title: Effect of three cueing devices for people with Parkinson's disease with gait initiation difficulties.
abstract: BACKGROUND
  Freezing of gait (FOG) remains one of the most common debilitating aspects of Parkinson's disease and has been linked to injuries, falls and reduced quality of life. Although commercially available portable cueing devices exist claiming to assist with overcoming freezing; their immediate effectiveness in overcoming gait initiation failure is currently unknown. This study investigated the effects of three different types of cueing device in people with Parkinson's disease who experience freezing.
  
  
  METHODS
  Twenty participants with idiopathic Parkinson's disease who experienced freezing during gait but who were able to walk short distances indoors independently were recruited. At least three attempts at gait initiation were recorded using a 10 camera Qualisys motion analysis system and four force platforms. Test conditions were; Laser Cane, sound metronome, vibrating metronome, walking stick and no intervention.
  
  
  RESULTS
  During testing 12 of the 20 participants had freezing episodes, from these participants 100 freezing and 91 non-freezing trials were recorded. Clear differences in the movement patterns were seen between freezing and non-freezing episodes. The Laser Cane was most effective cueing device at improving the forwards/backwards and side to side movement and had the least number of freezing episodes. The walking stick also showed significant improvements compared to the other conditions. The vibration metronome appeared to disrupt movement compared to the sound metronome at the same beat frequency.
  
  
  CONCLUSIONS
  This study identified differences in the movement patterns between freezing episodes and non-freezing episodes, and identified immediate improvements during gait initiation when using the Laser Cane over the other interventions.
authors.affiliation: Allied Health Research Unit, University of Central Lancashire, Preston, UK.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: McCandless
authors.affiliation: Allied Health Research Unit, University of Central Lancashire, Preston, UK.
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Evans
authors.affiliation: Allied Health Research Unit, University of Central Lancashire, Preston, UK. Electronic address: jjanssen@uclan.ac.uk.
authors.forename: Jessie
authors.initials: J
authors.lastname: Janssen
authors.affiliation: Allied Health Research Unit, University of Central Lancashire, Preston, UK.
authors.forename: James
authors.initials: J
authors.lastname: Selfe
authors.affiliation: School of Education and Social Science, University of Central Lancashire, Preston, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Churchill
authors.affiliation: Allied Health Research Unit, University of Central Lancashire, Preston, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Richards
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003463:Cues; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology*; D011897:Random Allocation; D012656:Self-Help Devices
keywords: Assistive devices; Cueing devices; Freezing of gait; Gait initiation; Parkinson's disease