One cue does not fit all: A systematic review with meta-analysis of the effectiveness of cueing on freezing of gait in Parkinson’s disease

• Published in: Neuroscience and biobehavioral reviews 2023-07, Vol.150, p.105189-105189, Article 105189
• Main Authors: Cosentino, Carola, Putzolu, Martina, Mezzarobba, Susanna, Cecchella, Margherita, Innocenti, Tiziano, Bonassi, Gaia, Botta, Alessandro, Lagravinese, Giovanna, Avanzino, Laura, Pelosin, Elisa
• Format: Article
• Language: English
• Subjects: Behavioral strategies; Cueing; Cues; Freezing of gait; Gait; Gait Disorders, Neurologic - etiology; Humans; Parkinson Disease - complications; Parkinson’s Disease; Physiotherapy; Walking
• ISSN: 0149-7634; 1873-7528
• DOI: 10.1016/j.neubiorev.2023.105189

The difficulty in assessing FOG and the variety of existing cues, hamper to determine which cueing modality should be applied and which FOG-related aspect should be targeted to reach personalized treatments for FOG. This systematic review aimed to highlight: i) whether cues could reduce FOG and improve FOG-related gait parameters, ii) which cues are the most effective, iii) whether medication state (ON-OFF) affects cues-related results. Thirty-three repeated measure design studies assessing cueing effectiveness were included and subdivided according to gait tasks (gait initiation, walking, turning) and to the medication state. Main results reveal that: preparatory phase of gait initiation benefit from visual and auditory cues; spatio-temporal parameters (e.g., step and stride length) are improved by visual cues during walking; turning time and step time variability are reduced by applying auditory and visual cues. Some findings on the potential benefits of cueing on FOG and FOG gait-related parameters were found. Questions remain about which are the best behavioral strategies according to FOG features and PD clinical characteristics. [Display omitted] •Cues variety hinder to determine which cueing modality to use for more personalized treatment of Freezing of Gait (FOG).•This systematic review explores cueing effectiveness on FOG related parameters during gait initiation, walking and turning.•Gait initiation (APAs) and turning (turning time, step time CV, FOG episodes) can be improved by visual and auditory cueing.•During walking visual cueing can ameliorate step and stride length but not FOG episodes.•Freezing features (subtypes and triggers) should be considered when designing a FOG-tailored cue trial.