Development and Implementation of The Frog-In-Maze Game to Study Upper limb Movement in People with Parkinson’s Disease

Abstract Background Upper-limb bradykinesia occurs early in Parkinson’s disease (PD) and is required for diagnosis. Methods to quantify upper-limb bradykinesia in salient movement tasks could help remotely monitor PD progression. Objectives To develop, implement and validate a game “walking” a frog through a maze using bimanual, alternating finger-tapping movements. Methods Twenty-five people with PD and 16 non-PD participants played a frog-in-maze game we developed. Responses on 5 different mazes were quantified and compared to spatiotemporal gait parameters and standard disease metrics in these participants. Results Intertap interval on maze 2, which included turns, was related to stride length and stride velocity as well as motor UPDRS scores. Levodopa decreased intertap interval in PD participants on maze 2. Participants with freezing of gait had longer inter-tap intervals on maze 2. Conclusion The responses quantified on maze 2 were related to disease severity and gait stride-length, were levodopa responsive, and were worse in people with freezing of gait, suggesting that this maze could be used to quantify motor dysfunction in PD. Further development of our frog-in-maze game onto a remotely distributable platform could provide a tool to monitor disease progression and therapeutic response in people with PD, including during clinical trials.