Connecting dots
In April 2023 (Post 42) I reflected on specific issues, such as spotting, a dance strategy, that was useful when dressing and trying to maintain my balance. By 2025 this has become irrelevant as, sadly, I am presently unable to dress myself. I also made observations on cueing (as well as in Posts 27, 28 and 38) and unpacked the concept (see extract below).
Post 42 (April 2023)"...I wondered if sequences of phrasing -- such as saying to myself "heel-toe heel-toe" -- could assist me to walk down and up the stairs in a measured manner: it did! This was my cueing, version 1.0, and I was walking confidently on stairs.
Later, I substituted the words with numbers. So, during late 2021, my "heel-toe" cue, a concrete concept to encourage my feet to move, evolved into my saying "1-2 1-2" which was more abstract. I was impressed with this adaptation to version 2.0 and believed that my using numbers (i.e. an 'abstract' representation to activate my movement) was superior to using words (i.e. a 'concrete' representation) when on the stairs."
In today's post, dear reader, I want to revisit my understanding of cues and introduce prompts.
Prompting for access
The words prompts and cues appear to be synonymous but for us Person/s with Parkinson's (PwP) they are not.
A PwP, like myself, sometimes needs a reminder and to
prompt myself to remain aware of hazards when negotiating spaces. An example would be my approaching a narrow space where there is nothing stable to hold onto. What makes my action dangerous is that I have to walk sideways. When I concentrate on balance I
prompt myself to be cautious the whole time, for instance, I talk to myself in full sentences: "OK, slowly, watch it now...". Consequently, I feel confident and safer as a result of the
prompt. In one such narrow space at home (at my desk/computer) I have fallen twice in two years, so I always
prompt myself to be cautious there. Fortunately, I only have to navigate this narrow space when it's blog time.
Another action requiring a prompt would be when being seated in one of three different chairs in the lounge. There are specific prompts for these chairs, namely, (A) a recliner, (B) a recliner/incliner and (C) a dining chair. Prompts are always required when I walk towards one of these three chairs. I stand still, facing one of them, before prompting myself to slowly turn before carefully moving backwards (the dodgy part) to flop down onto one of them as gently as possible.
A fourth chair (D) is one that needs to be slid out from under my desk in my bedroom. Then I need to prompt myself to shuffle slowly and carefully sideways into the ±45cm space between the desk and the chair in order to get seated. This is challenging because of the sideways access with nothing to hold onto, like I have in the shower. But, before sitting down in front of my computer, I still have to shuffle forward, my knees bent under the desk, while pulling the chair under my bottom: a potentially hazardous procedure! Oh, and I have a movement disorder, too 😓.
So, where were cues and prompts first used?
Well, in the theatre a prompter reminds actors of their lines. Prompters are a critical part of rehearsals as they allow the cast to put down scripts and to focus on acting. When the actual performance is underway, prompters help actors who might panic and forget dialogue.Specific lines spoken at specific parts of a scene are a reminder of what other actors are supposed to be saying and/or doing at that exact time and these reminders are called cues. Specific lines can also be cues for lighting changes or music or for actors to enter or exit a stage.
PD's cues
Cues used in the context of movement disorders, specifically for PD represent a form of external stimulus generated by the PwP in order to facilitate some form of repeated movement, such as walking. This
cue is created to substitute what is absent due to PD and may include rhythmic sounds, music, counting or following patterns/shapes on the floor.
Lim et al. (2005, p.696) cite Cools' definition of
cues as "
contextual or spatial stimuli which are associated with behaviour to be expected through past experience." For further clarity, Lim
et al. (2005, p.696) cite Horstink
et al. in order to distinguish between
cues and stimuli: "
cues give information on how an action should be carried out...more specific than simple stimuli".
Nieuwboer, (2015) indicates the need for further research into
cueing based on the fact that "
...gait and balance impairments...in Parkinson's Disease...are not well-controlled by levodopa" while "
cueing has an immediate and sustained effect on gait...". One drawback in cueing, is that not everyone who is a PwP has a sense of rhythm to sustain a repeated cue due to their "
inflexibility and lack of perceptual rhythmicity..." (Nieuwboer, 2015). This is yet another good reason for us PwP to exercise regularly, right?
My cue to exit...
A constructive way for a PwP to consider
cueing is to work with a therapist you trust and then experiment with different modes of cueing. I have found that some therapists have approaches that do not click with me, so do your homework. Check out this easy-to-read link and video of a
physiotherapist in Luxembourg which may give you an idea.
Till next time, dear reader. {Exit, Ari. Fade lights and background music. Cue cast for curtain call.}
