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Information Sheets on Cueing for People with Parkinson's Disease

Background information on Cueing

Distractions can make it difficulty to concentrate on walking and distract your attention. When this happens your steps may become smaller, your walking slower and you may find you begin to shuffle or freeze on the spot. People find this can occur whilst turning around, moving in tight spaces, through doorways or in crowded environments. Cues can be used to help you focus your attention on walking so that it is easier to keep your feet moving while you walk around your home and community. Cues allow you to use other areas of the brain that are not affected by Parkinson’s disease, making movement faster and easier for short periods of time. Cues are used to give information about the number of steps taken while you walk and the size of your steps. Different types of cue can be used to provide this information.

Visual cues such as lines on the ground that a person steps over can be helpful where someone has difficulty with freezing, such as in a doorway at home. Putting a piece of tape across the doorway and stepping over it can be useful. It helps to focus attention on stepping and enables you to keep your feet moving. Other examples of visual cues can be lines or patterns on the carpet that you step your feet on or over, or stepping on the cracks between tiles or paving stones. This helps to keep the size of your steps regular and to focus attention on the quality of your walking.

Rhythmical cues such as tones given at a steady beat are also useful. These can be given with a metronome or alternatively by using music with the appropriate rhythm to step in time to. The rhythm should be set to a comfortable pace that you try to step each foot in time to. As you hear the beat you should think about stepping your feet in time to it. You can also try to associate taking a big step in time to the beat, try saying this in your head to begin with and with practise this will become easier. Do not try to set the rhythm to high, start with it slower and see how your walking changes. You are aiming to take larger steps and practise at different speeds that are suited to the different surroundings. For example you will walk at a slower pace in your house compared to in an open space outside.

Attentional strategies can also be useful. This is where you rehearse movements in your mind (such as taking big steps) or count a rhythm in your head that you try to step in time to. As you walk you try to focus your attention on those aspects of your walking that are difficult. For example, people report that they focus on putting their heels down firmly on the ground. It may be more difficult to use attentional strategies and keep concentrating without an external cue or reminder present.

Some more specific examples are given in the information sheets in relation to individual problems experienced by people.

No. 1 - Why walking becomes difficult in Parkinson's Disease
No. 2 - What are cues and why can cues help?
No. 3 - I walk more slowly now
No. 4 - I tend to shuffle
No. 5 - My feet stick to the ground (I freeze)
No. 6 - The first step is the most difficult
No. 7 - I'm alright in a straight line but changing direction is difficult

No. 8 - I get stuck in the chair
No. 9 - I can feel myself stooping
No. 10 - I feel as if I am going to fall
No. 11 - My walking is fine as long as no one talks to me
No. 12 - I can't walk as far or as fast as I did
No. 13 - I feel stiff generally
No. 14 - Carers can cue too
No. 15 - Involuntary movements (dyskinesia) affect my walking

Disclaimer: The RESCUE project cannot be held responsible for any of the information contained in the above Information Sheets. Therefore, if you are in doubt, please contact your doctor for further advice.

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