Date of Award
Doctor of Philosophy (PhD)
Parkinson disease (PD) is a neurodegenerative movement disorder characterized by motor complications such as gait deficits and is caused by the depletion of dopamine producing neurons in the basal ganglia (BG). Gait deficits, including decreased velocity and increased variability, are among the most debilitating symptoms of PD and lead to an increased risk of falls. Common pharmacological treatments do not target many gait symptoms. Therefore, gait rehabilitation methods that can improve these deficits in gait are highly important. A common form of gait rehabilitation is known as rhythmic auditory cueing, in which an individual matches their footfalls to the beat an auditory stimulus while walking. This form of gait rehabilitation has shown benefits in older adults and people with neurological disorders such as PD, however it is still not fully understood who responds best or what underlying neural mechanisms are involved. The purpose of the studies of this dissertation is to expand our knowledge of these aspects of gait rehabilitation in people with PD. In Chapter 2, we aimed to investigate the effects of external and self-generated auditory cues on gait in people with PD with and without FOG. We found people with PD with and without FOG responded similarly to both cue types. We also found that those with higher baseline gait variability were more at risk of falls and responded best to both cue types. In Chapter 3, we aimed to investigate the effects of external and self-generated auditory cues on gait, finger tapping, and foot tapping, in an effort to design a methodology to be used in future neuroimaging studies. A secondary aim was to investigate associations between rhythm skills and auditory imagery abilities on response to rhythmic auditory cues. We found gait and finger tapping responded similarly to both cue types, suggesting finger tapping may serve as an adequate proxy for gait in neuroimaging studies. We found associations between beat perception and finger tapping performance, but not gait performance. In Chapter 4, we used resting state functional connectivity MRI to investigate associations between brain networks with gait characteristics and beat perception in people with PD. We found gait velocity was associated with functional connectivity within the visual network and between motor and cognitive networks; most notably between the BG and thalamus networks. There were no associations between beat perception with gait characteristics or functional connectivity. In Chapter 5, we investigated the usability of a mobile health (mHealth) application administering daily exercises including cued gait training for people with PD. We found no effects on outcome measures after a three-month intervention using the mHealth application, and low adherence indicated the usability of the mHealth application was limited. Overall, the results of this dissertation helped to expand our understanding of gait characteristics and rhythmic auditory cueing, and their clinical implications in people with PD.
Chair and Committee
Gammon M. Earhart
Meghan C. Campbell, Catherine E. Lang, Michael J. Mueller, Jonathan E. Peelle,
Horin, Adam Patrick, "Rhythmic Auditory Cueing of Gait in Parkinson Disease" (2020). Arts & Sciences Electronic Theses and Dissertations. 2200.