The studies examined in this literature review can be divided into three categories: the use of visual cues, both fixed and flashing, the use of auditory cues, and the use of cueing at different frequencies. Based on the results of these studies, the use of external cueing can improve the gait of people with Parkinson’s disease, with Hoehn and Yahr stages II-IV. Fixed visual cues are most effective at improving stride length when set at a distance of 150% of the individual’s preferred step length. Auditory cues are effective at increasing all parameters of gait at frequencies greater than 100% of the individual’s fastest walking cadence. In addition, there is evidence to support the use of auditory cues to decrease cadence without compromising stride length when the frequency is set at 70% of the individual’s fastest walking cadence. The use of flashing visual cues, while shown to improve gait speed at a frequency of 110% of the individual’s fastest walking cadence, is not recommended. Flashing visual cues were found to be less effective than auditory cues and, when subjects were given a choice, the least preferred method of cueing. The current evidence provides guidance regarding mode and frequency of cueing to improve gait parameters in individuals with PD; however, generalization of these results is limited. Since a majority of the studies examined the immediate changes from cueing and were done within a laboratory setting, further research is needed to determine the long-term benefits of these cueing techniques and to determine if similar effects are obtained with household or community ambulation.
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