AIM:
To overcome freezing while walking.
Rationale:
Freezing while walking is reduced by the use of the following strategies:
- Visual cues
- Counting steps (1, 2, 1, 2…)
- Stop, shift weight from side to side while counting 1,2,3, then walk
- Auditory cues
Note: Some patients will use permanent visual cues in the home environment and some patients will be unable to perform concurrent tasks without increasing the risk of freezing and/or falling.
Equipment:
- Obstacles for triggering freezing (chair and bin)
- Strips of cardboard (5 cm by 55cm) for visual cues
- Metronome for auditory cues
Key Points:
- Set up the environment to mimic the environment in which the patient reports freezing while walking
- Ensure therapist stays close by to steady patient if necessary
- When using auditory cues, set auditory cue frequency below the patients preferred cadence (usually 60-80 bpm)
Common Errors:
- Therapist does not stay close enough to steady the patient if necessary
- Therapist gives explanations or instructions while the metronome is “beeping”
Progression and Variety:
- Adjust auditory cue frequency according to patient response
- Increase environmental demands and distractions
- Practice strategies while performing additional cognitive and manual task
- Remove cues and encourage patient to self-cue