Objective: The goal of this work was to determine if personalization of musical cues, both externally and internally generated, can maximize individual responsiveness as reflected by improved walking.

Background: Internally generated cueing (in the form of mental singing) may provide a useful alternative to external cueing (in the form of listening to music) by eliminating the need to match an external source. However, not everyone responds the same to externally and internally generated cueing and we lack a strong understanding of how best to prescribe cues on an individualized basis.

Method: Fifty-eight participants (29 with PD and 29 controls) were tested during overground walking trials. Initial baseline trials (UNCUED) assessed preferred walking (PW) cadence. Participants then walked in two conditions: 1) while listening to music (MUSIC) and 2) while singing a song in their head (MENTAL). Within each condition, they walked at four tempos presented in random order (90%, 100%, 110%, 120% of PW), completing three 30-second walking trials at each tempo within each condition. Gait was assessed via six APDM Opal wearable sensors. For cued conditions, the tempo that elicited the longest strides for each participant was deemed “optimal” and used for analysis. Repeated-measures ANOVAs assessed differences between gait characteristics (velocity, cadence, and stride length) and gait variabilities (coefficients of variation) at different tempos.

Results: Both the PD and control groups exhibited the longest strides at the highest cue rate of 120% PW. Multivariate tests revealed a significant effect of condition on velocity, cadence, and stride length for both groups, showing that both cue types (MUSIC, MENTAL) significantly increased these measures from UNCUED. The median optimal cue rate was 130 beats per minute for both controls (range: 100-155) and people with PD (range: 75-150).  Velocity variability was lower for MENTAL than UNCUED, and both cadence variability and stride length variability were higher for MUSIC than for MENTAL.

Conclusion: Our results indicate that personalizing cues may help to enhance gait, and give clinicians information about parameters to explore to achieve optimization.  They also provide insight into how externally and internally generated cues may differentially affect gait variability, which could also inform choice of cue type for a given individual.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-personalized-musical-cues-to-optimize-walking-in-people-with-and-without-parkinson-disease/