Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Abstract

Progressive gait dysfunction is one of the primary motor symptoms in people with Parkinson's disease (PD). It is generally expressed as reduced step length and gait speed and as increased variability in step time and step length. People with PD also exhibit stooped posture which disrupts gait and impedes social interaction. The gait and posture impairments are usually resistant to the pharmacological treatment, worsen as the disease progresses, increase the likelihood of falls, and result in higher rates of hospitalization and mortality. These impairments may be caused by perceptual deficiencies (poor spatial awareness and loss of temporal rhythmicity) due to the disruptions in processing intrinsic information related to movement initiation and execution which can result in misperceptions of the actual effort required to perform a desired movement and maintain a stable posture. Consequently, people with PD often depend on external cues during execution of motor tasks. Numerous studies involving open-loop cues have shown improvements in gait and freezing of gait (FoG) in people with PD. However, the benefits of cueing may be limited, since cues are provided in a consistent/rhythmic manner irrespective of how well a person follows them. This limitation can be addressed by providing feedback in real-time to the user about performance (closed-loop cueing) which may help to improve movement patterns. Some studies that used closed-loop cueing observed improvements in gait and posture in PD, but the treadmill-based setup in a laboratory would not be accessible outside of a research setting, and the skills learned may not readily and completely transfer to overground locomotion in the community. Technologies suitable for cueing outside of laboratory environments could facilitate movement practice during daily activities at home or in the community and could strongly reinforce movement patterns and improve clinical outcomes. This narrative review presents an overview of cueing paradigms that have been utilized to improve gait and posture in people with PD and recommends development of closed-loop wearable systems that can be used at home or in the community to improve gait and posture in PD.

The Relationship Between Ankle Proprioception and Functional Mobility in People With Parkinson's Disease: A Cross-Sectional Study

“…In clinical practice, auditory and visual cues have been recommended as an effective intervention for people with PD to improve their gait ( 39 ). Rhythmic auditory cueing is used to improve the temporal parameters of gait, and the spatial parameters of gait are enhanced by accessing visual cues ( 40 ). It is possible that auditory and visual cues are beneficial for the sensory integration process in the CNS ( 41 ), and thus, external auditory and visual cues may improve the sensory input and compensate for other proprioceptive impairments in people with PD ( 42 , 43 ).…”

Functional MRI Reveals Locomotion-Control Neural Circuits in Human Brainstem

“…Brainstem networks are pivotal in motor/sensory functions including the gait control [ 37 , 38 ]. Clarification on the role of brainstem regions in locomotion control can facilitate developing therapeutic interventions targeting CN and PPN or related neural circuits to improve gait control in the elderly with risks of dementia and falls or in patients with a damaged gait such as those suffering from Parkinson’s disease [ 3 ] and stroke [ 4 ].…”

“…Locomotion is a fundamental ability in humans. Gait performance is related to the risk of dementia [ 1 ] and falls in the elderly [ 2 ] that lead to heavy burdens, and can be damaged by critical brain illnesses such as Parkinson’s disease [ 3 ] and stroke [ 4 ]. In the mesencephalic locomotor region (MLR) of vertebrates, the cuneiform nucleus (CN) supports defensive forms of locomotion, such as high-speed running to escape from dangerous contexts, whereas the pedunculopontine nucleus (PPN) may mediate slow, exploratory locomotion [ 5 , 6 ].…”

Wearables als unterstützendes Tool für den Paradigmenwechsel in der Versorgung von Parkinson Patienten

“…Sturchio et al zeigten, dass ein diastolischer Blutdruck < 75 mm Hg bei PwPD mit einer vermehrten Sturzneigung assoziiert ist [25] Silva De Lima bestätigte das in ihrer Studie allerdings nicht [30]. [31]. Daran wird in dem Feld der tiefen Hirnstimulation intensiv gearbeitet.…”