Applying Research on Cues
 
At Draper Rehabilitation & Care Center, we admitted a 79-year-old male patient with advanced Parkinson’s disease, referred to OT for wheelchair mobility. The patient recently obtained a power-assist lightweight manual wheelchair but has been unable to propel functional distances (to nursing station, dining room, activities, etc.). He demonstrates movements reminiscent of freezing of gait wherein he does not move for several seconds or minutes and appears stuck in place despite his efforts to initiate movement.

Research and Applications to WC Propulsion

Research on FOG reveals applications for WC mobility because freezing occurs in a variety of motor tasks, and UE kinematics have been shown to improve with the use of auditory cues.

OTs and PTs can innovate in low-tech and high-tech ways to apply this evidence to functional activities beyond gait. An example of a low-tech intervention would be attaching a laser to the wheelchair or using a bell, a metronome or music during WC propulsion. An example of a high-tech intervention would be designing a smartphone app that utilizes a smart watch or other sensor to monitor freezing and triggers visual cues or auditory cues. Therapists should also stay up to date on products that are in development and testing.

OTs and PTs can combine multiple sensory cues to increase effectiveness. OTs/PTs should also experiment with continuous and on-demand cuing.

By Amanda Call, MA, OTR/L, Draper Rehabilitation & Care Center, Draper, UT