A Scoping Review of Laser-based Visual Cueing Strategies for the Management of Freezing of Gait in Parkinson’s Disease

Abstract

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by dopaminergic degeneration and Lewy body pathology, leading to impaired basal ganglia function and motor symptoms such as bradykinesia, rigidity, tremor, and gait disturbances. Freezing of gait (FOG) is a challenging feature that may increase fall risk and affect quality of life. Visual cueing, particularly laser-based strategies, may enhance motor control by engaging cortical and visuomotor pathways. Objective: To synthesise evidence on laser-based visual cueing for managing FOG and gait dysfunction in PD, and to examine the influence of device design and patient characteristics on outcomes. Methods: A scoping review was conducted using PubMed, Scopus, and open-access sources. Studies involving PD patients using laser-based cueing with quantitative gait or FOG outcomes were included. Interventions were categorised by device type, delivery mode, study design, and duration. Results: Eight studies (sample sizes 10–80; Hoehn and Yahr stages 1–4) were included. Laser cueing was associated with reduced FOG severity and frequency in some studies, with reported improvements in NFOGO scores, reduced FOG episodes (~31%) and fewer falls and near-falls (~41% and ~58%); however, findings were not consistent across all devices or participants. Accelerometry showed a reduced Freeze Index in some studies. Laser canes demonstrated a benefit for gait initiation freezing in one study. Spatiotemporal outcomes were mixed, with some devices improving stride length and velocity, while others increased variability, suggesting cautious gait. Kinematic improvements included better joint motion and stability. Conclusion: Laser-based visual cueing may act as a promising non-pharmacological intervention for FOG in PD, though effects vary by device and patient profile, highlighting the need for individualised approaches, larger controlled trials and further long-term research to establish robust evidence.