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Mental Singing Reduces Gait Variability More Than Music Listening for Healthy Older Adults and People With Parkinson Disease

Harrison, Elinor C. BA, PhD; Horin, Adam P. MA, BS; Earhart, Gammon M. PT, PhD, FAPTA

Journal of Neurologic Physical Therapy: August 20, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/NPT.0000000000000288
Research Articles: PDF Only

Background and Purpose: Previously, we showed that internal cues (such as singing) produce similar motor benefits as external cues (such as listening to music) for people with Parkinson disease (PD). This study takes that research further by exploring how singing—either aloud or mentally—at different tempos can ameliorate gait, and it offers insight into how internal cueing techniques may enhance motor performance for older adults and people with PD.

Methods: Sixty participants aged 50 years and older (30 female) were recruited; 30 had PD and 30 were healthy age-matched controls. Participants completed walking trials involving internal and external cueing techniques at 90%, 100%, and 110% of preferred cadence. The effects of different cue types and rates were assessed in a repeated-measures cross-sectional study by comparing gait characteristics (velocity, cadence, stride length) and variabilities (coefficients of variation of stride length, stride time, single support time).

Results: All participants modified their cadence and stride length during cued conditions, resulting in changes in gait velocity closely reflecting expected changes based upon cue rate. External cues resulted in increased gait variability, whereas internal cues decreased gait variability relative to uncued walking. Variability decreases were more substantial during mental singing at tempos at or above preferred cadence.

Discussion and Conclusions: Matching movement to one's own voice improves gait characteristics while reducing gait variability for older adults and people with PD. Optimizing the use of internal cues to facilitate movement is an important step toward more effectively meeting the needs of people with gait disorders related to aging or neurological disease.

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

Departments of Neurology (E.C.H., G.M.E.) and Neuroscience (G.M.E.) and Program in Physical Therapy (A.P.H.), Washington University School of Medicine, St Louis, Missouri.

Correspondence: Gammon M. Earhart, PT, PhD, FAPTA, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd, St Louis, MO 63108 (

Authors E.C.H. and G.M.E. have received a grant from the GRAMMY Museum Grant Awards Program to fund this research. Author A.P.H. is supported by National Institutes of Health [T32HD007434].

The work represented in the manuscript was previously presented at Movement: Brain Body Cognition, Harvard Medical School, Boston, Massachusetts.

The authors declare no conflicts of interest.

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

© 2019 Academy of Neurologic Physical Therapy, APTA