Article

Effects of external rhythmical cueing on gait in patients with Parkinson's disease: A systematic review

Department of Physiotherapy, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Clinical Rehabilitation (Impact Factor: 2.24). 11/2005; 19(7):695-713. DOI: 10.1191/0269215505cr906oa
Source: PubMed

ABSTRACT To critically review studies evaluating the effects of external rhythmical cueing on gait in patients with Parkinson's disease.
Articles published from 1966 to January 2005 were searched by two physiotherapists in MEDLINE, PiCarta, PEDRo, Cochrane, DocOnline, CINAHL and SUMSEARCH. To be included, articles had to investigate the effects of external rhythmical cueing (i.e., auditory, visual or tactile cueing) on gait parameters in patients with idiopathic Parkinson's disease. Both controlled and noncontrolled studies were included. Based on the type of design and methodological quality a meta-analysis or best-evidence synthesis was applied.
Twenty-four studies (total number of patients = 626) out of the 159 screened studies were evaluated in this systematic review. Two out of 24 were randomized controlled trails (RCT), both of high methodological quality. One RCT did not focus specifically on external rhythmical cueing of individual patients with Parkinson's disease, but on group exercises in general, including walking with cues. All other studies were pre-experimental studies. Best-evidence synthesis showed strong evidence for improving walking speed with the help of auditory cues. Insufficient evidence was found for the effectiveness of visual and somatosensory cueing.
Only one high-quality study, specifically focused on the effects of auditory rhythmical cueing, suggesting that the walking speed of patients with Parkinson's disease can be positively influenced. However, it is unclear whether positive effects identified in the laboratory can be generalized to improved activities of daily living (ADLs) and reduced frequency of falls in the community. In addition, the sustainability of a cueing training programme remains uncertain.

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    • "Cueing appears to ameliorate deficient internal regulation of movement timing, not movement amplitude, by regulating step rate (Morris et al., 1994b). However, as the primary reason for slowed gait in PD is from shortened step length (smaller movement amplitude), not from slower step rate (Morris et al., 1994b), step length does not consistently increase after auditory cueing (Lim et al., 2005). Furthermore, the effect sizes of auditory cueing are not large and benefits tend not to persist over time (Nieuwboer et al., 2007). "
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    • "In a different scenario, human adults have been shown to use a different walking strategy under the guidance of music than under a metronome beat (Styns et al. 2007; Wittwer et al. 2013). A number of studies have revealed that musical rhythm can even enhance motor performance in Parkinson's disease (PD) (Thaut and Abiru 2010; Satoh and Kuzuhara 2008; Lim et al. 2005). Moreover, using a finger-tapping paradigm, it has been shown that synchronization error was significantly less when tapping with music cues than metronome ones (Thaut 1997). "
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