title: Effects of external rhythmical cueing on gait in patients with Parkinson's disease: a systematic review.
abstract: OBJECTIVE
  To critically review studies evaluating the effects of external rhythmical cueing on gait in patients with Parkinson's disease.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physiotherapy, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. i.lim@vumc.nl
authors.forename: I
authors.initials: I
authors.lastname: Lim
authors.forename: E
authors.initials: E
authors.lastname: van Wegen
authors.forename: C
authors.initials: C
authors.lastname: de Goede
authors.forename: M
authors.initials: M
authors.lastname: Deutekom
authors.forename: A
authors.initials: A
authors.lastname: Nieuwboer
authors.forename: A
authors.initials: A
authors.lastname: Willems
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: L
authors.initials: L
authors.lastname: Rochester
authors.forename: G
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000161:Acoustic Stimulation; D003463:Cues; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000534:rehabilitation*; D010775:Photic Stimulation; D014110:Touch