Effects of External Cueing on Gait Parameters in Parkinson’s Disease Patients

Purpose: This case study and evidence-based analysis aims to identify the effects of temporal and spatial cueing such as Rhythmic Auditory Stimulation (RAS) or Visual Cuing (VC) on gait parameters in individuals diagnosed with Parkinson’s disease. Background: External temporal and spatial cueing is frequently used as an adjunct method in gait training intervention and has clinically proven to facilitate normal gait patterns; thereby decreasing pathological gait characteristics such as variable stride length, frequency, decreased gait velocity and freezing episodes seen in a Parkinsonian gait. However, positive observational results in the clinical setting have limited quantitative validation. Current research is exploring the relationship between gait speed, cadence and the ability to maintain a larger stride length with the influence of external cueing and subsequently the effect on quality of life. Past research on RAS and VC needs to be reanalyzed and higher quality research designs need to be developed to determine optimal training parameters to provide greatest carryover to patients in everyday motor planning. Case Description: The individual selected for this case study and analysis is a 75-year-old male, with a Stage 2.5 Parkinson’s disease diagnosis, using the Hoehn and Yahr Scale. Pt. demonstrates mild bilateral involvement with recovery on the pull test and pathologic gait changes. Patient’s interest in non-invasive treatment options inspired evidence based analysis using the following PICO question: In individuals with a Parkinson’s disease diagnosis, what is the effect of conventional gait training intervention with external cueing on gait parameters, compared to conventional gait training intervention without external cuing? Effects of External Cuing on Gait Parameters in Parkinson’s Disease Patients 3 Outcomes: A review of the current literature revealed that the use of external cueing as an adjunct intervention to gait and functional mobility training can have immediate positive effects on multiple gait parameters including velocity, cadence, step/stride variability and frequency of freezing episodes. Discussion: The overall quality of the current research is sufficient to address the PICO question. Further studies should be performed to develop duration and intensity criteria as well as the most appropriate training period so the benefits obtained through the use of cues in individuals with PD would be extended for as long as possible and have the greatest effects on quality of life and functional mobility tasks.Ron Andrews, PT, Ph.