Effects of Auditory Rhythm and Music on Gait Disturbances in Parkinson's Disease

Abstract

Gait abnormalities, such as shuffling steps, start hesitation, and freezing, are common and often incapacitating symptoms of Parkinson's disease (PD) and other parkinsonian disorders. Pharmacological and surgical approaches have only limited efficacy in treating these gait disorders. Rhythmic auditory stimulation (RAS), such as playing marching music and dance therapy, has been shown to be a safe, inexpensive, and an effective method in improving gait in PD patients. However, RAS that adapts to patients' movements may be more effective than rigid, fixed-tempo RAS used in most studies. In addition to auditory cueing, immersive virtual reality technologies that utilize interactive computer-generated systems through wearable devices are increasingly used for improving brain-body interaction and sensory-motor integration. Using multisensory cues, these therapies may be particularly suitable for the treatment of parkinsonian freezing and other gait disorders. In this review, we examine the affected neurological circuits underlying gait and temporal processing in PD patients and summarize the current studies demonstrating the effects of RAS on improving these gait deficits.

Keywords: Parkinson’s disease; freezing; gait; music; rhythm.

Figure 1

Neurological schema of cued gait training. BG, basal ganglia; CMA, cingulate motor area; PMC, premotor cortex; SMA, supplementary motor area.

Figure 2

Self-improving relationship between beat perception and gait training efficacy.

Figure 3

Interactive rhythmic auditory stimulation using WalkMate. (A) Parkinson’s patients during rhythmic treatment, (B) Healthy participants during rhythmic treatment, and (C) Parkinson’s patients’ carry-over effect during a silent trial 5 min after the rhythmic treatment. The cueing conditions are unassisted silent control, interactive WalkMate rhythmic auditory stimulation (RAS), and fixed-tempo RAS. Error bars represent six SEM. *P < 0.05; n.s., non-significant. Reproduced from Hove et al. (109).

Figure 4

Smart music player: person–machine interaction loop and the main components involved. Reproduced from Moens et al. (112).

Figure 5

Rehabilitation of gait using virtual reality feedback cues. Measurements of walking speed and stride prior to the sessions (baseline), VR display off, VR display on, and 15 min after end of the session (15-min residual). Error bars represent SEM. *P < 0.01; **P < 0.001. Adopted from Badarny et al. (124).