Can cueing help "Parkies" walk better?

More research needed to validate product claims

While the hunt for a wonder drug to cure Parkinson’s goes on, a number of small tech companies are focusing on helping to treat one of the most distressing symptoms , poor mobility. As the condition progresses, many suffer frequent falls or freezing of gait where they suddenly find themselves unable to move,

Wearing the Cue-1

But now it seems that there is a new trend in gadgets using a technique called cueing to address this problem. Cueing involves using a rhythmic signal or a visual stimulus to encourage smooth movement. I’ve already written about the Cue-1, a round buzzing device you stick on your chest. But I have now encountered two more start-up companies hoping to build substantial businesses with cueing devices to help people with Parkinson’s walk better.

I first encountered gaitQ at an event held by a Parkinson’s UK group in Oxford. The company was demonstrating a product consisting of two straps you wear on your lower legs each with a vibrating device much like the Cue-1. One elderly man with mobility problems seemed impressed and I had a brief walk up and down the car park wearing the gaitQ, experiencing a mild rhythmic tingle in my calf muscles.

It seemed like a rather eccentric idea but a chat with one of the company’s founders Tristan Collins about the lengthy commercial and regulatory challenges involved in getting any medical device off the ground left me intrigued. So I arranged to meet Collins and his co-founder Dongli Li. She is a biomedical engineer and it was her doctoral research at Oxford University which sparked the idea for the cue-ing device. “Dongli and her colleagues had this idea,” says Tristan, “I heard about it and I thought if it does what these guys are claiming there should be investment available for it. That's why I got on board to help the guys take it out of the lab and very soon onto the marketplace.”

Dongli Li and Tristan Collins with their gaitQ system

They tried out an early version of the product with 17 members of the Oxford Parkinson’s group in 2019: “What we found was improvement in walking quality,” says Dongli. That showed up in areas like step symmetry - where both legs are moving at the same cadence - as well as in a reduction of the occurrence of freezing of gait.

In early 2020 they set about turning gaitQ into a commercial product - then the pandemic struck which put a stop to meetings with potential investors. But they did get a grant from the National Institute for Health Research and three years on they are about to launch a commercial product.

The updated gaitQ they show me consists of the two straps with the buzzing devices, a small handheld bluetooth controller and a charging station which doubles as a data store. Because the new vision is that one day this will be a data business measuring the symptoms of Parkinson’s, not just treating them. Tristan says you can sum it all up in two letters: “There's a big C for cueing and a big M for monitoring. We're working on C at the moment. And then we'll bring in M to do the data monitoring later on.”

He envisages that the product could be used for remote monitoring of patients by their consultants in the long months or years between face to face appointments:

“We can collect that data potentially in the home…..wouldn't it be great if your clinician could see your status every week when you do your exercises?”

Becoming a health data company, however, means clearing a lot of regulatory hurdles so in the short-term gaitQ will focus on trying to sell the device as a therapeutic product. I asked how much it would cost - a price had yet to be fixed but Tristan said the £249 Cue-1 had set quite a challenging benchmark. He was relieved when I told him that another cueing device called Stryd AR cost a lot more.

A crude way of using cueing to help people walk better is to paint lines on the road. The Stryd AR walking glasses take this idea and give it a hi-tech twist, projecting a horizontal yellow line on a lens in front of your right eye. The product is described as a ‘non-invasive wearable device for people with Parkinson’s to dramatically improve posture, balance, walking and quality of life.’

Big claims then and just as with the gaitQ and the Cue-1, behind the Stryd AR is a founder passionate about helping people with Parkinson’s and convinced their device can make a big difference.

Scott McLeod got in touch with me after hearing the Movers and Shakers podcast wanting to send me a pair of the glasses. “Since we did not spin out of a university or have a team of influential neurology scientists,” he explained, “it has been frustratingly difficult to get the attention of Parkinson's organisations. Therefore, we decided to work directly with people by offering them a chance to try the glasses for free.” So far, he said, there had been very encouraging feedback from users.

Wearing the Stryd AR glasses

He said other forms of visual cueing had been used to improve people’s gait and to stop freezing but his device went a stage further: “Our visual cue actually improves posture, which is a game changer - nobody's been able to do this before.”

The Stryd AR device, which was delivered to my door a few days later, looks like a pair of wraparound sunglasses rather than the bulky virtual or augmented reality headsets others in this field are using.

It was pretty easy to set up - just charge it and then press the bridge of the glasses and the system turns on, the yellow line appearing at the top of the right lens. I set off for a walk to see whether it made a difference. I tried the Stryd AR headset several times over the next few days and I cannot honestly say that I noticed any difference in the way I walked.

Now that may not be particularly significant. I have been trying out the Cue-1 for months and again I can’t say that it has had a major impact. (My stroll around the car park with the gaitQ was too brief to reach any verdict). While one of my symptoms is that I drag my right foot and I do notice that my walking deteriorates when I am due my next round of medication, I am probably not yet the target audience for this technology. Scott McLeod mentions an 85 year old man called Eddie with severe mobility problems who had managed to walk without his Zimmer frame while wearing the glasses.

But at this early stage in its development, and with little in the way of funding, the Stryd AR comes with a hefty price tag - £2000 to buy the glasses outright, £100 a month if you want to sign up to a subscription and try them out for a while.

The challenge for all the cueing devices is getting the backing of neurologists so that they can get approval from NICE and be prescribed on the NHS. That, however, means proper large-scale clinical trials rather than the very limited affairs which have taken place so far. Those are very costly and, of the three companies whose devices I have described, it is probably only the Cue-1 maker Charco with its substantial backing from the venture capital firm Amadeus which has the necessary resources.

I have to say that when I first heard the term cueing I was rather sceptical - it seemed like it might be just the kind of alternative therapy I shy away from, with little concrete evidence that it works. But I have been impressed by the credentials of many of the people exploring cueing technology and then last week a conversation with one of the UK’s leading neurologists made me think again.

Quite spontaneously, in a discussion about Parkinson’s drugs for a forthcoming podcast, he brought up cueing as a technique that could be useful in helping with mobility problems. The Cue-1 is now being trialled in an NHS hospital, so perhaps the tide is turning. Further research is needed but anything that can help people with Parkinson’s stay mobile for longer is worth exploring.