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Dr. Okun

Post of the Week: Be Careful with some cueing strategies in Parkinson's disease

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Dear forum members,

 

We thought this month's what's hot blog had some important practical information.

 

Watch out for Unexpected Obstacles if You Use a Cueing Strategy to Break Freezing of Gait in Parkinson’s Disease (this month's what's hot in PD column on the main NPF website)

 

Freezing, where one or both legs become literally stuck to the floor, can often result in falls. This makes the treatment of freezing a critical part of managing Parkinson’s disease. One of the most mysterious and scientifically elusive features of Parkinson’s has been the ability to break freezing episodes with what has been referred to as “cueing”. You may have witnessed this phenomenon in the 1990 movie Awakenings, featuring Robin Williams. The movie showed several cueing strategies, including a checkerboard floor. Cueing has long been used as a common and very simple strategy to improve walking and build on exercise regimens in Parkinson’s disease.

In this month’s issue of the journal Movement Disorders, Dr. Bastiaan Bloem and colleagues from the National Parkinson Foundation Center of Excellence in the Netherlands, examine the price of providing an auditory cue during walking for Parkinson’s disease sufferers by using a metronome that was set to a preferred pace for each patient. Patient heel strikes on a treadmill had to be synchronized to the sound generated by the metronome. Investigators, as a planned part of the study, would unexpectedly drop an obstacle onto the treadmill, and then observe if patients could successfully avoid it by using their most affected leg (one side of the body is usually more affected in Parkinson’s disease).

The study found that the metronome as a cueing strategy improved walking and most patients were able to avoid the obstacles. However, an important result of this study was that patients with known freezing problems were found to be less efficient at avoiding obstacles while using the metronome. This study will provide invaluable information to health care professionals asked to prescribe strategies to overcome walking and/or freezing problems in their Parkinson’s disease patients. Doctors and therapists will now need to be mindful that if their patients are freezing, a cueing strategy may potentially lead to falling, as a normal daily environment occasionally will include unexpected obstacles.

 

Selected Reference

Nanhoe-Mahabier W, Delval A, Snijders AH, Weerdesteyn V, Overeem S, Bloem BR. The possible price of auditory cueing: Influence on obstacle avoidance in Parkinson's disease. Mov Disord. 2012 Feb 16.doi:10.1002/mds.24935.

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