Individuals with Parkinson's Disease Retain Spatiotemporal Gait Control With Music and Metronome Cues

BackgroundParkinsons disease (PD) is marked by a loss of motor automaticity, resulting in decreased control of step length during gait. Rhythmic auditory cues (metronomes or music) may enhance automaticity by adjusting cadence. Both metronomes and music may offer distinct advantages, but prior attempts at quantifying their influence on spatiotemporal aspects of gait have been confounded by altered gait speeds from overground walking. We hypothesized that when gait speed is fixed, individuals with PD would experience difficulty in modifying cadence due to the concomitant requirement to alter step length, with greater changes noted with metronomes compared to music cues. Research QuestionCan a metronome or music promote spatiotemporal adjustments when decoupled from changes in gait speed in individuals with PD? Methods21 participants with PD were instructed to time their steps to a metronome and music cues (at 85%, 100%, and 115% of overground cadence) during treadmill walking. We calculated cadence, cadence accuracy, and step length during each cue condition and an uncued control condition. We compared the various cue frequencies and auditory modalities. ResultsAt fixed gait speeds, participants were able to increase and decrease cadence in response to auditory cues. Music and metronome cues produced comparable results in cadence manipulation with greater cadence errors noted at slower intended frequencies. Nevertheless, the induced cadence changes created a concomitant alteration in step length, with music and metronomes producing comparable changes. Notably, longer step lengths were induced with both music and metronome during slow frequency cueing. SignificanceThis important change conflicts with conventional prescriptive approaches, which advocate for faster cue frequencies, if applied on a treadmill. The music and metronome cues produced comparable changes to gait, suggesting that either cue may be effective at overcoming the shortened step lengths during treadmill walking if slower frequencies are used.