{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:26:26Z","timestamp":1781522786565,"version":"3.54.1"},"reference-count":37,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Parkinson\u2019s Foundation postdoctoral fellowship for basic scientists","award":["PF-FBS-1898"],"award-info":[{"award-number":["PF-FBS-1898"]}]},{"name":"Parkinson\u2019s Foundation postdoctoral fellowship for basic scientists","award":["PF-CRA-2073"],"award-info":[{"award-number":["PF-CRA-2073"]}]},{"name":"Parkinson\u2019s Foundation postdoctoral fellowship for basic scientists","award":["5R00HD078492-04"],"award-info":[{"award-number":["5R00HD078492-04"]}]},{"name":"Parkinson\u2019s Foundation clinical research award","award":["PF-FBS-1898"],"award-info":[{"award-number":["PF-FBS-1898"]}]},{"name":"Parkinson\u2019s Foundation clinical research award","award":["PF-CRA-2073"],"award-info":[{"award-number":["PF-CRA-2073"]}]},{"name":"Parkinson\u2019s Foundation clinical research award","award":["5R00HD078492-04"],"award-info":[{"award-number":["5R00HD078492-04"]}]},{"name":"National Institutes of Health (NIH) career development award","award":["PF-FBS-1898"],"award-info":[{"award-number":["PF-FBS-1898"]}]},{"name":"National Institutes of Health (NIH) career development award","award":["PF-CRA-2073"],"award-info":[{"award-number":["PF-CRA-2073"]}]},{"name":"National Institutes of Health (NIH) career development award","award":["5R00HD078492-04"],"award-info":[{"award-number":["5R00HD078492-04"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Turning is a common impairment of mobility in people with Parkinson\u2019s disease (PD), which increases freezing of gait (FoG) episodes and has implications for falls risk. Visual cues have been shown to improve general gait characteristics in PD. However, the effects of visual cues on turning deficits in PD remains unclear. We aimed to (i) compare the response of turning performance while walking (180\u00b0 and 360\u00b0 turns) to visual cues in people with PD with and without FoG; and (ii) examine the relationship between FoG severity and response to visual cues during turning. This exploratory interventional study measured turning while walking in 43 participants with PD (22 with self-reported FoG) and 20 controls using an inertial sensor placed at the fifth lumbar vertebrae region. Participants walked straight and performed 180\u00b0 and 360\u00b0 turns midway through a 10 m walk, which was done with and without visual cues (starred pattern). The turn duration and velocity response to visual cues were assessed using linear mixed effects models. People with FoG turned slower and longer than people with PD without FoG and controls (group effect: p &lt; 0.001). Visual cues reduced the velocity of turning 180\u00b0 across all groups and reduced the velocity of turning 360\u00b0 in people with PD without FoG and controls. FoG severity was not significantly associated with response to visual cues during turning. Findings suggest that visual cueing can modify turning during walking in PD, with response influenced by FoG status and turn amplitude. Slower turning in response to visual cueing may indicate a more cautious and\/or attention-driven turning pattern. This study contributes to our understanding of the influence that cues can have on turning performance in PD, particularly in freezers, and will aid in their therapeutic application.<\/jats:p>","DOI":"10.3390\/s22186746","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T04:18:32Z","timestamp":1662610712000},"page":"6746","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Visual Cues for Turning in Parkinson\u2019s Disease"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7006-6695","authenticated-orcid":false,"given":"Julia","family":"Das","sequence":"first","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK"},{"name":"Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-9452","authenticated-orcid":false,"given":"Rodrigo","family":"Vitorio","sequence":"additional","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allissa","family":"Butterfield","sequence":"additional","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK"},{"name":"Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK"},{"name":"Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Graham","sequence":"additional","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gill","family":"Barry","sequence":"additional","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"McDonald","sequence":"additional","affiliation":[{"name":"Gateshead Health NHS Foundation Trust, Gateshead NE8 2PJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Walker","sequence":"additional","affiliation":[{"name":"Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Mancini","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Stuart","sequence":"additional","affiliation":[{"name":"Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK"},{"name":"Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"612","DOI":"10.3389\/fnins.2018.00612","article-title":"Parkinson\u2019s Disease: Biomarkers, Treatment, and Risk Factors","volume":"12","author":"Emamzadeh","year":"2018","journal-title":"Front. Neurosci."},{"key":"ref_2","first-page":"504","article-title":"Parkinson\u2019s Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis","volume":"40","author":"DeMaagd","year":"2015","journal-title":"Pharm. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1136\/jnnp-2011-300869","article-title":"The relationship between motor planning and freezing of gait in Parkinson\u2019s disease","volume":"83","author":"Knobl","year":"2012","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jns.2012.06.018","article-title":"Risk factors for freezing of gait in Parkinson\u2019s disease","volume":"320","author":"Contreras","year":"2012","journal-title":"J. Neurol. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1002\/mds.27499","article-title":"Impaired step-length setting prior to turning in Parkinson\u2019s disease patients with freezing of gait","volume":"33","author":"Virmani","year":"2018","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s12984-016-0147-4","article-title":"The quality of turning in Parkinson\u2019s disease: A compensatory strategy to prevent postural instability?","volume":"13","author":"Mellone","year":"2016","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/1545968313508470","article-title":"The relative contribution of physical and cognitive fall risk factors in people with Parkinson\u2019s disease: A large prospective cohort study","volume":"28","author":"Paul","year":"2014","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1002\/mds.27195","article-title":"Falls in Parkinson\u2019s disease: A complex and evolving picture","volume":"32","author":"Fasano","year":"2017","journal-title":"Mov. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Koschel, J., Ray Chaudhuri, K., T\u00f6nges, L., Thiel, M., Raeder, V., and Jost, W. (2021). Implications of dopaminergic medication withdrawal in Parkinson\u2019s disease. J. Neural Transm., 1\u201310.","DOI":"10.1007\/s00702-021-02389-x"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1002\/mds.26269","article-title":"Levodopa is a Double-Edged Sword for Balance and Gait in People with Parkinson\u2019s Disease","volume":"30","author":"Curtze","year":"2015","journal-title":"Mov. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1136\/jnnp.200X.097923","article-title":"Cueing training in the home improves gait-related mobility in Parkinson\u2019s disease: The RESCUE trial","volume":"78","author":"Nieuwboer","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.rehab.2017.08.002","article-title":"Cueing for people with Parkinson\u2019s disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives","volume":"61","author":"Ginis","year":"2018","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1177\/1545968318805159","article-title":"Reduced Gait Variability and Enhanced Brain Activity in Older Adults with Auditory Cues: A Functional Near-Infrared Spectroscopy Study","volume":"32","author":"Vitorio","year":"2018","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.neuroscience.2014.07.024","article-title":"Visual cues and gait improvement in Parkinson\u2019s disease: Which piece of information is really important?","volume":"277","author":"Moraes","year":"2014","journal-title":"Neuroscience"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S1353-8020(99)00062-0","article-title":"Construction of freezing of gait questionnaire for patients with Parkinsonism","volume":"6","author":"Giladi","year":"2000","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1212\/WNL.17.5.427","article-title":"Parkinsonism: Onset, progress\/on and morta","volume":"17","author":"Hoehn","year":"1967","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1002\/mds.22340","article-title":"Movement Disorder Society-sponsored revision of the Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results","volume":"23","author":"Goetz","year":"2008","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1212\/WNL.0b013e3181fc29c9","article-title":"The MoCA: Well-suited screen for cognitive impairment in Parkinson disease","volume":"75","author":"MacAskill","year":"2010","journal-title":"Neurology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1136\/jnnp.64.5.588","article-title":"CLOX: An executive clock drawing task","volume":"64","author":"Royall","year":"1998","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2466\/pms.1992.74.1.39","article-title":"An interrater reliability study of the Trail Making Test (Parts A and B)","volume":"74","year":"1992","journal-title":"Percept. Mot. Ski."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1080\/13854046.2011.564209","article-title":"Developing a short form of Benton\u2019s Judgment of Line Orientation Test: An item response theory approach","volume":"25","author":"Calamia","year":"2011","journal-title":"Clin. Neuropsychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"095003","DOI":"10.1088\/1361-6579\/ab4023","article-title":"Validity of Mobility Lab (version 2) for gait assessment in young adults, older adults and Parkinson\u2019s disease","volume":"40","author":"Morris","year":"2019","journal-title":"Physiol. Meas."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1093\/gerona\/glw019","article-title":"Continuous monitoring of turning mobility and its association to falls and cognitive function: A pilot study","volume":"71","author":"Mancini","year":"2016","journal-title":"J. Gerontol. Ser. A Biomed. Sci. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3390\/s140100356","article-title":"Continuous monitoring of turning in patients with movement disability","volume":"14","author":"Pearson","year":"2013","journal-title":"Sensors"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.3109\/09638288.2014.961661","article-title":"A narrative review of turning deficits in people with Parkinson\u2019s disease","volume":"37","author":"Hulbert","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.gaitpost.2007.04.010","article-title":"The association between impaired turning and normal straight walking in Parkinson\u2019s disease","volume":"26","author":"Crenna","year":"2007","journal-title":"Gait Posture"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/NPT.0000000000000286","article-title":"Prefrontal cortical activation with open and closed-loop tactile cueing when walking and turning in Parkinson disease: A pilot study","volume":"44","author":"Stuart","year":"2020","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_28","first-page":"396","article-title":"Effects of auditory cues on gait initiation and turning in patients with Parkinson\u2019s disease","volume":"34","year":"2019","journal-title":"Neurolog\u00eda"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"12773","DOI":"10.1038\/s41598-018-31156-4","article-title":"Assessment of the ability of open-and closed-loop cueing to improve turning and freezing in people with Parkinson\u2019s disease","volume":"8","author":"Mancini","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.neuroscience.2012.01.024","article-title":"Turning and unilateral cueing in Parkinson\u2019s disease patients with and without freezing of gait","volume":"207","author":"Spildooren","year":"2012","journal-title":"Neuroscience"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1177\/1545968309337136","article-title":"The short-term effects of different cueing modalities on turn speed in people with Parkinson\u2019s disease","volume":"23","author":"Nieuwboer","year":"2009","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1002\/mds.21445","article-title":"Turning in Parkinson\u2019s disease patients and controls: The effect of auditory cues","volume":"22","author":"Willems","year":"2007","journal-title":"Mov. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3389\/fneur.2020.00185","article-title":"The effects of augmented reality visual cues on turning in place in Parkinson\u2019s disease patients with freezing of gait","volume":"11","author":"Janssen","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3389\/fspor.2020.00022","article-title":"Visual Cues Promote Head First Strategies During Walking Turns in Individuals With Parkinson\u2019s Disease","volume":"2","author":"Baker","year":"2020","journal-title":"Front. Sports Act. Living"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1177\/15459683211041317","article-title":"Brain Activity Response to Visual Cues for Gait Impairment in Parkinson\u2019s Disease: An EEG Study","volume":"35","author":"Stuart","year":"2021","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/ejn.13864","article-title":"Saccade frequency response to visual cues during gait in Parkinson\u2019s disease: The selective role of attention","volume":"47","author":"Stuart","year":"2018","journal-title":"Eur. J. Neurosci."},{"key":"ref_37","first-page":"4104712","article-title":"The beneficial effects of conventional visual cues are retained when augmented reality glasses are worn","volume":"2020","author":"Janssen","year":"2020","journal-title":"Parkinson\u2019s Dis."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/18\/6746\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:24:42Z","timestamp":1760142282000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/18\/6746"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,7]]},"references-count":37,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["s22186746"],"URL":"https:\/\/doi.org\/10.3390\/s22186746","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,7]]}}}