Adding cueing to walking training is expected to make walking training more effective. What is the theory behind this?

External cueing helps to initiate or maintain walking by synchronising motor responses into coupled relationships; this is intended to compensate for the loss of dopaminergic neurons that occurs in Parkinson’s disease.

External stimuli cues patients to take steps, which may lead to immediate and long-term changes in their walking parameters.

What types of cueing did you consider in the review?

We planned to examine the effects of auditory, somatosensory and visual cueing.

However, we were unable to find trials that utilised somatosensory cues; therefore, only studies that employed auditory and visual cueing were used.

What effects did auditory cueing have?

The addition of auditory cueing during walking training improved walking speed by 0.09 m/s (95% CI 0.02 to 0.15) more than walking training alone.

The best estimate was that auditory cueing may also improve stride length by 5 centimetres, but this estimate was imprecise (95% CI –2 to 11).

Associate Professor Lucas Rodrigues Nascimento

What about the other forms of cueing?

Only two trials examined the effects of visual cueing, which produced imprecise estimates on walking speed (MD 0.05 m/s; 95% CI –0.19 to 0.08) and stride length (MD –2 cm; 95% CI –13 to 9).

Unfortunately, no trials examined the effects of somatosensory cueing.

What do you think research in this field of research should address next?

Future trials should employ larger sample sizes.

It is also important that individuals with severe symptoms of Parkinson’s disease are included.

In addition, trials using wearable technology, such as wearable sensors or lasers, could be designed to examine and measure the effects of somatosensory and visual cueing.

>> Lucas Rodrigues Nascimento is a physiotherapist, researcher and associate professor at the Center of Health Sciences, Universidade Federal do Espírito Santo, Brazil. Lucas has a PhD in rehabilitation sciences from the University of Sydney in Australia and Universidade Federal de Minas Gerais in Brazil. His key research interests are neuroscience and neurological rehabilitation.

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