Effects of Internal and External Cues on Brain Activity and Gait in Parkinson's Disease: Findings From BARC-PD.
Rodrigo Vitorio, Rosie Morris, Lisa Graham and 5 others
PMID 40652355WHAT IT FOUND
Internal and visual cues improved gait speed and stride length more than auditory or tactile cues.
Disease stage did not change who benefited, contradicting guidelines that reserve internal cues for early Parkinson's. The brain's response varied by cue type, suggesting different mechanisms for each strategy.
Key findings
01Internal and visual cueing produced large effect sizes for gait speed and stride length, whereas auditory and tactile cueing produced smaller effects.
02Disease severity (Hoehn and Yahr stage) did not influence the immediate gait response to any cueing strategy.
03Internal cues increased prefrontal brain activity, while external cues increased sensorimotor activity, indicating different neural mechanisms for each type.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Participants and assessors could not be blinded to the cueing conditions, which may introduce bias in subjective reporting or performance. The study measured immediate responses to a single exposure; results cannot be generalized to long-term adaptation or sustained benefits of cueing. Hoehn and Yahr staging is a broad classification; more granular measures of disease progression might reveal subtle stage-specific effects. Two participants dropped out due to fatigue, and their data were treated as missing, which could affect the robustness of the results for those specific conditions.
Declared interests
The study was supported by non-U.S. government funding. No specific commercial conflicts of interest were declared in the text provided.
The easy way to misread this
Do not assume that internal cues are ineffective for patients with balance issues (H&Y III). The study found no difference in gait response across stages, suggesting internal cues remain a viable option for mid-to-late stage Parkinson's, contrary to some existing guidelines.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →