Parkinsonian gait improvement through vibratory stride parameter feedback

BACKGROUND: Hypokinetic gait increases morbidity and mortality of persons with Parkinson's disease and constitutes a major target symptom for therapy. Feedback on gait quality, e.g. by a physiotherapist, improves stride length and reduces shuffling. Wearable devices measuring gait parameters and providing feedback could improve parkinsonian gait during everyday life when no physiotherapist is available. Here, we report on the efficacy of a new device providing discreet vibratory feedback upon decreased stride length and increased shuffling. METHODS: 33 persons with Parkinson's disease, in two cohorts, received automatic vibratory feedback administered via a newly developed sensor-equipped insole when their stride length and heel strike angle decreased while walking a 730 m walking course. Gait of 14 persons with Parkinson's disease in the first cohort was investigated in OFF and ON medication state to allow for a comparison of the feedback effect with the effect of medication on stride length, heel strike angle and gait variability. In both cohorts, the effect of feedback on gait parameters was compared against a control walk without stimulation and was subjectively evaluated by the study participants. In the second cohort of 19 participants, the effect of feedback was additionally compared with vibration at random time points to investigate the efficacy of context-adequate feedback. RESULTS: Both stride length and heel strike angle improved upon feedback to a degree that, on average, was close to the medication effect on parkinsonian gait. Stimulation at random time points showed intermediate values with non-significant improvements in gait parameters compared to control walks. Closed-loop feedback resulted in a less variable gait pattern compared to control walks. Persons with Parkinson's disease rated the feedback mode as subjectively useful. CONCLUSIONS: Our results demonstrate the use of closed-loop feedback can improve parkinsonian gait and suggest such a device could effectively complement the available approaches in the treatment of persons with Parkinson's disease. TRIAL REGISTRATION: This trial was retrospectively registered in the German Clinical Trials Register (DRKS00038516) on 9 December 2025.