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Mobility Issues with Parkinson's Disease

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What is Cueing?

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Physiotherapy and cueing in the RESCUE trial

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What is Cueing?

In Parkinson’s disease, a deficit in a specific brain area (basal ganglia) results in disturbed internal cueing of automatic, sequential movements, such as walking. Alternative cueing techniques, which utilise a different pathway in the brain, can improve the quality of movement by providing an alternative means to guide movements.

External cues provide temporal (timing) or spatial (size) stimuli associated with the initiation and ongoing facilitation of motor activity (gait). External cues can be applied in the form of visual, auditory and tactile information that can trigger movements or that can provide rhythmic or spatial support to improve the quality of movements. An example of an accepted method to improve walking ability is auditory rhythmic cueing using a metronome: subjects are asked to synchronise their steps to the rhythm of a sound beat. This technique can improve the quality of walking and it can help in overcoming and preventing so-called freezing, episodes in which patients with Parkinson’s disease report ‘being glued to the ground’.

In the Rescue project, we investigated two further rhythmic cueing modalities besides a metronome to provide rhythmic support during walking-related activities: a flashing light attached to a pair of spectacles and a small vibration-device attached to the wrist. All three modalities were combined in a prototype cueing device, which allowed the delivery of rhythms in a controlled fashion.

Besides a rhythmic beat, flash or vibration, external cueing can also be in the form of spatial prompts, giving a sense of size, e.g. a pattern of repetitive transverse lines on the ground (which has been shown to improve freezing gait in Parkinson patients).

Attentional strategies to facilitate movement are generated in one’s mind, for example counting in one’s head to time, thinking about stepping or paying extra attention to individual sub-movements of a movement sequence. Attentional strategies are distinct from external cues as they have to be self-generated by the patient. However, some overlap with cueing exists as cues may direct an individual to pay attention to the movement.

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Using cueing to improve mobility in Parkinson’s Disease: A CD-Rom for therapists Click here for more details

         

   


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