Advice
The technology
The technology
Path Finder (Walk With Path Ltd.) is a laser shoe attachment designed to prevent freezing of gait in people with Parkinson's disease. The device is mounted on a strap that is attached to each shoe. It works by projecting a green laser line in front of the opposing foot, providing a visual obstacle over which the user should aim to step. By providing a visual cue, the device aims to trigger walking by focusing the attention of the wearer. The lasers are activated by each step and provide continuous cueing while walking. Path Finder operates on a rechargeable battery and the company recommend users charge the unit daily.
Innovations
Path Finder is the only hands-free, visual-cueing device currently available in the UK for people with Parkinson's disease. Agilitas was also identified as a hand-free, visual-cueing aid; however, this device is not yet available in the UK. Alternative visual-cue walking aids exist but all depend on the use of either a cane or walking frame, which are not necessarily needed by all people with Parkinson's disease. The hands-free aspect of Path Finder is designed to reduce complexity for the user by minimising the need for multi-tasking.
Current care pathway
NICE's guideline on Parkinson's disease in adults recommends starting treatment with levodopa, a dopamine agonist or a monoamine oxidase (MAO-B) inhibitor depending on the effect of symptoms on quality of life, as well as the person's individual circumstances, treatment preferences, needs and goals. A dopamine agonist, MAO‑B inhibitor or catechol‑O‑methyl transferase (COMT) inhibitor may be considered as add-on therapy to levodopa when symptoms are not well controlled by levodopa alone. Deep brain stimulation is an option for people with advanced Parkinson's disease whose symptoms are not well enough controlled by best medical therapy. Impaired gait and postural instability are the leading causes of falls and disability in Parkinson's disease. Symptoms can become increasingly problematic as the condition progresses and may not be improved with pharmacological intervention. Non-pharmaceutical interventions such as physiotherapy can help improve function and maintain independence for patients, by correcting and improving posture, balance and general mobility. People with early stages of the disease may also be referred to a physiotherapist for assessment, education and advice about maintaining physical activity. People with Parkinson's disease and impaired gait may choose to use walking aids such as a cane or frame, with or without visual-cue technology.
Population, setting and intended user
Use of Path Finder is intended to reduce freezing of gait episodes and time spent freezing in people with Parkinson's disease. Around 1 in 350 people are affected by Parkinson's disease with an estimated 145,000 people in the UK with the condition (Parkinson's UK, 2018). It is estimated that freezing of gait symptoms may affect around 40% of these people. Path Finder is likely to be used in place of other visual-cue walking aids but with a reduced number of physiotherapy sessions; this will be dependent on the patient's disease stage and individual preferences. The PD-REHAB study (Clarke et al. 2016) states that 4 58-minute physiotherapy and occupational therapy sessions over an 8-week period is reflective of standard NHS practice. The technology will be started by a physiotherapist but may also be recommended by a neurologist. Path Finder is intended to be used by patients at home or in the physiotherapy clinic. It can also be used as a training tool in the clinic for people with early stages of Parkinson's disease.
Costs
Costs of standard care
Alternative treatment options to Path Finder in the UK include other walking aids, such as LaserCane and U-step walker, and physiotherapy sessions. The associated costs for each of these is summarised in table 1.
Table 1 Cost of standard care
|
Description |
Cost |
Additional information |
|
LaserCane |
£225 |
Walking stick with visual-cue technology. |
|
U-step 2 with laser/audio module |
£795 |
Walking frame with visual-cue technology. |
|
Physiotherapy |
Costs of services vary across UK |
After applying a unit cost per contact time, Gumber et al. (2017) estimated the mean annual cost to the NHS as £24.72 per person with Parkinson's disease. |
Resource consequences
If adopted, the technology has the potential to reduce the number of falls caused by freezing of gait among users, resulting in a decrease in associated healthcare costs and resources. The company claim the use of the device may have the potential to help to increase activity levels and reduce the number of physiotherapy sessions in users, as well the number of emergency department visits, all of which would have the potential to contribute to further cost savings. There is no available evidence that supports these claims. According to Gumber et al. (2017), the estimated mean annual cost of ambulance and emergency department services is £95.37 per patient with Parkinson's disease. No changes in facilities or infrastructure will be needed to adopt the technology, and a small amount of basic training on how to use the device would be needed. Training is provided by the company or their distributor free of charge in the form of visits, demonstrations and online video content. The technology is not yet widely used in the NHS but is available in 2 private physiotherapy clinics, as well as for small-scale testing by neurologists at 1 UK NHS centre.