Rhythmic Auditory Cueing Research Articles

The Effects of Treadmill Training with Visual Feedback and Rhythmic Auditory Cue on Gait and Balance in Cerebral Palsy: A Randomized Controlled Trial

The Effects of Treadmill Training with Visual Feedback and Rhythmic Auditory Cue on Gait and Balance in Cerebral Palsy: A Randomized Controlled Trial

Model-based cueing-as-needed for walking in Parkinson's disease: A randomized cross-over study

BackgroundCorrecting of the lack of regularity in steps is a key component of gait rehabilitation in Parkinson's disease. We proposed to introduce adaptive spatial auditory cueing (ASAC) based on verbal instruction “lengthen the step” automatically delivered when the stride length decreased below a predetermined threshold. ObjectivesThe present study compared the effect of usual rhythmic auditory cueing versus ASAC used during a walking training in Parkinson's disease. MethodsFifteen patients with Parkinson's disease performed both interventions in randomized order, one week apart: a 20-minute walking training with rhythmic auditory cueing, in form of a metronome adjusted on 110% of the patient's own cadence, or ASAC delivered when the stride length is less than 110% of the patient's own stride length. Assessment criteria were walking distance covered during the intervention, speed, step length, cadence, coefficients of variation of step length and step duration, and indexes of spatial and temporal asymmetry during a walking test before and just after the intervention. ResultsThe walking distance is higher with ASAC compared with rhythmic auditory cueing (rhythmic auditory cueing, 905 (203) m, mean (standard deviation); ASAC, 1043 (212) m; P=0.002). Between-intervention comparison showed some similar effects on walking after the intervention including free speed and step length increases (P<0.05). ConclusionThe distance covered during 20-minute walking with ASAC increases by 15% compared to the use of classical rhythmic auditory cueing, while the immediate therapeutic effects show similar spatial-temporal benefits on short-distance walking. Auditory biofeedback cueing promoting the increase in step length might improve gait relearning in Parkinson's disease.

Facilitation of motor adaptation using multiple gait rehabilitation interventions.

The rate of adjustment in a movement, driven by feedback error, is referred to as the adaptation rate, and the rate of recovery of a newly adapted movement to its unperturbed condition is called the de-adaptation rate. The rates of adaptation and de-adaptation are dependent on the training mechanism and intrinsic factors such as the participant's sensorimotor abilities. This study investigated the facilitation of the motor adaptation and de-adaptation processes for spatiotemporal features of an asymmetric gait pattern by sequentially applying split-belt treadmill (SBT) and asymmetric rhythmic auditory cueing (ARAC). Two sessions tested the individual gait characteristics of SBT and ARAC, and the remaining four sessions consisted of applying the two interventions sequentially during training. The adjustment process to the second intervention is referred to as "re-adaptation" and is driven by feedback error associated with the second intervention. Ten healthy individuals participated in the randomized six-session trial. Spatiotemporal asymmetries during the adaptation and post-adaptation (when intervention is removed) stages were fitted into a two-component exponential model that reflects the explicit and implicit adaptation processes. A double component was shown to fit better than a single-component model. The decay constants of the model were indicative of the corresponding timescales and compared between trials. Results revealed that the explicit (fast) component of adaptation to ARAC was reduced for step length and step time when applied after SBT. Contrarily, the explicit component of adaptation to SBT was increased when it was applied after ARAC for step length. Additionally, the implicit (slow) component of adaptation to SBT was inhibited when applied incongruently after ARAC for step time. These outcomes show that the role of working motor memory as a translational tool between different gait interventions is dependent on (i) the adaptation mechanisms associated with the interventions, (ii) the targeted motor outcome of the interventions; the effects of factors (i) and (ii) are specific to the explicit and implicit components of the adaptation processes; these effects are unique to spatial and temporal gait characteristics.

Evidence of Implicit and Explicit Motor Learning during Gait Training with Distorted Rhythmic Auditory Cues

Gait training with rhythmic auditory cues contains motor learning mechanisms that are weighted more explicitly than implicitly. However, various clinical populations may benefit from a shift to gait training with greater implicit motor learning mechanisms. To investigate the ability to incorporate more implicit-weighted motor learning processes during rhythmic auditory cueing, we attempted to induce error-based recalibration using a subtly varying metronome cue for naïve unimpaired young adults. We assessed the extent of implicit and explicit retention after both an isochronous metronome and subtly varying metronome frequency during treadmill and overground walking. Despite 90% of participants remaining unaware of the changing metronome frequency, participants adjusted their cadence and step length to the subtly changing metronome, both on a treadmill and overground (p < 0.05). However, despite evidence of both implicit and explicit processes involved with each metronome (i.e., isochronous and varying), there were no between-condition differences in implicit or explicit retention for cadence, step length, or gait speed, and thus no increased implicit learning advantage with the addition of error-based recalibration for young, unimpaired adults.

Rhythmic auditory cueing in atypical parkinsonism: A pilot study.

Rhythmic auditory cueing (RAC) can improve gait parameters in neurological disorders such as Parkinson's disease and stroke. However, there is a lack of research on the effects of RAC in patients with atypical parkinsonian disorders (APD). Using a smartphone metronome application, we aimed to investigate the immediate effects of RAC in patients with clinically diagnosed APD, namely Progressive Supranuclear Palsy (PSP-Richardson Syndrome and other variants, PSP-nonRS), Corticobasal Syndrome (CBS), Multiple System Atrophy (MSA), and Dementia with Lewy Bodies (DLB). A total of 46 APD participants (25 PSP, 9 CBS, 8 MSA and 4 DLB; age: mean = 70.17, standard deviation = 7.15) walked at their preferred pace for 2 min without any rhythmic auditory cueing (RAC). Participants then walked the same path for another 2 min with RAC set at a tempo 10% faster than the baseline cadence of each participant. After a 10-15-min break, participants walked the same path for another 2 min without RAC to observe for carryover effects. Gait parameters [cadence (steps/minute), gait velocity (meters/minute), and stride length (centimeters)] were collected at baseline, during RAC, and post-RAC. There was a significant improvement in cadence in all participants from baseline to during RAC and post-RAC (corrected p-values = 0.009 for both). Gait velocity also improved from baseline to during RAC and post-RAC in all participants, although this improvement was not significant after correcting for multiple comparisons. The changes in cadence and gait velocity were most pronounced in PSP. In addition, our exploratory analysis showed that the cadence in the suspected TAU group (PSP+CBS) showed a significant improvement from baseline to during RAC and post-RAC (corr. p-value = 0.004 for both). This pilot study using short-term RAC in APD patients demonstrated improvements in cadence and velocity. There is an urgent need for effective gait rehabilitation modalities for patients with APD, and rhythmic cueing can be a practical and useful intervention to improve their gait pattern.

Insight into postural control in unilateral sensorineural hearing loss and vestibular hypofunction.

This pilot study aimed to identify postural strategies in response to sensory perturbations (visual, auditory, somatosensory) in adults with and without sensory loss. We tested people with unilateral peripheral vestibular hypofunction (N = 12, mean age 62 range 23-78), or with Unilateral Sensorineural Hearing Loss (USNHL, N = 9, 48, 22-82), or healthy controls (N = 21, 52, 28-80). Postural sway and head kinematics parameters (Directional Path in the anterior-posterior and medio-lateral directions (sway & head); pitch, yaw and roll (head) were analyzed in response to 2 levels of auditory (none, rhythmic sounds via headphones), visual (static, dynamic) and somatosensory cues (floor, foam) within a simulated, virtual 3-wall display of stars. We found no differences with the rhythmic auditory cues. The effect of foam was magnified in the vestibular group compared with controls for anterior-posterior and medio-lateral postural sway, and all head direction except for medio-lateral. The vestibular group had significantly larger anterior-posterior and medio-lateral postural sway and head movement on the static scene compared with controls. Differences in pitch, yaw and roll emerged between vestibular and controls only with sensory perturbations. The USNHL group did not increase their postural sway and head movement with the increased visual load as much as controls did, particularly when standing on the foam. They did not increase their medio-lateral sway with the foam as much as controls did. These findings suggest that individuals with USNHL employ a compensatory strategy of conscious control of balance, the functional implications of which need to be tested in future research.

Effects of rhythmic auditory cueing on gait variability and voluntary control of walking -a cross-sectional study.

Temporal gait variability is strongly associated with motor function and falls in the context of numerous diseases. Rhythmic auditory cueing (RAC) can influence stride-to-stride time, although its effects on temporal gait variability remain unclear. Therefore, the aim of the present cross-disease study was to examine the effects of RAC on stride time variability (STV), as well as the factors affecting changes in STV during walking with RAC. Participants with post-stroke (n=12) and orthopedic disease (n=23) performed a random block design under four conditions: comfortable walking speed (CWS) and walking with RAC (RAC 0%, RAC +10%, RAC -10%). STV was measured along with co-contraction and inter-muscular coherence of the shank muscles during walking for each condition. The contributions of the muscle activity pattern and voluntary control to the change in STV between the CWS and RAC 0% conditions were examined using hierarchical multiple regression analysis. STV was significantly lower in the RAC 0% condition than in the CWS condition (p=0.03). Hierarchical multiple regression analysis revealed that the change in STV was explained by STV in the CWS condition (β=-0.36) and by changes in co-contraction (β=0.43) and inter-muscular coherence (β=0.38) during the stance phase between the CWS and RAC 0% conditions (R2=0.56, p<0.001). These findings indicate that walking training with RAC is effective in reducing gait variability and immediately improves muscle activity patterns and excessive corticospinal activity.

Comparison of effect of rhythmic auditory cueing versus rhythmic visual cueing on gait abnormalities with gait parameters in Parkinson’s patients

: Parkinson’s patients benefit from multisensory cues, therefore it is vital to determine which sensory cue is more effective on gait.A Case-Control study design with a correlational technique wherein the evaluation of the relationship of the variables between two different groups was performed (baseline &amp; post-intervention). The study consisted of 14 individuals with Group A (n=7) &amp; Group B (n=7) using Random allocation by Chit Method. Group A (Rhythmic Auditory Cueing) with the help of metronomic cues given based on the subject’s initial cadence and progressed by 10% each week and Group B (Rhythmic Visual Cueing) with colorful stripes on the ground, the placement of which was changed each week. The duration of the study was 4 weeks (3 times each week), wherein the patients were made to walk on a 10m pathway. The outcome measures used were the crude method of gait analysis and the 10m Walk Test (at baseline and post-intervention). We conclude that both the group had improvements in their Spatio-temporal gait parameters, however, Group A had better results. The clinical study takes us to the conclusion that the intervention of Rhythmic auditory cueing proves to be more effective in improving the patient’s stride length, cadence, and, step-width thus helping in improving the patient's walking pattern.

Sensorimotor synchronization with music and metronome in school-aged children

Sensorimotor synchronization (SMS), the coordination of body movements with external stimuli (e.g., dancing, clapping along with music, sport activities), increases throughout childhood when assessed by finger-tapping (FT) tasks following rhythmic auditory cues using metronomes. However, metronomes may support less rhythmic entrainment than naturalistic auditory cues like music, so they may be less effective in showing developmental improvement. This study investigated the effects of age and sex on SMS comparing metronome versus music stimuli in four auditory FT tasks with regular fast (inter-stimulus interval [ISI] = 333 ms) and slow tempi (ISI = 1,000 ms). Participants were 305 typically developing children aged 6 to 11 years. We found improvement (lower variability) in performance with increasing age irrespective of the metronome or music FT and sex, particularly between 6 and 9 years, after which performance stabilized. Nonetheless, mostly irrespective of age, performance for music and metronome stimuli showed differences in synchronization accuracy and variability, indicating that the type of rhythmic stimuli affects performance. A developmental effect was also found in inter-tap variability (but not inter-tap accuracy). Overall, developmental effects were more robust in FT variability (motor implementation) although responses to music and metronome stimuli differed in ways that may be relevant to SMS deficits in clinical populations.

Association Between Temporal Asymmetry and Muscle Synergy During Walking With Rhythmic Auditory Cueing in Survivors of Stroke Living With Impairments

ObjectiveTo examine the relationship between temporal asymmetry and complexity of muscle synergy during walking using rhythmic auditory cueing (RAC) and the factors related to changes in muscle synergy during walking with RAC in survivors of stroke. DesignCross-sectional study. SettingWards at 2 medical corporation hospitals. ParticipantsForty survivors of stroke (N=40; mean age, 70.4±10.3 years; time since stroke, 72.2±32.3 days) who could walk without physical assistance. InterventionsNot applicable. Main Outcome MeasuresThe participants were assessed in a random block design under 2 conditions: comfortable walking speed (CWS) and walking with RAC. Single-leg support time, kinematics, and electromyograms were measured. Factors related to the complexity of muscle synergy (variance accounted for by 1 synergy [VAF1]) between the walking conditions were examined using hierarchical multiple regression analysis. ResultsIn the RAC condition, lower limb flexion and knee flexion angles, single-leg support time on the paretic side, and the symmetry index of single-leg support time were increased compared with those in the CWS condition. VAF1 was decreased in the RAC condition (73.9±0.15) compared with that in the CWS condition (76.9±0.13, P=.002). Hierarchical multiple regression analysis revealed that the change in VAF1 was explained by change in single-leg support time (R2=0.43, P=.002). ConclusionsThe RAC condition demonstrated a more complex representation of muscle synergy than the CWS condition; the change in single-leg support time on the paretic side related to the changes in muscle synergy more than changes in lower limb angle. These findings can help in the walking-training concept to improve muscle synergy deficits in survivors of stroke.

Effects of actual and imagined music-cued gait training on motor functioning and brain activity in people with multiple sclerosis: protocol of a randomised parallel multicentre trial

IntroductionMotor imagery (MI) refers to the mental rehearsal of a physical action without muscular activity. Our previous studies showed that MI combined with rhythmic-auditory cues improved walking, fatigue and quality...

Rhythm and Reaching: The Influence of Rhythmic Auditory Cueing in a Goal-Directed Reaching Task With Adults Diagnosed With Cerebral Palsy.

Improvements in functional reaching directly support improvements in independence. The addition of auditory inputs (e.g.,music, rhythmic counting) may improve goal-directed reaching for individuals with cerebral palsy (CP). To effectively integrate auditory stimuli into adapted teaching and rehabilitation protocols, it is necessary to understand how auditory stimuli may enhance limb control. This study considered the influence of auditory stimuli during the planning or execution phases of goal-directed reaches. Adults (with CP = 10, without CP = 10) reached from a home switch to two targets. Three conditions were presented-no sound, sound before, and sound during-and three-dimensional movement trajectories were recorded. Reaction times were shorter for both groups in the sound before condition, while the group with CP also reached peak velocity relatively earlier in the sound before condition. The group with CP executed more consistent movements in both sound conditions. Sound presented before movement initiation improved both the planning and execution of reaching movements for adults with CP.

Motor Imagery: A Resource in the Fatigue Rehabilitation for Return-to-Work in Multiple Sclerosis Patients—A Mini Systematic Review

Fatigue is a multidimensional symptom with both physical and cognitive aspects, which can affect the quality of daily and working life activities. Motor Imagery (MI) represents an important resource for use during the rehabilitation processes, useful, among others, for job integration/reintegration, of neurological pathologies, such as Multiple Sclerosis (MS). To define the effective rehabilitation protocols that integrate MI for the reduction of fatigue in patients with MS (PwMS), a literary review was performed through August 2020. Five articles were included in the qualitative synthesis, including two feasibility pilot randomized control trials (RCTs) and 3 RCTs with good quality according to the PEDro score and a low risk of bias according to the Cochrane Collaboration tool. The literature suggested that MI, in association with rhythmic-auditory cues, may be an effective rehabilitation resource for reducing fatigue. Positive effects were observed on perceived cognitive and psychological fatigue. PwMS require greater compensatory strategies than healthy individuals, and the use of rhythmic-auditory cues may be useful for optimizing the cognitive processing of MI, which acts as an internal stimulus that is enhanced and made more vivid by outside cues. These findings provide evidence that MI is a promising rehabilitation tool for reducing fatigue in PwMS and return to work strategies.

The Impact of Exercise Intervention with Rhythmic Auditory Stimulation to Improve Gait and Mobility in Parkinson Disease: An Umbrella Review.

Difficulties in walking, controlling balance, and performing activities of daily living are common problems encountered by individuals affected by Parkinson disease. Scientific evidence suggests that exercise performed with music or auditory or rhythmical cues facilitates movement and improves balance, gait, mobility, and activities of daily living (ADL) performance in patients with PD. The aim of this umbrella review was to summarize available high-quality evidence from systematic reviews and meta-analyses on the effectiveness of rhythmically cued exercise to improve gait, mobility, and ADL performance in individuals with PD. PubMed, Cochrane, and Embase databases were searched from January 2010 to October 2020 for systematic reviews and meta-analyses which had to be (1) written in English, (2) include studies on populations of males and females with PD of any age, (3) analyze outcomes related to gait, mobility, and ADL, and (4) apply exercise interventions with music or auditory or rhythmical cues. Two independent authors screened potentially eligible studies and assessed the methodological quality of the studies using the AMSTAR 2 tool. Four studies, two systematic reviews and meta-analyses, one a systematic review, and one a meta-analysis, were selected. Overall results indicated positive effects for gait and mobility of the use of rhythmic auditory cueing with exercise and suggested that it should be incorporated into a regular rehabilitation program for patients affected by PD. Nonetheless, more primary level research is needed to address the identified gaps regarding the application of this method to physical exercise interventions.

FNIRS & e-drum: An ecological approach to monitor hemodynamic and behavioural effects of rhythmic auditory cueing training

Converging evidence suggests a beneficial effect of rhythmic music-therapy in easing motor dysfunctions. Nevertheless, the neural systems underpinning both the direct effect and the influence of rhythm on movement control and execution during training in ecological settings are still largely unknown. In this study, we propose an ecological approach to monitor brain activity and behavioural performance during rhythmic auditory cueing short-term training. Our approach envisages the combination of functional near-infrared spectroscopy (fNIRS), which is a non-invasive neuroimaging technique that allows unconstrained movements of participants, with electronic drum (e-drum), which is an instrument able to collect behavioural tapping data in real time. The behavioural and brain effects of this short-term training were investigated on a group of healthy participants, who well tolerated the experimental settings, since none of them withdrew from the study. The rhythmic auditory cueing short-term training improved beat regularity and decreased group variability. At the group level, the training resulted in a reduction of brain activity primarily in premotor areas. Furthermore, participants with the highest behavioural improvement during training showed the smallest reduction in brain activity. Overall, we conclude that our study could pave the way towards translating the proposed approach to clinical settings.

Music as Add-On Therapy in the Rehabilitation Program of Parkinson's Disease Patients-A Romanian Pilot Study.

Music has been proven to have therapeutic potential in neurological disorders, especially Parkinson’s disease (PD), since rhythmic auditory cueing can partially replace the progressive loss of rhythmicity and automaticity. Several reports have highlighted improvements in motor outcomes in PD patients undergoing music therapy, but only a few studies have evaluated non-motor outcomes, such as quality of life (QoL), which deteriorates with disease progression. The current pilot study aims to examine the effects of a multimodal rehabilitation program centered on physical therapy combined with listening to music on self-reported QoL in people with PD, compared to the same rehabilitation program alone. The study was conducted on patients with idiopathic PD who attended a specific rehabilitation program with a duration of 2.5 h daily for 14 days. The patients were divided into the study group (16 patients), who listened to background music during the rehabilitation program sessions, and the control group who did not listen to music during sessions. The patients were assessed using the self-report Parkinson’s Disease Questionnaire (PDQ-39) at the beginning of the program and 1 month after its initiation. The patients in the study group registered greater improvements in five of the eight areas of life assessed by PDQ-39 compared to the control group. In conclusion, listening to music combined with a multimodal rehabilitation program centered on physical therapy may be beneficial for the patients’ quality of life.

Familiarity with music influences stride amplitude and variability during rhythmically-cued walking in individuals with Parkinson's disease.

Entrainment of walking with rhythmic auditory cues (e.g., metronome or music) induces gait improvements in people with Parkinson's disease (PD). However, evidence regarding acute impacts of music cues on parkinsonian gait is lacking. Findings in healthy adults imply that familiarity with music cues modulates stride amplitude and stride-to-stride variability; yet the role of familiarity with music on parkinsonian gait remains unknown. To investigate 1) whether familiar and unfamiliar music cueing differentially influences stride and arm swing amplitude and stride-to-stride variability, 2) how stride and arm swing amplitude and stride-to-stride variability are altered by enhanced familiarity with music by repeated listening and walking during rhythmically-cued walking in persons with PD. Twenty individuals with idiopathic PD (mean age = 68.9 years, 7 females, H&Y stage 1-3) walked in time with familiar and unfamiliar music cues (Session 1). Participants then repeatedly listened and walked to the same familiar and unfamiliar music cues (Session 2). Spatiotemporal gait parameters in each 2-min trial were recorded with motion capture wearable sensors. In Session 1, gait velocity, stride length, arm swing peak velocity and range of motion, and stride-to-stride variability increased with both music cues compared with baseline; stride length, enjoyment and beat salience were greater in familiar than unfamiliar music cues. In Session 2, repeatedly listening and walking to unfamiliar music, but not familiar music, increased gait velocity, stride length, familiarity, enjoyment, and beat salience, and reduced stride-to-stride time variability. Music cues in general induced acute improvements of stride and arm swing amplitude but not stride-to-stride variability, and enhanced familiarity with music improved stride amplitude and variability along with increased enjoyment and reduced cognitive demand in people with PD. Our findings aid in understanding the role of familiarity with music in alleviating gait disturbance and optimizing music-based interventions for PD.

Temporal accuracy of gait after metronome practice.

Humans readily entrain their movements to a beat, including matching their gait to a prescribed tempo. Rhythmic auditory cueing tasks have been used to enhance stepping behavior in a variety of clinical populations. However, there is limited understanding of how temporal accuracy of gait changes over practice in healthy young adults. In this study, we examined how inter-step interval and cadence deviated from slow, medium, and fast tempos across steps within trials, across trials within blocks, and across two blocks that bookended a period of practice of walking to each tempo. Participants were accurate in matching the tempo at the slow and medium tempos, while they tended to lag behind the beat at the fast tempo. We also found that participants showed no substantial improvement across steps and trials, nor across blocks, suggesting that participants had a robust ability to entrain their gait to the specified metronome tempo. However, we did find that participants habituated to the prescribed tempo, showing self-paced gait that was faster than self-paced baseline gait after the fast tempo, and slower than self-paced baseline gait after the slow tempo. These findings might represent an "after-effect" in the temporal domain, akin to after-effects consistently shown in other sensorimotor tasks. This knowledge of how healthy participants entrain their gait to temporal cues may have important implications in understanding how clinical populations acquire and modify their gait in rhythmic auditory cueing tasks.

From the Editor: Looking Forward in the New Year.

As I move into my third year as editor of the Journal of Music Therapy (JMT), I am grateful for the all the individuals who show continued support and commitment to music therapy and music therapy research. This past year was not what any of us expected—our communities are dealing with loss, hardships, and unexpected changes in the midst of a global pandemic. Clinicians and researchers have been met with obstacles that are unlike anything experienced previously, and many have shown a resilience that speaks to the power of music and music therapy. As we enter 2021, I can only hope that science and research, along with a renewed sense of compassion and humanity, will lead the way toward healing, recovery, and wellness. Part of my optimism for the future comes in terms of possibilities for the JMT. As this issue of the JMT illustrates, there is a wide range of scholarly activity occurring in the profession of music therapy. This research is valuable as it helps us understand the broad reach and application of music therapy practice. In a systematic review, Boster et al. (p. 12) present the ways in which music can improve social and participation outcomes in individuals with communication disorders. Thompson et al. (p. 70) conducted a pilot study on the use of rhythmic auditory cuing for gait in individuals with traumatic brain injury, showing favorable indicators for continued research. In a feasibility study, Polascik et al. (p. 43) found that a perioperative music listening program was feasible and acceptable. Lastly, Wilhelm and Knight (p. 95) conducted a survey on music therapy private practice, providing financial and marketing recommendations. The range of studies in this issue is an example of the various ways in which music therapy may be considered and researched.

The neural correlates of gait improvement by rhythmic sound stimulation in adults with Parkinson's disease – A functional magnetic resonance imaging study

IntroductionAdults with Parkinson's disease (PD) experience gait disturbances that can sometimes be improved with rhythmic auditory stimulation (RAS); however, the underlying physiological mechanism for this improvement is not well understood. We investigated brain activation patterns in adults with PD and healthy controls (HC) using functional magnetic resonance imaging (fMRI) while participants imagined gait with or without RAS. MethodsTwenty-seven adults with PD who could walk independently and walked more smoothly with rhythmic auditory cueing than without it, and 25 age-matched HC participated in this study. Participants imagined gait in the presence of RAS or white noise (WN) during fMRI. ResultsIn the PD group, gait imagery with RAS activated cortical motor areas, including supplementary motor areas and the cerebellum, while gait imagery with WN additionally recruited the left parietal operculum. In HC, the induced activation was limited to cortical motor areas and the cerebellum for both the RAS and WN conditions. Within- and between-group analyses demonstrated that RAS reduced the activity of the left parietal operculum in the PD group but not in the HC group (condition-by-group interaction by repeated measures analysis of variance, p < 0.05). ConclusionDuring gait imagery in adults with PD, the left parietal operculum was less activated by RAS than by WN, while no change was observed in HC, suggesting that rhythmic auditory stimulation may support the sensory-motor networks involved in gait, thus alleviating the overload of the parietal operculum and compensating for its dysfunction in these patients.