Cueing Technologies in Parkinson's Disease: A Systematic Review

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms that significantly impact daily life. Wearable cueing technologies have emerged as promising interventions to alleviate these symptoms by providing external sensory stimuli to enhance movement, cognition, and overall function. However, the landscape of wearable cueing methodologies in PD clinical applications remains fragmented. In this systematic review, we analyze the effectiveness of wearable cueing technologies designed for people with PD (PwPD), focusing on their impact on motor and non-motor symptoms. Following PRISMA guidelines, we conducted a comprehensive literature search, identifying 1,640 studies, of which 39 met the inclusion criteria. These studies explored various cueing modalities, including auditory, visual, haptic, and multimodal approaches, tested in clinical settings. Our findings indicate that wearable cueing technologies show significant potential in mitigating motor symptoms, such as freezing of gait, bradykinesia, and postural instability. Although our review framework considered both motor and non-motor symptoms, none of the included studies explicitly addressed non-motor impairments (e.g., cognitive, affective, or sleep-related symptoms), highlighting an unmet research need in this area and confirming the current technological focus on motor rehabilitation. However, the effectiveness of these interventions varies depending on the cueing modality, patient-specific factors, and study design. Despite promising results, the heterogeneity in study protocols, sample sizes, and outcome measures poses challenges in establishing standardized conclusions. This review underscores the growing role of wearable cueing technologies in PD management and highlights the need for high-quality, standardized clinical trials to refine device design, optimize cueing parameters, and integrate these solutions into personalized treatment strategies. Our findings provide a foundation for future research and the development of evidence-based wearable interventions to enhance the quality of life for PwPD.