Does Auditory Rhythmical Cueing Improve Gait in People with Parkinson's Disease and Cognitive Impairment? A Feasibility Study

Gait and balance problems resulting from Parkinson's disease (PD) are more common in people with PD and dementia (PDD), yet, it is unknown whether the benefits of cueing therapy for mobility generalize to them. We aimed to determine the feasibility and effectiveness of auditory cues to improve gait in PD and cognitive impairment (PD-CI). Nine participants with PD-CI walked with and without auditory cues using two different strategies: (1) Cue with temporal instruction to step in time to the beat, (2) Cue with spatio-temporal instruction to take a big step in time to the beat. Cues were delivered with a metronome at preferred stepping frequency while on medication during single and dual-task gait. Gait was assessed using GAITRite and walking speed, stride amplitude, step frequency, and variability (CV%) of step and double limb support time were measured. Data were analyzed in SPSS version 16 using fixed-effect linear mixed models. An adjusted, P value of 0.01 was considered significant. Participants were men, aged 74.89 (6.45) years with median MMSE of 22 (range 20.5-25) and UPDRS III score of 44 (35.5-47.0). Participants complied with testing and instructions. The cue that focused attention on both temporal and spatial parameters of gait significantly improved single and dual-task walking speed and stride amplitude. This study provides evidence for the potential of cueing to improve gait in PD-CI. Only individuals with mild Cl were included, and the effect with increased CI and different types of dementia requires further evaluation. (C) 2009 Movement Disorder Society