Research Review: Cueing for people with Parkinson's disease with freezing of gait (FOG)

Auditory and visual cues are common strategies used to help people with PD move better by facilitating more goal-directed type of motor control in the brain. Cues work by activating other parts of the brain (cortical structures) to compensate for the lack of automatic motor processing in the basal ganglia. These types of cues are often used as a strategy to reduce freezing severity in patients with PD.

Freezing, which may happen during walking and other movements such as speech and handwriting, is a motor symptom experienced by many people with Parkinson's disease (PD). Even though it is still unclear how cueing affects activation of specific brain areas in people with different PD motor symptoms, cueing is often used as a rehabilitation intervention for people with FOG.

In general, people with FOG can benefit by learning to shift their attention to their gait by using internal (self-prompting) cues, external (visual or auditory) cues or a combination of these. The main aims of cueing and self-prompting are to: 1) improve gait mechanics in order to prevent FOG and 2) provide a rescue strategy if a freezing episode happens.

A recent research review examined 24 studies looking at the use of external cues for people with PD who experience FOG. The review found that:

• Evidence suggests that training with visual and auditory cues can reduce FOG severity and improve gait mechanics.

• Effects on gait were more powerful with visual than auditory cues in people with FOG and reduced FOG to a greater extent.

• Retention of learning was improved in a group who trained in stepping movements supported by auditory cueing and benefits for FOG were also sustained.

• Action-related auditory cues (i.e., sounds of walking on gravel) were more effective in reducing FOG severity than were traditional sound beats.

• Timing of applying “intelligent” cues through wearable sensors could enhance the anticipation of an event before the actual onset of a potential FOG episode.

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