Speaker Profile

Executive Summary：
Professor Yasuyuki Okuma is emeritus Professor in the Department of Neurology at Juntendo University Shizuoka Hospital in Japan. He graduated from Juntendo University School of Medicine in 1982 and completed his residency in Neurology at Juntendo University Hospital and affiliated institutes in 1986. He studied neurophysiology under Professor Robert G. Lee at the University of Calgary, Canada, from 1992 to 1994. He has served on the Japanese Society of Neurology Guideline Committee for the treatment of Parkinson’s disease (1st Edition: Chair, Professor Yoshikuni Mizuno) from 2000 to 2002. He has also served as Treasure-Elect of the Asian-Oceanian Section of the International Parkinson and Movement Disorder Society from 2015 to 2017 and its Treasurer from 2017 to 2019.
Professor Okuma’s research interests have been focused on the clinical and neurophysiological aspects of movement disorders, particularly freezing of gait and falls in Parkinson’s disease and related disorders. He received the Alumni Scientific Award of Juntendo University School of Medicine in 2008. Recently, he served as a Dean of Faculty of Health Science and Nursing in Juntendo University from 2017 to 2023, and he received Best Professor Award three times.

Lecture Abstract：
Freezing of gait (FOG) and falls are common and disabling phenomena in Parkinson’s disease (PD) and related disorders as they may lead to loss of independence. The precise evaluation of FOG and falls is necessary for appropriate therapy and prediction/prevention of future falls. The most common evaluation methods include the Freezing of Gait Questionnaire (FOGQ), the New Freezing of Gait Questionnaire (N-FOGQ), Characterized Freezing of Gait Questionnaire (C-FOGQ), and various fall diaries. Objective evaluations in the gait laboratories include floor reaction forces, video capturing, ambulatory gait analysis system with pressure sensitive insoles/mats, and so on. Recently, wearable technology has been developed to detect FOG and falls; the combination of accelerometer and gyroscope was the most frequently used sensors, and the threshold-based algorithm and machine-learning algorism are used. However, there was a significant variability in outcomes measured and results reported. Advantage and limitation of the questionnaire-based and wearable technology-based evaluations will be discussed.

References
1. Okuma Y. Practical approach to freezing of gait in Parkinson’s disease. Pract Neurol 2014;14:222-230
2. Okuma Y, et al. A prospective study of falls in relation to freezing of gait and response fluctuations in Parkinson's disease. Parkinsonism Relat Disord 2018;46:30-35

Executive Summary：
Dr. Cheng-Ya Huang graduated from Department of Physical Therapy, College of Medicine, National Cheng Kung University. She received her PhD training from Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, investigating postural dual-task control and its related cortical mechanisms.
Dr. Huang is now a professor in School and Graduate Institute of Physical Therapy, National Taiwan University and an adjunct Physical Therapist in Physical Therapy Center, National Taiwan University Hospital. In addition, she is also a Distinguished Research Fellow in Industrial Technology Research Institute. Her main academic interests are postural/gait control in older adults and people with Parkinson’s disease. She investigated the association between postural/gait performance and cortical activities by electroencephalogram (EEG) data.

Lecture Abstract：
Dual task is defined as maintaining postural balance and performing another task (suprapostural task) concurrently, which is a common situation in daily life. Appropriate attention allocation is required to achieve task goals and maintain balance safety for dual tasks. Due to impaired motor automaticity and attentional resource, people PD have difficulty in dual tasks. Moreover, PD with freezing of gait (FoG) have high risk of loss balance and fall in dual-task situations than PD without FOG because of greater severities of walking de-automatization and executive dysfunction. With measurements of behavioral performance and cortical activities, we investigated the effects of task-priority (posture-focus vs. supraposture-focus) and attentional-focus (internal-focus vs. external-focus) strategies on dual-task standing and dual-task walking. The major findings about task-priority strategy are 1) supraposture-focus strategy led to better dual-task standing performance and less cortical loading for people with PD, and 2) postural-focus strategy improved dual-task walking performance with filtering out task-irrelevant information. In the aspect of attentional-focus strategy, we found 1) external-focus strategy was a better attentional strategy for dual-task walking in non-freezers, because it could facilitate automatic control, and 2) dual-task walking of freezers benefited from internal-focus strategy due to increased conscious control for walking. Moreover, gait training with internal-focus strategy reduced numbers of FOG and falling for freezers. Since attentional strategies could be easily applied in clinical training and daily activities, it is recommended that people with PD should adopt appropriate attentional strategies according to their walking impairment (with/without FOG) and dual-task situations (dual-task standing/walking) for improving dual-task control and reducing falling risk.

Executive Summary：
Akira Uehara received a PhD degree in Engineering from the University of Tsukuba, Japan, in 2020. He was an interaction designer at Sony Corporation and an adjunct researcher at Sony Computer Science Laboratories, Inc. He is currently an assistant professor of Institute of Systems and Information Engineering, the University of Tsukuba. In this role, he is actively involved in research at the Center for Cybernics Research and R&D Center for Frontiers of MIRAI in Policy and Technology (F-MIRAI), where he focuses on pioneering the interdisciplinary field of cybernics. He focuses on cybernics technologies such as wearable cyborg HAL and cybernics space to facilitate functional improvement and independence living support for patients with neurodegenerative or neuromuscular diseases.

Lecture Abstract：
Cybernics treatment involves the generation of an interactive bio-feedback loop between an individual’s nervous system and the worn cyborg Hybrid Assistive Limb (HAL); this treatment has been applied for several intractable neuromuscular disorders. Thus, it is of interest to determine its potential for Parkinson's disease or parkinsonian patients. This study confirmed the feasibility of using a HAL trunk unit to improve their gait disturbance. HAL establishes functional and physical synchronization with the wearer by providing lateral cyclic forces to the chest in the form of somatosensory and motor cues. To confirm the feasibility of its use for improving the gait disturbances, we conducted experiments with three Parkinson’s disease patients and two patients with progressive supranuclear palsy. During the experiments, the immediate effect of the intervention was assessed; all participants exhibited improvements in gait disturbance while wearing the HAL unit, and this improvement effect persisted without the HAL unit in two participants. Afterward, based on the assessment, we conducted a continuous intervention for one participant. In this intervention, the number of steps in the final experiment was significantly decreased compared with the initial state. These findings suggest that the proposed method is an option for treating Parkinson's disease or parkinsonian patients to generate somatosensory and motor cues.