Cueing effects in Parkinson’s disease: benefits and drawbacks
Prof Alice NIEUWBOERa
a KU Leuven - Leuven University
Gait and balance impairments are considered a priority area for research in Parkinson’s disease (PD) as these problems are not well-controlled by levodopa. Many studies demonstrated that providing additional sensory information to motor training can improve gait and balance in PD.The extraordinary sensitivity for sensory-motor input can be attributed to the automaticity deficit as a result of basal ganglia dysfunction in PD. Hence, movement guidance by sensory cues, music or augmented feedback has been used to promote a goal-oriented mode of motor control.Cueing is defined as temporal or spatial stimuli, which facilitate repetitive movement usually provided as visual, tactile or auditory rhythmic signals. Several systematic reviews have shown the cueing has an immediate and sustained effect on gait and reduces the severity of freezing of gait. However, not all patients respond well to cueing and this may be why studies showed heterogeneity. Several factors may explain this lack of response, of which cognitive overload and inflexibility and lack of perceptual rhythmicity are the most important. In almost all studies, cueing was delivered in a one-size fits all fashion without being adjusted to walking performance. Therefore, we conducted astudy as part of the CuPiD project (FP7 EU-funded) to investigate if intelligent cueing was more effective than a conventional gait training program. The CuPiD system was developed especially for PD and comprised of sensor-technology embedded in a smartphone, allowing online cueing and feedback when patients’ gait deviated from their reference walk. Forty PD patients participated in a six-week training program in which they walked three times for 30 minutes per week outside their home. Participants were randomly assigned to i) CuPiD, or ii) control, who received personalized advice from a physiotherapist and trained without cues. Interestingly, the CuPiD group trained significantly less than the control group, but made nevertheless significantly more progress on balance. Both groups improved on single and dual task gait speed. These results point to the difficulty of delivering cueing in a clinically meaningful fashion and that more study is needed to understand this complex intervention.