The parts of the brain most affected by Huntington’s disease (HD), the basal ganglia, are groups of neurons at the base of the brain. Basal ganglia are responsible for the motor movements of the muscles in the body. When cells in basal ganglia die, a common pathological symptom of HD, patients experience uncontrollable muscular movements. Another neurodegenerative disorder that produces similar abnormal movement is Parkinson’s disease, due to the disease’s effects on a specific area of the basal ganglia called the substantia nigra. Parkinson’s disease is a neurodegenerative disorder that results in characteristic motor abnormalities including postural instability and gait impairment. It consists of short shuffling steps, decreased walking speed, increased cadence, and gait freezing.
Current research is attempting to develop visual, auditory or somatosensory cues, or signals, to improve gait of Parkinson’s disease patients. Cueing device is defined as a device that uses external temporal or spatial stimuli to facilitate movement or gait initiation and continuation. The cueing device for improving gait ability in Parkinson’s disease was researched by Professor Areerat Suputtitada, M.D.,leading Physiatrist in Thailand. The main objective is to examine the effect of cueing devices using visual, auditory and somatosensory stimuli during walking in Parkinson’s patient using motion analysis. The study hypothesizes that the use of laser point, rhythmic sound and rhythmic vibration will increase the patients’ stride length, step length and speed, and decrease gait freezing.
Twenty Parkinson’s disease patients were asked to walk at a normal speed along a 10 meter walkway eight times using different combinations of cueing devices. The spatiotemporal data were recorded with motion analysis as seen in figure 1. The conditions tried include:
- Walking without a cueing device
- Walking with visual cue
- Walking with an auditory cue
- Walking with a somatosensory cue
- Walking with visual and auditory cues
- Walking with visual and somatosensory cues
- Walking with auditory and somatosensory cues
- Walking with all three cues.
All conditions were done three times by every patient.
The cueing device consists of 3 components (Figure 2):
- Visual: used a laser pointer made from optic fibers with a switch to project the straight line
- Auditory: generated a rhythmic sound
- Somatosensory: used vibration and a microcontroller to create a rhythmic vibration
The researchers found statistically significantly better scores for gait freezing, step length and walking velocity in the patients group that used the cueing device compared to those who didn’t use the device. There was no statistically significant difference between each type of cues or combined cues. In figure 3, the left picture demonstrates short steps at baseline before the cueing device is used and the right picture shows an improved step stride when light and sound cues were used.
The study reveals the significantly effective use of visual, auditory and somatosensory cues for improving gait ability in Parkinson patients. The combined cueing device is a product designed by Professor Areerat Suputtitada,M.D. and her team. Although her team is using the cueing device to help patients with Parkinson’s disease improve their gait, it is also highly applicable to HD patients. For more information on Dr. Suputtitada, her work and her contact information, please refer to our spotlight article link.
- Suputtitada A, Sriyudthasak M, PongmalaCueing devices for gait ability in Parkinson patient using motion analysis. Gait & Posture 2009; 30 (Suppl 2): S127.
- Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems A.M, Kwakkel G, Wegen E. The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease. Arch Phys Med Rehabil 2005; 86: 999-1006
- Suteerawattananon M, Morris G.S, Etnyre B.R, Jankovic J, Protas E.J. Effect of visual and auditory cues on gait in individuals with Parkinson’s disease. J Neurol Sci 2004; 219: 63-69
- Novak P, Novak V. Effect of step-synchronized vibration stimulation of soles on gait in Parkinson’s disease: a pilot study. J NeuroEng Rehab 2006; 3:9.
- Lim I, Wegen EV, de Goede C, et als . Effects of external rhythmical cueing on gait in patients with parkinson’s diease: a systematic review.Clin Rehabil 2005;19:695-713.