Patients with Parkinson’s disease (PD) have various types of gait disturbance that are thought to result from impairments in motor timing. Gait disturbances are markedly improved with the use of appropriate visual and auditory cues. In this study, patients suffering from mild to moderate PD underwent a structured music therapy session in which they were trained to walk while mentally singing. The patients were trained in 7 progressive tasks, with a final goal of walking while mentally singing. Before and after the training session, they were videotaped. The video was analyzed for time and steps while walking straight paths and while turning. After a single session of training, the time and steps were significantly improved in both situations. Follow-up interviews with the patients indicated that they effectively utilized mental singing while walking in their daily lives. We propose that singing regulates basal ganglia function and allows patients with PD to keep time regularly. The task used in the present study was simple, required no special tools, and could be utilized anytime and anyplace. Thus, walking while mentally singing has potential for improving the gait of individuals with PD.

Fahn S: Parkinsonism; in Rowland LP (ed): Merritt’s Textbook of Neurology. Baltimore, Williams & Wilkins, 1995, pp 713–730.
Lim I, van Wegen E, de Goede C: Effects of external rhythmical cueing on gait in patients with Parkinson’s disease: a systematic review. Clin Rehabil 2005;19:695–713.
Yahalom G, Simon ES, Thorne R, Peretz C, Giladi N: Hand rhythmic tapping and timing in Parkinson’s disease. Parkinsonism Relat Disord 2004;10:143–148.
Meck WH: Neuropharmacology of timing and time perception. Cogn Brain Res 1996;3:227–242.
O’Boyle D, Freeman JS, Cody FWJ: The accuracy and precision of timing of self-paced, repetitive movements in subjects with Parkinson’s disease. Brain 1996;119:51–70.
Penhune VB, Zatorre RJ, Evans AC: Cerebellar contributions to motor timing: a PET study of auditory and visual rhythm reproduction. J Cogn Neurosci 1998;10:752–765.
Von Wilzenben HD: Methods in the Treatment of Postencephalic Parkinson’s. New York, Grune & Stratten, 1942, pp 135–138.
Cunnington C, Iansek R, Bradshaw JL, Philips JG: Movement-related potentials in Parkinson’s disease: presence and predictability of temporal and spatial cues. Brain 1995;118:935–950.
Dick JPR, Rothwell JC, Day BL, Cantello R, Buruma O, Gioux M, Benecke R, Berardelli A, Thompson PD, Marsden CD: The Bereitschaftspotential is abnormal in Parkinson’s disease. Brain 1989;112:233–244.
Glickstein M, Stein J: Paradoxical movement in Parkinson’s disease (review). Trends Neurosci 1991;14:480–482.
Praamstra P, Stegeman DF, Cools AR, Horstink MWIM: Reliance on external cues for movement initiation in Parkinson’s disease: evidence from movement-related potentials. Brain 1998;121:167–177.
Jiang Y, Norman KE: Effects of visual and auditory cues on gait initiation in people with Parkinson’s disease. Clin Rehabil 2006;20:36–45.
Cubo E, Leurgans S, Goetz CG: Short-term and practice effects of metronome pacing in Parkinson’s disease patients with gait freezing while in the ‘on’ state: randomized single blind evaluation. Parkinsonism Relat Disord 2004;10:507–510.
Ebersbach G, Heikmenberg M, Kindermann L, Trottenberg T, Wissel J, Poewe W: Interference of rhythmic constraint on gait in healthy subjects and patients with early Parkinson’s disease: evidence for impaired locomotor pattern generation in early Parkinson’s disease. Mov Disord 1999;14:619–625.
Freedland RL, Festa C, Sealy M, McBean A, Elghazaly P, Capan A, Brozycki L, Nelson AJ, Rothman J: The effects of pulsed auditory stimulation on various gait measurements in persons with Parkinson’s disease. Neurorehabilitation 2002;17:81–87.
Howe TE, Lovgreen B, Cody FW, Ashton VJ, Oldham JA: Auditory cues can modify the gait of persons with early-stage Parkinson’s disease: a method for enhancing parkinsonian walking performance? Clin Rehabil 2003;17:363–367.
McIntosh GC, Brown SH, Rice RR, Thaut MH: Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1997;62:22–26.
Morris ME, Iansek R, Matyas TA, Summers JJ: Ability to modulate walking cadence remains intact in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1994;57:1532–1534.
Suteerawattananon M, Morris GS, Etnyre BR, Jankovic J, Protas EJ: Effects of visual and auditory cues on gait in individuals with Parkinson’s disease. J Neurol Sci 2004;219:63–69.
Zijlstra W, Rutgers AW, Van Weerden TW: Voluntary and involuntary adaptation of gait in Parkinson’s disease. Gait Posture 1998;7:53–63.
Thaut MH, McIntosh GC, Rice RR, Miller RA, Rathbun J, Brault JM: Rhythmic auditory stimulation in gait training for Parkinson’s disease patients. Mov Disord 1996;11:193–200.
O’Shea S, Morris ME, Iansek R: Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks. Phys Ther 2002;82:888–897.
Berardelli A, Rothwell JC, Thompson PD, Hallett M: Pathophysiology of bradykinesia in Parkinson’s disease. Brain 2001;124:2131–2146.
Yogev G, Giladi N, Peretz C, Springer S, Simon ES, Hausdorff JM: Dual tasking, gait rhythmicity, and Parkinson’s disease: which aspects of gait are attention demanding? Eur J Neurosci 2005;22:1248–1256.
Pastor MA, Jahanshahi M, Artieda J, Obeso JA: Performance of repetitive wrist movements in Parkinson’s disease. Brain 1992;115:875–891.
Stewart L, von Kriegstein K, Warren JD, Griffiths TD: Music and the brain: disorders of musical listening. Brain 2006;129:2533–2553.
Xu D, Liu T, Ashe J, Bushara KO: Role of the olivo-cerebellar system in timing. J Neurosci 2006;26:5990–5995.
Laitinen LV, Bergenheim AT, Hariz ML: Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease. J Neurosurg 1992;76:53–61.
Lang AE, Lozano AM, Montgomery E, Duff J, Tasker R, Hutchinson W: Posteroventral medial pallidotomy in advanced Parkinson’s disease. N Engl J Med 1997;337:1036–1042.
Limousin P, Brown RG, Jahanshahi M, Asselman P, Quinn NP, Thomas D, Obeso JA, Rothwell JC: The effects of posteroventral pallidotomy on the preparation and execution of voluntary hand and arm movements in Parkinson’s disease. Brain 1999;122:315–327.
The Deep-Brain Stimulation for Parkinson’s Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001;345:956–963.
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