Imaginary cues in freezing of gait in patients with Parkinson’s disease

Background: Freezing of gait is a disabling core feature of Parkinson’s disease. Several studies have proven that implementation of visual, auditory cues have improved freezing of gait, which requires conspicuous horizontal lines, audio instrument such as metronome. Objective: Our aim is to evaluate the effect of imaginary cues in freezing of gait in patients with Parkinson’s disease. Methodology: 22 patients who presented with freezing of gait and diagnosis consistent with Parkinson’s disease were included in the study. Patients were asked to perform the 50 feet walk test. They have to walk 25 feet, turn around, and walk back 25 feet. Subjects were allowed to perform all tasks at their own speed. The parameters measured were the number of freezing episodes and the time taken to walk 50 feet. In the second part, subjects were asked to imagine themselves that they are riding a bicycle and asked to lift their legs and walk as if riding a bicycle (pedaling a bicycle) for 25 feet, turn around, and walk back 25 feet. The above mentioned parameters were measured again. The effect of test-retest variability was assessed. Results: The mean time taken to walk without cues was 51.45 ± 7.84 seconds and with cues was 45.59 ± 8.51 seconds. The mean value of the number of freezing episodes while walking without cues was 2.32 ± 0.48 and with imaginary cues was 1.5 ± 0.51. There is statistically significant difference (p<0.05) in time taken to walk 50 feet and number of freezing episodes between before and after imaginary cues. 10 out of 22 patients showed immediate improvement in freezing of gait. Whereas six patients showed improvement on the repeated attempts. Six patients did not show any improvement. Conclusion: This study reiterates the fact that such a simple measure that requires no special instruments, can improve the mobility and the quality of life in Parkinson’s patients. Further studies are required to assess sensitivity/specificity.