Effects of rhythmic auditory cueing on stepping in place in patients with Parkinson's disease

Background: Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease (PD). Methods: Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition). Results: In the primary outcome, the cortical silent period (CSP) duration increased (P=.005), whereas short intracortical inhibition (SICI) decreased after training (P=.001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P=.033; NC: P=.009), whereas walking cadence increased after training (AC: P=.019; NC: P=.0023). Conclusions: Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.