symptom, so we've had to take unconventional approaches to addressing it.”
For Parkinson’s patients who experience freezing, it is often triggered by a change in environment–such as walking through a narrow doorway or approaching a turn–but the symptom is unpredictable and difficult to break out of. Because of this, it can severely lower quality of life due to both potential fall risk and the mental health toll anxiety around sudden freezing creates.
Prior studies show providing patients with visual, auditory or tactile cues when frozen encourages goal-oriented thinking, which can be helpful when trying to unfreeze. However, outside of controlled environments these types of cues don’t exist–but Baugher’s research may change that.
Using the Magic Leap 2 headset, he and a group of collaborators from the Cleveland Clinic, created and tested a variety of visual cues using augmented reality with the goal of helping Parkinson’s patients safely break out of freezing, or avoid freezing altogether. On a population level, they found this method of cueing to be successful in reducing gait freezing in patients–the first study of this kind to do so. While this research and technology are still in their early phases, Baugher’s work has the potential to be applied outside of the lab in any environment, allowing Parkinson’s patients greater freedom, mobility and quality of life.
Baugher’s passion for neurology drove this work, though this project also holds personal significance to the fourth year medical student.
“My grandfather recently passed away from Parkinson's disease, and I've had a couple other family members with spinal cord injuries and things like that,” he said. “These are just crippling issues that have very little treatment at this point. We've made leaps and bounds to improve quality of life, but there's so much more work to do to address these illnesses.”
Freezing Of Gait
The temporary, involuntary inability to move.
Research participants use the clicker to move through a course, as portrayed in the video.
Originally from rural Northeastern Ohio, Baugher left the region to pursue a bachelor's degree at Ohio State University. He later returned to attend medical school at Ohio University’s Heritage College of Osteopathic Medicine Cleveland Campus, driven by his desire to serve the community he grew up in.
When developing his thesis, Baugher knew he wanted to research neurodegenerative diseases, like Parkinson’s, but initially planned on taking a different (much squirmier) path.
“Originally, we discussed that he'd come down to Athens and learn a bit about how to do neurodegeneration research using worms,” said Nathaniel Szewczyk, Ph.D., executive director of research initiatives at Heritage College and Baugher’s thesis advisor. “Worms have nerves and muscles, people have nerves and muscles–the mechanisms and treatments for muscle wasting are the same between worms and people. So, you can actually learn things about human health by studying worms.”
However, as Baugher was based in Cleveland, developing a research plan based in Athens wasn’t necessarily ideal, so he started looking into other possibilities. It was while working at Cleveland Clinic’s Center for Neurological Restoration where he eventually met his primary research collaborator and the study’s lead investigator, James Liao, M.D., a movement disorders neurologist at the Cleveland Clinic, that his current project began to take shape.
“It was kind of like serendipity, we were both in the right place at the right time,” Liao said of the collaboration. “Brendan had already been working on ideas related to research we were conducting here at the Cleveland Clinic, and after we met we developed this project idea together. It just worked out, and we were able to spark a beautiful collaboration–a beautiful friendship.”
Additional collaborators from Cleveland Clinic include Ryan Kaya, D.P.T., Claire Sonneborn, M.S., Kenneth Baker, Ph.D., Hubert Fernandez, M.D., and Jay Alberts, Ph.D. Together, they were able to help adapt therapeutic augmented reality techniques used in past studies at the clinic to focus on treating freezing of gait.
Previous research on freezing of gait gives few concrete insights into the root causes of the symptom. What is known, however, is there are different types of freezing, which occur for unique reasons, with no one-size-fits-all approach to preventing or alleviating the sensation.
“Some people, when they freeze, it looks like they're trembling or shivering–other people don't have any shivering. There's freezing that is partially alleviated by raising the dose of the main medicine for Parkinson's (Levodopa), and there's freezing that gets worse when you raise the dose,” Liao said. “There's so many different forms of freezing that make this problem more complicated to solve.”
In their study, Baugher and Liao were not attempting to understand the causes of gait freezing. Instead, they were specifically trying to discover how augmented reality technology may be harnessed as a therapeutic tool to reduce freezing. To do so, they developed an augmented reality visual cue and tested several methods for triggering said cue to find which one may be most successful in assisting their patients.
The cue appeared beneath participants as two bright green rings they are instructed to move toward while walking through a simple virtual obstacle course. In a given trial, this cue may be eye controlled, hand controlled, controlled by the investigator observing the trial or appear constantly. It was predicted that the trigger that required the least amount of effort to activate would be the most successful, but this was found to be untrue.
Just as Parkinson’s patients experience freezing in different ways for different reasons, the participants in this study benefited from different cue triggers. No single trigger was consistently preferred over another, it just came down to personal preference.
Brendan Baugher, OMS IV.
“That was a surprising result, but maybe it shouldn't have been,” Szewczyk said. “Everyone is different, if you're looking for a solution that works for everybody, you may overlook other possible solutions that work for unique subsets of patients.”
Regardless of how it was triggered, however, in almost all cases the augmented reality cues were successful in reducing freezing as the patient navigated the virtual obstacle course. A life-changing prospect for those who cope with freezing of gait in their day-to-day lives.
“We had one participant who thought that this was so useful that they reached out to their local TV station just to try to promote it more,” Liao said. “We’re definitely trying to bring this out to people, but it’s a slow process.”
The researchers’ ultimate vision for this technology is to give Parkinson’s patients access to these augmented reality cues beyond the clinic in any location. Doing so will require developing larger clinical trials incorporating more research participants, but this future of Parkinson’s therapy may be available in the not-so-distant future.
Strolll, a medical equipment manufacturer specializing in augmented reality therapeutics, is developing a commercially available Parkinson’s gait rehab system. According to Liao, the cueing mechanism he, Baugher and the research team developed has already been licensed to the company to eventually become part of their system used in hospitals around the U.S.
“That's happening slowly,” Liao said. “I don't know when it will be widely available, but the machinery is moving to make that happen.”
Both Baugher and Liao credit the success of this study to the collaboration between Heritage College and Cleveland Clinic. The latter researcher claiming the former pushed the research forward:
“Brendan ran the day-to-day–recruiting people, performing experiments, analyzing data, writing manuscripts,” Liao said. “I was advising him, but he really did all of the work. Without him, it would not have happened.”
And Baugher asserting it was his clinical collaborators that kept the project on track:
“Looking back, if I had to say, could I get this done in the time frame I did, I'd say no,” he said. “But I was able to because of the generosity and the resources available at the Cleveland Clinic. The partnerships that the college has allow students to get a lot of opportunities that students from non-affiliated sites just don't have access to.”
In either case, the work this collaboration produced has the potential to change the lives of countless Parkinson’s patients–and it’s due in no small part to the transformative student research taking place at Heritage College.
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