Retraining gait in Parkinson's Disease via a personalised app: A study protocol

Parkinson's disease (PD) is a progressive neurological disorder that often leads to gait impairments and an increased risk of falls, negatively impacting quality of life. Inertial-based wearables have extended gait evaluation beyond clinical settings, but their technical integration and general accessibility hinder widespread adoption. Smartphones, equipped with inertial sensors, present a scalable approach for gait assessment and retraining/rehabilitation. Auditory cueing, specifically music, has shown promise to retrain gait, yet its use and uptake is often limited by a lack of personalisation. This paper outlines an exploratory and experimental protocol to evaluate CuePD, a smartphone application/app that delivers near real-time gait assessment and personalised auditory cues (including music) for gait retraining in people with PD (PwPD). The protocol characterises beneficial and non-beneficial responses to different cueing strategies and presents separate analysis for the technical validation and gait response outcomes to reduce interpretive ambiguity between measurement performance and behavioural effects. Specifically, the protocol presents: 1) validation of CuePD's spatio-temporal gait characteristics in a controlled laboratory setting; 2) process to understand the usefulness of various auditory cues (metronome beats, instrumental music, and vocal music) to improve gait stability (i.e., increase gait speed and stride length while reducing gait variability); 3) evaluation of acceptance and preference of PwPD for personalised music cues; and 4) relationship between PwPD's musicality and their ability to adhere to auditory cues. Findings from the study will inform the suitability of gait retraining via smartphone-based app technology, personalised to the individual. Personalisation (gait characteristics and music) may potentially encourage long-term engagement for gait retraining which could lead to reduce falls and improved quality of life for PwPD. By explicitly accounting for individual variability, this protocol aims to clarify for whom and under what conditions auditory cueing is appropriate. Future work should systematically evaluate this approach as responses to auditory and/or music-based cueing in PwPD are heterogeneous with possible neutral or adverse effects, e.g., cognitive overload or exacerbation of freezing. This trial is registered at ClinicalTrials.gov (NCT06941779).