Visual Cueing in Neurological Movement Disorders

Visual cueing is a rehabilitation technique that uses external visual signals—such as lines on the floor, projected laser beams, or digital overlays—to help people with neurological movement disorders walk more smoothly. It is most commonly used in Parkinson’s disease (PD), but can also benefit people with other conditions that affect movement, such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), stroke, and multiple sclerosis.

History

The idea of using visual cues goes back more than 50 years.

  • In the 1960s, neurologist James Purdon Martin noticed that people with Parkinson’s who struggled to start walking could suddenly take normal steps if they were asked to walk over stripes on the floor.

  • This discovery was one of the first demonstrations of kinesia paradoxa—a phenomenon where external stimuli allow patients to move more freely than usual.

  • In the 1980s and 1990s, researchers such as Meg Morris, Alice Nieuwboer, and Fay Horak studied cueing in detail, confirming that simple floor markers or obstacles could improve stride length and reduce episodes of “freezing of gait.”

By the 2000s, large clinical studies showed that regular use of visual and rhythmic cues could improve walking and daily function in people with Parkinson’s.

How It Works

Parkinson’s disease and related disorders disrupt the brain’s basal ganglia, which normally help control automatic movements like walking. Visual cues appear to “bypass” this problem by:

  • Engaging other brain circuits, such as the motor cortex and cerebellum.

  • Turning walking into a goal-directed task (e.g. “step on the line”) rather than an automatic process.

  • Providing spatial feedback and rhythm that help regulate stride length and pace.

In short, the brain can still produce a normal walking pattern—but it often needs an external signal to trigger it.

Benefits

Research has shown that visual cueing can:

  • Reduce freezing of gait (when the feet suddenly stop moving).

  • Improve stride length and walking speed.

  • Enhance posture and balance.

  • Lower the risk of falls.

  • Boost confidence and independence in daily activities.

The effect is often immediate: someone who is stuck in place may be able to move forward as soon as a cue appears.

Traditional Cueing Methods

  • Floor markings: Strips of tape or contrasting tiles used at home or in therapy.

  • Laser canes and walkers: Mobility aids with a built-in laser that projects a line to step over.

  • Laser shoes: Devices that shine a line in front of each foot as it lifts, shown to reduce freezing episodes by almost half.

These methods are low-tech but effective. However, they can sometimes encourage people to look down, which may worsen posture.

Digital and Augmented Reality Cueing

Recent innovations use virtual and augmented reality (AR) to create floating cues in a person’s field of view. Examples include AR headsets and smart glasses, such as the StrydAR glasses, which project a holographic line in the upper peripheral vision.

Unlike floor cues, these digital systems:

  • Improve posture (by encouraging people to look up).

  • Work automatically without conscious effort.

  • Can be used anywhere, without needing tape or special equipment.

Use Beyond Parkinson’s

While most evidence is in Parkinson’s disease, cueing can also help people with:

  • Stroke: to retrain step length and walking symmetry.

  • Multiple sclerosis and cerebellar ataxia: by providing visual feedback for steadier gait.

  • Atypical parkinsonism (PSP, MSA): though results vary depending on the severity of balance and gaze problems.

Conclusion

Visual cueing began as a simple clinical observation and has grown into a widely recognised therapy for gait problems. From tape lines on the floor to modern AR glasses, the principle remains the same: an external visual signal can “unlock” movement, helping people walk with longer steps, fewer freezes, and greater confidence.