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Auditory Cueing for Gait Impairment in Persons With Parkinson Disease

A Pilot Study of Changes in Response With Disease Progression

Lirani-Silva, Ellen, PhD; Lord, Sue, PhD; Moat, Dionne, BSc; Rochester, Lynn, PhD; Morris, Rosie, PhD*

Journal of Neurologic Physical Therapy: January 2019 - Volume 43 - Issue 1 - p 50–55
doi: 10.1097/NPT.0000000000000250
Research Articles

Background and Purpose: Gait impairments in persons with Parkinson disease (PD) are difficult to manage. Auditory cueing has been shown to be an effective therapy. However, the optimal time to introduce cues with respect to disease stage has not yet been established. This longitudinal study examines the effect of auditory cues on gait characteristics in people with early PD at 2 time points, 3 years apart.

Methods: We assessed 25 people with PD from the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation-Parkinson's disease (ICICLE-PD) study. Participants walked with and without an auditory cue set at individual cadence. Characteristics of step velocity, step length, step time, step length variability, and step time variability were collected using an instrumented walkway. In a subset of 9 participants with PD, all assessments were repeated 3 years later. Twenty-nine healthy older adults were assessed at 1 time point to provide comparison data.

Results: At baseline, independent of group, step velocity, step length, and step time improved with auditory cue; however, there was an increase in step time variability, indicating a worsening of gait with the cue. Three years later, in the smaller subset the response to cue was improved, demonstrated by increased step velocity and length but step time variability was no longer increased.

Discussion and Conclusions: This pilot study indicates that people with early PD have small benefits from auditory cues and the benefit increases as disease progresses. Early in disease the benefit of cue may come at the cost of increased variability. Therefore, the time to introduce an auditory cue in PD rehabilitation may be important to optimize therapeutic effect.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at:

Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom (E.L.S., S.L., D.M., L.R., R.M.); Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil (E.L.S.); School of Clinical Sciences, Auckland University of Technology, New Zealand (S.L.); John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, United Kingdom (D.M.); The Newcastle upon Tyne Hospitals, NHS Foundation Trust, United Kingdom (L.R.); and Department of Neurology, Oregon Health & Science University, Portland (R.M.)

Correspondence: Rosie Morris, PhD, Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom (

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA