Hi Harriet,
Love the questions! Good timing on this one- I am actually current recording the updated Parkinson’s lecture and have some more info on external cueing/strategies in the new presentation! There’s not a ton out there directly comparing types of strategies. There is one article indicating that visual cues are better for individuals who freeze while auditory cues may be better for non-freezers.
In terms of practical, clinical ideas:
– If someone is consistently experiencing problems in their own space (e.g., freezing when entering their bathroom), I often recommend parallel lines running perpendicular to the walking path and spaced about a stride length apart. With this, it’s important that the lines cross the entire problem area. If the problem is a doorway, the lines should start a few steps outside the doorway and continue a few steps into the next room. Here’s a video example of what the lines may look like: https://www.youtube.com/watch?app=desktop&v=UzPdHYgMbGE
– In the community, I find attentional strategies to work fairly well. I encourage my patients to reflect on when they are freezing (where they are, what they’re doing, etc.) to identify patterns and then plan. If doorways are a problem, we experiment with different strategies (visually looking past the doorway, counting steps through the doorway, etc.), then plan how to implement them.
– For turning, I find the mental image of a clock often works well. Think of turning 90 degrees at a time- so step to 3:00 then 6:00 to do a 180. Counting steps during turns often works well.
– I’ve had patients use a tactile cue of tapping their leg before initiating gait to increase attention to taking a big first step.
– Picking a target on the floor to step to when initiating gait also works well.
– If it’s possible to implement, music or metronomes as auditory cues during gait can be helpful
That’s just a few off the top of my head. The strategies I end up recommending are typically pretty patient-centered. It is often difficult to make patients freeze in the clinic because they are less comfortable than at home, so that reflecting on patterns piece is key. Patient buy-in and remembering to utilize any strategy is the most important thing because attention to task will increase safety and reducing freezing itself.
Hope this helps!
Chrissy