How cueing works in NexStride to help freezing of gait

The Art of Cueing

Freezing of Gait (FoG) is considered one of the most debilitating symptoms experienced by people with Parkinson’s disease¹. It is also one of the leading causes of falls and hospitalizations, with the management of freezing episodes considered to be a significant pain point.

As medication and surgery have not previously been successful in treating these symptoms, more recently, cueing has been studied and has shown immense promise in overcoming episodic freezing.

FOG can be characterized into three different forms:

Pure Akinesia

No motion of the person’s legs is observed².

"Tremble in Place" Form

The person’s inability to step with their legs trembling.

"Shuffling" Form

A spontaneously increasing cadence and a decrease in step length³.

'Freezing of gait,' (FoG)also known as 'Parkinson's Disease walk' or 'Parkinsonian gait,' is an advanced symptom of Parkinson's Disease and might need more than medication to be treated. The other forms of Freezing of Gait are shuffling and trembling in place. These forms of FoG have been known to be major contributors to falls in people with Parkinson’s. This places an immense strain on carers and increased pressure on the health system due to the rise of hospitalizations⁴. Additionally, other non-motor effects can be caused by FoG complications, including anxiety, depression, and the overall decrease in a person’s quality of life⁵.

How does cueing help?

The treatment of Freezing of gait or Parkinsonian gait through cueing could offer a breakthrough in helping people with Parkinson’s recover their independence, restore their motor ability, and increase confidence. Sensory and auditory cueing could be the key to assisting people from experiencing this debilitating symptom.

Reduces Freezing Episodes

Studies conducted as early as 1990 show that visual cueing can help people with Parkinson’s overcome the effects of FoG. Over the years, further research has been demonstrated that cueing can help people with Parkinson’s improve their gait, walking speed, step length, and the number of steps per minute. These studies have also shown strength in reducing the number of freezing episodes.

Allows For Continued Movement

Cueing works by using physical stimuli to help the brain process time and create spatial awareness; this facilitates the initiation of movement and the continuation of movement. Recently, studies have shown that three different cueing variations can assist the brain in allowing movement. These techniques include visual cueing, auditory cueing, and somatosensory cueing.

As seen in the news

Cueing In NexStride

NexStride is the first multi-cue daily assist mobility device that attaches to any standard cane, walker, or walking pole. Users can activate the audio cue, visual cue, or both, and adjust to preferred speed and distance.

These visual and audio cues help users re-establish the connection between the brain and the body and allow the user to walk smoothly again.

1. Sweeney D, Quinlan LR, Browne P, Richardson M, Meskell P, ÓLaighin G. A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson's Disease. Sensors (Basel). 2019;19(6):1277. Published 2019 Mar 13. DOI:10.3390/s19061277 • 2. Bloem B.R., Hausdorff J.M., Visser J.E., Giladi N. Falls and freezing of gait in Parkinson’s disease: A review of two interconnected, episodic phenomena. Mov. Disord. Off. J. Mov. Disord. Soc. 2004;19:871–884. DOI: 10.1002/mds.20115. • 3. Hausdorff J.M., Balash Y., Giladi N. Time series analysis of leg movements during freezing of gait in Parkinson’s disease: Akinesia, rhyme or reason? Phys. A Stat. Mech. Appl. 2003;321:565–570. DOI: 10.1016/S0378-4371(02)01744-2. • 4. Paul S.S., Harvey L., Canning C.G., Boufous S., Lord S.R., Close J.C.T., Sherrington C. Fall-related hospitalization in people with Parkinson’s disease. Eur. J. Neurol. 2017;24:523–529. doi: 10.1111/ene.13238 • 5. Ishii M., Okuyama K. Influence of Freezing of Gait on Quality of Life in Patients with Parkinson’s disease. J. Fac. Health Sci. 2018;12:1–10.