Effect of Cue Timing and Modality on Gait Initiation in Parkinson Disease With Freezing of Gait.
Chiahao Lu, Sommer L Amundsen Huffmaster, Paul J Tuite and 2 others
PMID 28167093WHAT IT FOUND
External cues, especially predictable sound or light cues, improved preparatory weight shifts before stepping and reduced missing preparatory movements in people with Parkinson disease with or without freezing.
Ankle vibration cues helped less and were unreliable.
Key findings
01Incomplete preparatory movement sequences occurred in 16% of self-initiated trials and 1% of all cued trials.
02Acoustic and visual cues increased loading and unloading force amplitudes by an average of 60%, and increased centre of pressure excursions by 52%; vibrotactile cues increased them by 40% and 31%.
03All cueing modalities improved a late forward propulsion measure in participants without freezing, but not in participants with freezing.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 20 of 25 participants had complete data sets. Four participants could not reliably detect the vibrotactile stimulus, and one participant did not complete the visual and vibrotactile conditions due to fatigue. Participants were tested after at least 12 hours off antiparkinson medication. The study tested acute laboratory gait initiation, not long-term use or other environments. The reported outcomes were timing, size, and completeness of preparatory weight shifts measured on force platforms. Groups were small, with 11 participants with freezing and 14 without. People with a tremor score greater than 2, significant vision or hearing loss, lower limb neuropathy, dementia, or a Montreal Cognitive Assessment score below 24 were excluded.
Declared interests
The supplied metadata lists NIH extramural and non-U.S. government research support. No author conflict of interest declaration is included in the supplied text.
The easy way to misread this
Do not read the cueing benefits as proven long-term improvement in everyday freezing. The study measured acute laboratory preparatory weight shifts, and four participants could not reliably detect the vibrotactile stimulus.