A Wearable Neuromonitoring Platform to Map Motor and Neural Biomarkers of Gait Dysfunction in People with Parkinson’s Disease across Daily Life

A majority of individuals with advanced Parkinson’s disease develop severe gait and balance deficits that significantly restrict mobility, independence, and quality of life. Despite impressive technological advances, gait impairments remain poorly understood and notoriously hard to treat. Most attempts to characterize gait deficits or to identify neural biomarkers of gait dysfunction have been confined to well-controlled, sophisticated laboratory settings. However, such environments fail to capture many critical contextual factors that exacerbate gait deficits in real-world conditions, such as stress, fatigue, or unexpected distractions and environmental constraints. Replicating these unpredictable conditions in laboratory settings remains a significant challenge. To address this, we developed a wearable neuromonitoring platform integrating (i) smart, sensorized shoes with embedded microchips running A.I. algorithms for online gait quality assessment, along with (ii) wireless recordings of local field potentials from chronically implanted electrodes for deep brain stimulation. This platform enables continuous monitoring of motor and neural biomarkers of gait function and dysfunction across activities of daily life. 13 participants with advanced Parkinson’s disease were monitored during a comprehensive set of out-of-laboratory locomotor tasks, both in the ON and OFF medication conditions. Our platform allowed to assess gait quality, quantify modulations in response to medication, fatigue, and context-specific demands, and to map the underlying neural correlates. This neuromonitoring platform offers valuable possibilities for refining neuromodulation protocols and supporting closed-loop therapies for gait impairments in real-life conditions.