Combined auditory and visual cueing provided by eyeglasses influence gait performance in Parkinson Disease patients submitted to deep brain stimulation: a pilot study

Background: Auditory-visual cueing using portable cueing devices has been effective for gait training in rehabilitation programs with Parkinson patients. However, it is possible that some gait problems arise due to interference from chronic high frequency stimulation with the gait and balance neural networks in patients with Parkinson Disease. Thus, it should be useful to test whether advanced Parkinson Disease patients experiencing gait problems (despite the treatment with medication and high frequency deep brain stimulation) would benefit from therapy using cueing. Methods: Eyeglasses combining auditory-visual cueing were used with 18 patients with advanced Parkinson Disease and treated with medication and deep brain stimulation. Patients were assessed using the Dynamic Gait Index, Timed Up and Go and Six-Minute Walking Test and performance was measured with and without the cueing (with and without eyeglasses on). Results: One way ANOVA on the performance measures indicated that Dynamic Gait Index and Six-Minute Walking Test significantly improved in the cued condition. Since cueing was task specific, and Timed Up and Go includes subtasks such sitting and standing, the combined auditory-visual cueing did not improve performance on such tasks. Conversely, the combined cueing may have worked as distractors during these subtasks. Conclusion: Combined auditory-visual cueing provided by this wearable technology may have practical applicability in rehabilitation therapy. It provided additional benefits on gait in patients with advanced Parkinson Disease with deep brain stimulation in the subthalamic nucleus.