Gait Responses in People with Parkinson Disease During Autonomous Closed-loop Rhythmic Auditory Stimulation: An...

Background. Closed-loop rhythmic auditory stimulation (RAS) systems show promise for improving gait quality in people with Parkinson disease (PD). Objective: To examine auditory-motor entrainment and spatiotemporal gait responses to system-controlled rhythm tempo increase before and after a community-based RAS walking intervention. Methods. Thirteen persons with PD used an autonomous closed-loop RAS system during 30 walking sessions. Baseline (BL) and post-intervention (POST) gait responses to tempo increase were assessed as participants walked with the system in a clinic hallway. Rhythm tempo, entrainment, cadence, stride length, gait speed, and stride time variability (STV) were measured during the first minute (tempo at preferred walking cadence, prior to increase) and fifth minute (tempo above preferred cadence, following increase) of each assessment. Within- and between-assessment responses of entrainment and spatiotemporal variables to tempo increase were evaluated. Results. During each assessment, participants entrained to rhythmic cues while significantly increasing their cadence and stride length in response to tempo increase. Gait speed increased significantly only during the POST assessment. Nearly 70% of participants had significantly lower mean STV at the POST assessment compared to BL, indicating increased gait rhythmicity. The between-assessment decrease in STV was associated with increased stride length. Conclusions. Study findings supported the potential of an autonomous closed-loop RAS system to induce entrainment and meaningful gait responses to system-controlled tempo increase in persons with PD. The system appeared to promote implicit motor learning processes during use. Associated post-intervention improvements in rhythmicity and stride length in a subset of participants were suggestive of fall prevention effects.Trial registration: Prospectively registered at ClinicalTrials.gov (NCT05421624).