Effects of Auditory Cues on Gait Initiation in Patients With Parkinson's Disease: A Preliminary Study

The purpose of this study was to investigate the effects of auditory cues in the form of a metronome on gait initiation (GI) in Parkinson's disease (PD). 2 patients (mean age: 54 yrs) with idiopathic PD participated in the study. All patients (Hoehn and Yahr disability score of 2.0) were tested in the "on" state approximately 1.5 hours following the administration and fully responding to their PD medications. Subjects first initiated walking at self-initiated speeds to determine their cadences. Then, subjects were asked to initiate gait along the walkway while keeping pace with a metronome. The metronome rate (in beats/min) was set at a cadence 85% (slow condition), 100% (normal condition) and 115% (fast condition) of gait for each subject. Subjects were able to increase the speed of GI with faster cadence, but the speed of GI for the slow condition was similar to that of the normal condition. Swing toe-off was 578.3 ms for the fast condition, 709.4 ms for the normal condition and 736.2 ms for the slow condition. Respective times for swing heel-strike were 894.3 ms, 1110.2 ms and 1119.1 ms, and stance toe-off were 1105.4 ms, 1338.5 ms, and 1343.1 ms. Except for stance unloading ground reaction forces were greatest for the fast condition and smallest for the slow condition. It appears that PD patients were able to modulate GRFs and temporal events in response to auditory cues to achieve the peak acceleration force of the swing and stance limb. The findings from this study provided preliminary data, which could be used to investigate how PD patients modulate GRFs and temporal events during GI in response to tasks.