Can rhythm abilities and musical training help Parkinson’s disease?

Music is a universal trait of humankind. The majority can move to the beat, react emotionally to music, recognize well-known tunes, and sing proficiently. These skills, which can be improved via dedicated training, are generally referred to as “musicality”, 1 and vary considerably among individuals. Remarkably, individual differences in musicality may play a critical role in understanding the variability of the response to music-based interventions in neurological rehabilitation.

In particular, rhythmic skills and the ability to move to the beat of music may predict the well-known response to rhythmic auditory cueing (RAC) on gait of patients with Parkinson’s Disease (PD). In PD, the dysfunctional basal ganglia-cortical circuitry is associated with timing distortions in the perception and production of rhythmic events. Providing an external rhythmic cue is likely to compensate for the impaired internal generation of rhythm, as suggested recently. The magnitude of this effect and whether RAC improves or deteriorates motor performance may depend on individual differences in rhythmic skills.

To date there are no guidelines for using RAC as an individualized clinical tool. The ability to track the beat of rhythmic cues may allow predicting a patient’s response to cueing, as suggested for healthy young adults. Moreover, other aspects of musicality such as perceptual skills, emotional response to music, and musical training, as well as clinical and cognitive functioning may also modulate the beneficial effect of cueing.

To verify this, Nature’s paper measured the rhythmic signal gait of 39 non-demented patients with Parkinson’s disease and 39 healthy controls, and showed individual patients for various rhythmic stimuli. The gait responses were investigated, motor and nonmotor rhythm functions were tested, and general musicality was assessed.

As a result, Rhythmic auditory cues can immediately improve gait in Parkinson’s disease. Patients’ rhythmic abilities and musicality (e.g.,perceptual and singing abilities, emotional response to music, and musical training) may foster a positive response to rhythmic cues.

Other factors such as emotional and motivational aspects may also contribute to improve gait.Music is typically a motivating stimulus, known for its ability to engage emotions and stimulate the reward system, while acting on the dopaminergic system. Walking with music may be a rewarding activity in itself.

A response to cueing was qualified as positive when the stimulation led to a clinically meaningful increase in gait speed. It observed that patients with positive response to cueing were more musically trained, aligned more often their steps to the rhythmic cues while walking, and showed better music perception as well as poorer cognitive flexibility than patients with non-positive response. It concluded that rhythmic and musical skills, which can be modulated by musical training, may increase beneficial effects of rhythmic auditory cueing in Parkinson’s disease.