AIM:
To improve initiation of walking
Rationale:
Freezing (akinesia) on initiation of walking is reduced by the use of the following strategies:
- Shifting weight
- Stepping on the spot
- Visual cue
- Take one step backwards, then walk forwards
- Take one step sideways, then walk forwards
- 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:
- Strip of cardboard (5 cm by 55cm) for visual cue
- Metronome for auditory cues
Key Points:
- Modify the environment initially by reducing clutter and removing distractions
- Ensure therapist stays close by to steady patient if necessary
- When using auditory cues, set auditory cue frequency 10% 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 tasks
- Remove cues and encourage patient to self-cue