Co-Design of a Mixed Reality Application to Support Freezing of Gait Rehabilitation

Freezing of Gait (FoG) is a common motor impairment in Parkinson's disease, affecting mobility and increasing fall risk. Traditional rehabilitation methods using physical therapy and, visual or auditory, cueing have demonstrated benefits but can be limited in adaptability and accessibility. Recent advancements in Mixed Reality (MR) provide new opportunities for rehabilitation. MR preserves spatial awareness by integrating digital elements into the real world while offering real-time adaptability in therapeutic settings. This study presents a co-designed MR rehabilitation platform with training exercises for FoG therapy. The system comprises an Oculus Quest 3 application and a Companion tablet app for real-time exercise personalization and cue activation. Nine medical professionals were involved in the whole process and two patients with Parkinson's disease were involved in refining the platform. Three iterative workshops led to key refinements enhancing usability. Initial sessions defined core FoG rehabilitation needs addressed with two exercises: obstacle avoidance and corridor crossing, and through the design of visual and auditory cues to help patients in training. Usability improvements included a Companion tablet app for real-time exercise customization, refined and personalized cueing. These updates reduced discomfort and enhanced adaptability in rehabilitation. This study highlights the potential of MR for FoG rehabilitation and presents a system that supports real-time adaptive cueing. Future research should explore a wider usability study, and the implementation of additional cueing techniques to address diverse patient needs across different stages of FoG.