Predicting Freezing of Gait in Parkinson’s Disease: A Machine-Learning-Based Approach in ON and OFF Medication States

Background: Freezing of gait (FoG) is a debilitating motor symptom of Parkinson’s disease (PD), characterized by sudden episodes where patients struggle to initiate or sustain movement, often describing a sensation of their feet being “glued to the ground.” This study investigates the potential of machine-learning (ML) models to predict FoG severity in PD patients, focusing on the influence of dopaminergic medication by comparing gait parameters in ON and OFF medication states. Methods: Specifically, this study employed spatiotemporal gait features to develop a predictive model for FoG severity, leveraging a random forest regressor to identify the most influential gait parameters associated with this in each medication state. The results indicate that the model achieved higher predictive performance in the OFF-medication condition (R² = 0.82, MAE = 2.25, MSE = 15.23) compared to the ON-medication condition (R² = 0.52, MAE = 4.16, MSE = 42.00). Results: These findings suggest that dopaminergic treatment alters gait dynamics, potentially reducing the reliability of FoG predictions when patients are medicated. Feature importance analysis revealed distinct gait characteristics associated with FoG severity across medication states. In the OFF condition, step length parameters, particularly left step length mean, were the most dominant predictors, alongside swing time and stride width, indicating the role of spatial and temporal gait control in FoG severity without medication. In contrast, under the ON medication condition, stride width and gait speed emerged as the most influential predictors, followed by stepping frequency, reflecting how medication influences stability and movement rhythm. Conclusions: These findings highlight the need for predictive models that account for medication-induced gait variability, ensuring more reliable FoG detection. By integrating spatiotemporal gait analysis and ML-based prediction, this study contributes to the development of personalized intervention strategies for PD patients experiencing FoG episodes.