MJFF Freezing of Gait (FOG) in Parkinson’s Disease Research Program

Support for clinical studies to increase understanding of Freezing of Gait and balance disorders in people with Parkinson’s disease.

Established in 2000, the Michael J Fox Foundation (MJFF) was set up to find a cure for Parkinson’s disease (PD) and ensure the development of improved therapies.

MJFF’s Freezing of Gait (FOG) in Parkinson’s Disease Research Program seeks to support clinical proposals that address FOG and balance disorders on multiple levels. FOG is one of the most debilitating yet difficult to assess gait impairments in Parkinson’s disease. It is defined as ‘brief, episodic absence or marked reduction of forward progression of the feet despite the intention to walk’. FOG reduces quality of life, increases the risk of falls and results in a loss of independence.

The pathophysiology that underlies FOG is not well understood, hence the treatment of FOG remains particularly challenging. Multiple theories have been proposed to explain the underlying mechanisms, with motor, sensory, cognitive and affective impairments all implicated.

Assessment in everyday conditions and the development of criteria for the identification of subtypes of FOG might lead to better understanding of the problem and treatment for it. Although there is some evidence that FOG can be evaluated and measured ecologically, at least to some degree, the multiplicity of triggers and heterogeneity of presentation of this symptom makes its prediction challenging. To this end, MJFF has issued this Request for Applications (RFA) for clinical studies that can address the critical challenges and foster understanding of the pathophysiology and biological correlates of FOG and balance disorders in people with PD, and identify suitable therapeutic approaches.

Funding will support projects that aim to:

• Develop and validate new study designs, measurements and outcome assessments for FOG. Studies may include but are not limited to:
  • Evaluating new methods to assess/predict FOG.
  • Improving/validating objective clinical assessment of FOG.
  • Identification of FOG at home using wearable technology.
  • Assessment of gait or behavioural changes alluding to imminent FOG etc.
• Advance understanding of pathophysiological mechanisms of FOG. Studies may include different imaging techniques or electrophysiology to better understand the mechanisms of FOG, neural involvement and impact. Studies proposing analysis of large available datasets for better understanding and classifying sub-types of FOG will be considered.
• Conduct interventional studies testing therapeutic strategies to alleviate FOG, improve mobility and/or reduce falls. Studies could include neuromodulation, pharmacological or non-pharmacological (including technological) interventions. The approach should be novel and reproducible. Studies exploring intensity and dosing of novel or established techniques will be considered.

When considering proposals submitted to this RFA, MJFF will prioritise those with the strongest potential to advance knowledge of and treatment for FOG. Priority will be given to studies fulfilling the following criteria:

• Multi-centric studies that foster a comprehensive approach or facilitate longitudinal work in function of early detection and prevention.
• Cross-disciplinary teams with collaborators from multiple areas of expertise (eg clinicians, pathologists, experts in imaging, statisticians, epidemiologists etc).
• Funded programmes are willing to share data in a pre-competitive manner, to help progress the field.

Relevant projects include hypothesis-driven clinical projects. All projects should be sufficiently powered, thus proposed studies suitable for funding should have compelling data from human pilot studies.