Cueing
Cueing refers to "the use of temporal or spatial stimulus to regulate movement" (Spaulding et al., 2013, p. 563). It can be used as a significant component of rehabilitation for individuals with Parkinson's Disease and resulting gait impairment. Auditory cueing and visual cueing can be used to match an individual's gait to an external stimulus to alter the characteristics of their gait including stride length, cadence, velocity, and postural stability (Spaulding et al., 2013).
It is common for stride length to be consistently reduced in individuals with Parkinson's Disease. Reduced stride length can contribute to postural instability and increased fall risk (Spaulding et al., 2013). Cadence is the temporal aspect of an individual's gait, specifically the number of steps taken per minute. As Parkinson's Disease progresses, it is common for steps to become shorter and more rapid, demonstrating reduced stride length and increased cadence (Spaulding et al., 2013). Decreased velocity, or slowed gait, is a well-established symptom of Parkinson's Disease. Increased velocity can enhance mobility, increase independence and improve quality of life by enabling participation in valued daily activities (Spaulding et al., 2013).
It is common for stride length to be consistently reduced in individuals with Parkinson's Disease. Reduced stride length can contribute to postural instability and increased fall risk (Spaulding et al., 2013). Cadence is the temporal aspect of an individual's gait, specifically the number of steps taken per minute. As Parkinson's Disease progresses, it is common for steps to become shorter and more rapid, demonstrating reduced stride length and increased cadence (Spaulding et al., 2013). Decreased velocity, or slowed gait, is a well-established symptom of Parkinson's Disease. Increased velocity can enhance mobility, increase independence and improve quality of life by enabling participation in valued daily activities (Spaulding et al., 2013).
Auditory cueing includes the use of a rhythmic auditory stimulus such as music, counting, or a metronome beat. For example, the beat of a metronome may be matched to the cadence of an individual with Parkinson's and reduced to reach an optimal walking pace (Spaulding et al., 2013). The specific mechanism of auditory cueing remains unknown; however, it is hypothesized that auditory cueing may compensate for a degenerated sense of rhythm in the basal ganglia of the brain (Spaulding et al., 2013). In a meta-analysis conducted by Spaulding et al. in 2013, it was concluded that auditory cueing was effective in improving cadence, velocity, and stride length in individuals with Parkinson's Disease. Many auditory cueing strategies were used within the research studies identified and no single stimulus was found to be superior in enhancing gait characteristics (Spaulding et al., 2013). Auditory cueing should be considered as a component of occupational therapy intervention to improve gait quality and client safety.
Visual cueing can include the use of laser pointers, adaptive glasses, or lines placed on the surface of the floor. For example, a therapist may mark lines perpendicularly along a straight path at intervals which match a normal stride length. The specific mechanism of visual cueing to improve gait remains unclear; however, it is hypothesized that marked lines may focus attention on the process of stepping in individuals with Parkinson's Disease (Spaulding et al., 2013). In a meta-analysis conducted by Spaulding et al. in 2013, it was concluded that visual cueing was effective at significantly improving stride length in individuals with Parkinson's Disease. Therefore, visual cueing or auditory cueing may be beneficial components of occupational therapy intervention to increase stride length and decrease fall risk in individuals with gait impairment (Spaulding et al., 2013).