Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial

Abstract

Objectives: Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity. Methods: A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. Results: Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p,0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up. Conclusions: Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease.

At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease

“…This is the first study examining the effects of a virtual (or augmented) reality device for at-home use aimed at improving gait in patients with PD. A prior randomized crossover trial of an external cue training program provided at home by physiotherapists demonstrated small but significant improvements in the Posture and Gait Scale score, a composite of related UPDRS items (13-15 and 29-30) [7]. While that study was the first controlled trial that used a cueing device at home, it relied on an open-loop system with cueing parameters that needed separate adjustments to increase stride length and avoid festination and a training program led by a rehabilitation specialist.…”

“…Examples are fixed-velocity visual cues [5] or rhythmic auditory cues [6]. While open-loop stimulation may offer some benefit to some patients [3,7], such cues were found to cause confusion and exacerbate freezing of gait in others [3]. Indeed, it is well known that the stabilization of open-loop dynamic systems, which are inherently unstable, can only be achieved by feedback, that is closed-loop, systems [8].…”

Possibilities of non-drug treatment for Parkinson’s disease

“…[31]. Сходные данные получены в результате исследования эффективности ау-дио-и визуальной стимуляции [32].…”

Referral to rehabilitation in Parkinson's disease: who, when and to what end?

“…Ideally, there should be a balance between efficacy, safety and usefulness of a given intervention in order to be considered clinically useful and recommend for referral. However, regarding safety it has only been reported concerns on potential adverse effects of cueing-based gait training but it was shown not to increase the risk of falling 20 . Similarly, there has also been concerns of the possible adverse effects of nutritional supplements and its influence on antiparkinsonian medication 3 .…”