{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T06:47:24Z","timestamp":1776840444538,"version":"3.51.2"},"reference-count":121,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>External and internal auditory cueing strategies improve gait function, including velocity and stride length, in people with Parkinson disease (PD). Further, internal cueing can reduce gait variability, a measure associated with falls. In the present study, we asked whether the efficacy of external and internal rhythmic cues depends on dopaminergic status, i.e., OFF vs. ON medication. This question is relevant to the real-world use of cueing, as dopaminergic medication responsiveness fluctuates for individuals. We measured gait while participants with PD walked with an external cue (music playing aloud) and with an internal cue (mentally singing) in both OFF and ON medication states. We hypothesized both cues would improve gait regardless of medication status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f36) walked at a preferred pace without cues (Uncued), while a song played aloud at 120% of each participant\u2019s uncued cadence (Music), and while singing the same song in their head (Mental) in the OFF state and again after taking their normal dose of anti-PD medication. Variables were collected using Opal Sensors. Two, 2 (ON, OFF)\u202f\u00d7\u202f3 (Uncued, Music, Mental) repeated-measures multivariate ANOVAs were conducted: one for mean gait outcomes (cadence, velocity, stride length, double limb support) and one for their linear variability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Medication improved spatial measures of gait but did not change cadence. Both Music and Mental singing increased velocity, stride length, and cadence. For measures of linear variability, Music trials had statistically higher variability than Mental trials. There was an interaction effect between medication and cueing condition for double limb support; in the OFF-medication state, Music had longer double support times than Uncued and Mental singing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cueing strategies improved gait regardless of medication status, suggesting they may be useful throughout the day despite medication fluctuations. However, internally-based mental singing cues produced greater benefits than external music cues, in both the ON and OFF state, for measures of gait variability. Further investigation of the efficacy of cues within and across anti-PD medication cycles would be helpful to understand their utility in the real world.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnhum.2026.1808526","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:49:33Z","timestamp":1776836973000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of anti-parkinsonian medication on gait during internal and external rhythmic auditory cueing in PD"],"prefix":"10.3389","volume":"20","author":[{"given":"Sidney T.","family":"Baudendistel","sequence":"first","affiliation":[{"name":"Program in Physical Therapy, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren E.","family":"Tueth","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan P.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]},{"name":"Department of Neurology, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison M.","family":"Haussler","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liza","family":"Birov","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gammon M.","family":"Earhart","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]},{"name":"Department of Neurology, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]},{"name":"Department of Neuroscience, Washington University in St. Louis School of Medicine","place":["Saint Louis, MO, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.26685\/urncst.410","article-title":"The use of rhythmic auditory stimulation on gait parameters in Parkinson\u2019s disease: a systematic review","volume":"6","author":"Agarwal","year":"2022","journal-title":"URNCST J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"99","DOI":"10.11138\/FNeur\/2014.29.2.099","article-title":"\u201cMasters and servants\u201d in parkinsonian gait: a three-dimensional analysis of biomechanical changes sensitive to disease progression","volume":"29","author":"Albani","year":"2014","journal-title":"Funct. Neurol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1002\/mds.21603","article-title":"Dopaminergic modulation of timing control and variability in the gait of Parkinson\u2019s disease","volume":"22","author":"Almeida","year":"2007","journal-title":"Mov. Disord."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S50","DOI":"10.1002\/mdc3.13786","article-title":"Beyond the dopaminergic system: lessons learned from levodopa resistant symptoms in Parkinson\u2019s disease","volume":"10","author":"Antonini","year":"2023","journal-title":"Movement Disord Clin Pract"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"147727","DOI":"10.1016\/j.brainres.2021.147727","article-title":"Temporal dynamics of cortical activity and postural control in response to the first levodopa dose of the day in people with Parkinson\u2019s disease","volume":"1775","author":"Ara\u00fajo-Silva","year":"2022","journal-title":"Brain Res."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1093\/brain\/115.1.199","article-title":"Temporal discrimination is abnormal in Parkinson\u2019s disease","volume":"115","author":"Artieda","year":"1992","journal-title":"Brain"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1002\/mdc3.14016","article-title":"3D kinematics quantifies gait response to levodopa earlier and to a more comprehensive extent than the MDS-unified Parkinson\u2019s disease rating scale in patients with motor complications","volume":"11","author":"Barbosa","year":"2024","journal-title":"Movement Disord Clin Pract"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e164","DOI":"10.1212\/WNL.0000000000004795","article-title":"The laser shoes: a new ambulatory device to alleviate freezing of gait in Parkinson disease","volume":"90","author":"Barthel","year":"2018","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1080\/17582024.2025.2493465","article-title":"Characteristics of responders to interventions for Parkinson disease: a scoping systematic review","volume":"15","author":"Baudendistel","year":"2025","journal-title":"Neurodegener Dis Manag"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.gaitpost.2023.11.016","article-title":"Minimal clinically important differences of spatiotemporal gait variables in Parkinson disease","volume":"108","author":"Baudendistel","year":"2024","journal-title":"Gait Posture"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"110366","DOI":"10.1016\/j.jbiomech.2021.110366","article-title":"Levodopa facilitates improvements in gait kinetics at the hip, not the ankle, in Parkinson\u2019s disease","volume":"121","author":"Baudendistel","year":"2021","journal-title":"J. Biomech."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"19638","DOI":"10.1038\/s41598-019-55827-y","article-title":"Differential temporal perception abilities in Parkinson\u2019s disease patients based on timing magnitude","volume":"9","author":"Bernardinis","year":"2019","journal-title":"Sci. Rep."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"249","DOI":"10.3389\/fneur.2015.00249","article-title":"Parkinson\u2019s is time on your side? Evidence for difficulties with sensorimotor synchronization","volume":"6","author":"Bie\u0144kiewicz","year":"2015","journal-title":"Front. Neurol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/0022-510X(91)90283-D","article-title":"Dopa-sensitive and Dopa-resistant gait parameters in Parkinson\u2019s disease","volume":"103","author":"Blin","year":"1991","journal-title":"J. Neurol. Sci."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"106359","DOI":"10.1016\/j.clinbiomech.2024.106359","article-title":"Spatiotemporal, kinematic and kinetic gait characteristics in Parkinson\u2019s disease compared to healthy individuals: a systematic review with meta-analysis","volume":"120","author":"Bonacina","year":"2024","journal-title":"Clin. Biomech."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1111\/j.1365-2125.1990.tb03738.x","article-title":"Determinants of gait in the elderly parkinsonian on maintenance levodopa\/carbidopa therapy","volume":"30","author":"Bowes","year":"1990","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3390\/diseases7010018","article-title":"Assessing gait in Parkinson\u2019s disease using wearable motion sensors: a systematic review","volume":"7","author":"Brognara","year":"2019","journal-title":"Diseases"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1179\/1743132811Y.0000000044","article-title":"Gait variability in Parkinson\u2019s disease: influence of walking speed and dopaminergic treatment","volume":"33","author":"Bryant","year":"","journal-title":"Neurol. Res."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/ane.12505","article-title":"Gait variability in Parkinson\u2019s disease: levodopa and walking direction","volume":"134","author":"Bryant","year":"2016","journal-title":"Acta Neurol. Scand."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"247","DOI":"10.3233\/NRE-2011-0700","article-title":"Effects of levodopa on forward and backward gait patterns in persons with Parkinson\u2019s disease","volume":"29","author":"Bryant","year":"","journal-title":"NeuroRehabilitation"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1038\/s41746-024-01236-z","article-title":"Integrating digital gait data with metabolomics and clinical data to predict outcomes in Parkinson\u2019s disease","volume":"7","author":"Brzenczek","year":"2024","journal-title":"NPJ Digit. Med."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1097\/HNP.0000000000000462","article-title":"Effectiveness of rhythmic auditory stimulation on gait in Parkinson disease: a systematic review and meta-analysis","volume":"38","author":"Burrai","year":"2024","journal-title":"Holist. Nurs. Pract."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.gaitpost.2010.12.020","article-title":"Levodopa effect on electromyographic activation patterns of tibialis anterior muscle during walking in Parkinson\u2019s disease","volume":"33","author":"Caliandro","year":"2011","journal-title":"Gait Posture"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3389\/fneur.2016.00019","article-title":"The effect of dopaminergic medication on beat-based auditory timing in Parkinson\u2019s disease","volume":"7","author":"Cameron","year":"2016","journal-title":"Front. Neurol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/BF02080464","article-title":"Characteristics of the electromyographic patterns of lower limb muscles during gait in patients with Parkinson\u2019s disease when OFF and ON L-Dopa treatment","volume":"18","author":"Cioni","year":"1997","journal-title":"Ital J Neuro Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1038\/s41531-018-0043-7","article-title":"Rhythmic abilities and musical training in Parkinson\u2019s disease: do they help?","volume":"4","author":"Cochen De Cock","year":"2018","journal-title":"NPJ Parkinson\u2019s Dis"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1038\/npp.2010.113","article-title":"Neuroanatomical and neurochemical substrates of timing","volume":"36","author":"Coull","year":"2011","journal-title":"Neuropsychopharmacology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1002\/mds.26269","article-title":"Levodopa is a double-edged sword for balance and gait in people with Parkinson\u2019s disease: levodopa is a double-edged sword","volume":"30","author":"Curtze","year":"2015","journal-title":"Mov. Disord."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1002\/mdc3.12422","article-title":"Prevalence and correlates of anti-Parkinson drug use in a nationally representative sample","volume":"4","author":"Dahodwala","year":"2017","journal-title":"Mov Disord Clin Pract"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"8","DOI":"10.17294\/2330-0698.2057","article-title":"Real-world experiences of Parkinson\u2019s disease OFF time and role of demographics","volume":"11","author":"Devraj","year":"2024","journal-title":"J Patient Cent Res Rev"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1146\/annurev-neuro-072116-031548","article-title":"The role of variability in motor learning","volume":"40","author":"Dhawale","year":"2017","journal-title":"Annu. Rev. Neurosci."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1177\/147470491201000403","article-title":"Performance of music elevates pain threshold and positive affect: implications for the evolutionary function of music","volume":"10","author":"Dunbar","year":"2012","journal-title":"Evol. Psychol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e29635","DOI":"10.1371\/journal.pone.0029635","article-title":"Abnormal activity in the Precuneus during time perception in Parkinson\u2019s disease: an fMRI study","volume":"7","author":"Du\u0161ek","year":"2012","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"370","DOI":"10.2340\/16501977-1123","article-title":"Is gait speed a valid measure to predict community ambulation in patients with Parkinson\u2019s disease?","volume":"45","author":"Elbers","year":"2013","journal-title":"J. Rehabil. Med."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/j.clinph.2019.07.013","article-title":"Immediate effects of rhythmic auditory stimulation on gait kinematics in Parkinson\u2019s disease ON\/OFF medication","volume":"130","author":"Erra","year":"2019","journal-title":"Clin. Neurophysiol."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1002\/mds.27790","article-title":"Measuring Parkinson\u2019s disease over time: the real-world within-subject reliability of the MDS-UPDRS","volume":"34","author":"Evers","year":"2019","journal-title":"Mov. Disord."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.3233\/JPD-213082","article-title":"Reaching and grasping movements in Parkinson\u2019s disease: a review","volume":"12","author":"Fasano","year":"2022","journal-title":"J Parkinsons Dis"},{"key":"ref38","volume-title":"Discovering Statistics using IBM SPSS Statistics: and Sex and Drugs and Rock \u201cn\u201d Roll","author":"Field","year":"2013"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"685","DOI":"10.3390\/brainsci11060685","article-title":"The impact of exercise intervention with rhythmic auditory stimulation to improve gait and mobility in Parkinson disease: an umbrella review","volume":"11","author":"Forte","year":"2021","journal-title":"Brain Sci."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/1743-0003-2-23","article-title":"Effect of gait speed on gait rhythmicity in Parkinson\u2019s disease: variability of stride time and swing time respond differently","volume":"2","author":"Frenkel-Toledo","year":"2005","journal-title":"J Neuroeng Rehabil"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1093\/geronj\/39.6.662","article-title":"The effect of age on variability in gait","volume":"39","author":"Gabell","year":"1984","journal-title":"J. Gerontol."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"11781","DOI":"10.3390\/app142411781","article-title":"Cueing interventions for gait and balance in Parkinson\u2019s disease: a scoping review of current evidence","volume":"14","author":"Giorgi","year":"2024","journal-title":"Appl. Sci."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1002\/mds.20213","article-title":"Movement disorder society task force report on the Hoehn and Yahr staging scale: status and recommendations the movement disorder society task force on rating scales for Parkinson\u2019s disease","volume":"19","author":"Goetz","year":"2004","journal-title":"Mov. Disord."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1002\/mds.22340","article-title":"Movement disorder society-sponsored revision of the unified Parkinson\u2019s disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results: MDS-UPDRS: clinimetric assessment","volume":"23","author":"Goetz","year":"2008","journal-title":"Mov. Disord."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"3753","DOI":"10.1007\/s00421-025-05884-1","article-title":"Probing gait adaptations: the impact of aging on dynamic stability and reflex control mechanisms under varied weight-bearing conditions","volume":"125","author":"Gwerder","year":"2025","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1111\/j.1749-6632.2001.tb05733.x","article-title":"Cerebral substrates of musical imagery","volume":"930","author":"Halpern","year":"2001","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"113","DOI":"10.2217\/nmt-2021-0050","article-title":"The effect of auditory cues on gait variability in people with Parkinson\u2019s disease and older adults: a systematic review","volume":"13","author":"Harrison","year":"2023","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"15525","DOI":"10.1038\/s41598-018-33942-6","article-title":"Internal cueing improves gait more than external cueing in healthy adults and people with Parkinson disease","volume":"8","author":"Harrison","year":"2018","journal-title":"Sci. Rep."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/NPT.0000000000000288","article-title":"Mental singing reduces gait variability more than music listening for healthy older adults and people with Parkinson disease","volume":"43","author":"Harrison","year":"2019","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.gaitpost.2017.02.008","article-title":"The feasibility of singing to improve gait in Parkinson disease","volume":"53","author":"Harrison","year":"2017","journal-title":"Gait Posture"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1097\/NPT.0000000000000508","article-title":"Personalized auditory rhythmic cues to optimize gait in older adults and people with Parkinson disease","volume":"49","author":"Harrison","year":"2025","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e42337","DOI":"10.1371\/journal.pone.0042337","article-title":"Quantitative normative gait data in a large cohort of ambulatory persons with Parkinson\u2019s disease","volume":"7","author":"Hass","year":"2012","journal-title":"PLoS One"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"026113","DOI":"10.1063\/1.3147408","article-title":"Gait dynamics in Parkinson\u2019s disease: common and distinct behavior among stride length, gait variability, and fractal-like scaling","volume":"19","author":"Hausdorff","year":"2009","journal-title":"Chaos"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/17582024.2026.2647109","article-title":"Exploring maintenance of spatiotemporal gait parameters during internal and external rhythmic auditory cueing in Parkinson disease","author":"Haussler","year":"2026","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.gaitpost.2011.03.024","article-title":"Normative spatiotemporal gait parameters in older adults","volume":"34","author":"Hollman","year":"2011","journal-title":"Gait Posture"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.gaitpost.2020.09.005","article-title":"People with Parkinson disease with and without freezing of gait respond similarly to external and self-generated cues","volume":"82","author":"Horin","year":"2020","journal-title":"Gait Posture"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1016\/j.parkreldis.2015.10.006","article-title":"Minimal clinically important difference on the motor examination part of MDS-UPDRS","volume":"21","author":"Horv\u00e1th","year":"2015","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref58","doi-asserted-by":"publisher","first-page":"81","DOI":"10.3389\/fnint.2011.00081","article-title":"Modeling accuracy and variability of motor timing in treated and untreated Parkinson\u2019s disease and healthy controls","volume":"5","author":"Jones","year":"2011","journal-title":"Front. Integr. Neurosci."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.bandc.2008.02.121","article-title":"Basal ganglia, dopamine and temporal processing: performance on three timing tasks on and off medication in Parkinson\u2019s disease","volume":"68","author":"Jones","year":"2008","journal-title":"Brain Cogn."},{"key":"ref60","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1002\/mds.29410","article-title":"Levodopa dose equivalency in Parkinson\u2019s disease: updated systematic review and proposals","volume":"38","author":"Jost","year":"2023","journal-title":"Mov. Disord."},{"key":"ref61","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.baga.2017.05.001","article-title":"Patients\u2019 perspective on current treatment options for Parkinson\u2019s disease","volume":"9","author":"Jost","year":"2017","journal-title":"Basal Ganglia"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"e12144","DOI":"10.1002\/dad2.12144","article-title":"T-MoCA: a valid phone screen for cognitive impairment in diverse community samples","volume":"13","author":"Katz","year":"2021","journal-title":"Alzheimers Dement (Amst)"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1152\/jn.00197.2009","article-title":"Effect of dopaminergic medications on the time course of explicit motor sequence learning in Parkinson\u2019s disease","volume":"103","author":"Kwak","year":"2010","journal-title":"J. Neurophysiol."},{"key":"ref64","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/j.clinph.2017.11.022","article-title":"Abnormal somatosensory temporal discrimination in Parkinson\u2019s disease: pathophysiological correlates and role in motor control deficits","volume":"129","author":"Lee","year":"2018","journal-title":"Clin. Neurophysiol."},{"key":"ref65","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1080\/14737175.2023.2176220","article-title":"Optimizing levodopa therapy, when and how? Perspectives on the importance of delivery and the potential for an early combination approach","volume":"23","author":"Lees","year":"2023","journal-title":"Expert. Rev. Neurother."},{"key":"ref66","doi-asserted-by":"publisher","first-page":"601721","DOI":"10.3389\/fphys.2020.601721","article-title":"Influence of autocorrelated rhythmic auditory stimulations on Parkinson\u2019s disease gait variability: comparison with other auditory rhythm variabilities and perspectives","volume":"11","author":"Lheureux","year":"2020","journal-title":"Front. Physiol."},{"key":"ref67","doi-asserted-by":"publisher","first-page":"e3000504","DOI":"10.1371\/journal.pbio.3000504","article-title":"Mental operations in rhythm: motor-to-sensory transformation mediates imagined singing","volume":"18","author":"Li","year":"2020","journal-title":"PLoS Biol."},{"key":"ref68","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1191\/0269215505cr906oa","article-title":"Effects of external rhythmical cueing on gait in patients with Parkinson\u2019s disease: a systematic review","volume":"19","author":"Lim","year":"2005","journal-title":"Clin. Rehabil."},{"key":"ref69","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1097\/NPT.0000000000000250","article-title":"Auditory cueing for gait impairment in persons with Parkinson disease: a pilot study of changes in response with disease progression","volume":"43","author":"Lirani-Silva","year":"2019","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref70","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1007\/s00415-010-5789-8","article-title":"Gait variability in Parkinson\u2019s disease: an indicator of non-dopaminergic contributors to gait dysfunction?","volume":"258","author":"Lord","year":"2011","journal-title":"J. Neurol."},{"key":"ref71","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1093\/gerona\/gls255","article-title":"Independent domains of gait in older adults and associated motor and nonmotor attributes: validation of a factor analysis approach","volume":"68","author":"Lord","year":"2013","journal-title":"J. Gerontol. Ser. A Biol. Med. Sci."},{"key":"ref72","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3233\/THC-219003","article-title":"Application of nonlinear analysis for the assessment of gait in patients with Parkinson\u2019s disease","volume":"30","author":"Luk\u0161ys","year":"2021","journal-title":"Technol. Health Care"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1093\/ptj\/78.10.1083","article-title":"Variability in spatiotemporal gait characteristics over the course of the L-dopa cycle in people with advanced Parkinson disease","volume":"78","author":"MacKay-Lyons","year":"1998","journal-title":"Phys. Ther."},{"key":"ref74","doi-asserted-by":"publisher","first-page":"7","DOI":"10.4172\/2155-9538.S1-007","article-title":"Mobility lab to assess balance and gait with synchronized body-worn sensors","volume":"1","author":"Mancini","year":"2011","journal-title":"J. Bioeng. Biomed. Sci. Suppl."},{"key":"ref75","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1002\/mds.28406","article-title":"Is levodopa response a valid Indicator of Parkinson\u2019s disease?","volume":"36","author":"Martin","year":"2021","journal-title":"Mov. Disord."},{"key":"ref76","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1007\/s00415-012-6624-1","article-title":"Expanded and independent validation of the Movement Disorder Society\u2013unified Parkinson\u2019s disease rating scale (MDS-UPDRS)","volume":"260","author":"Martinez-Martin","year":"2013","journal-title":"J. Neurol."},{"key":"ref77","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.parkreldis.2014.10.026","article-title":"Parkinson\u2019s disease severity levels and MDS-unified Parkinson\u2019s disease rating scale","volume":"21","author":"Mart\u00ednez-Mart\u00edn","year":"2015","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref78","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1002\/mds.27242","article-title":"Validation study of the hoehn and yahr scale included in the MDS-UPDRS","volume":"33","author":"Martinez-Martin","year":"2018","journal-title":"Mov. Disord."},{"key":"ref79","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1136\/jnnp.62.1.22","article-title":"Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson\u2019s disease","volume":"62","author":"McIntosh","year":"1997","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref80","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/0022-510X(72)90002-0","article-title":"Micrographia in Parkinson\u2019s disease","volume":"15","author":"McLennan","year":"1972","journal-title":"J. Neurol. Sci."},{"key":"ref81","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/S1474-4422(19)30044-4","article-title":"Gait impairments in Parkinson\u2019s disease","volume":"18","author":"Mirelman","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref82","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1093\/brain\/117.5.1169","article-title":"The pathogenesis of gait hypokinesia in Parkinson\u2019s disease","volume":"117","author":"Morris","year":"1994","journal-title":"Brain"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/mds.870130115","article-title":"Abnormalities in the stride length-cadence relation in parkinsonian gait","volume":"13","author":"Morris","year":"1998","journal-title":"Mov. Disord."},{"key":"ref84","doi-asserted-by":"publisher","first-page":"95003","DOI":"10.1088\/1361-6579\/ab4023","article-title":"Validity of mobility lab (version 2) for gait assessment in young adults, older adults and Parkinson\u2019s disease","volume":"40","author":"Morris","year":"2019","journal-title":"Physiol. Meas."},{"key":"ref85","doi-asserted-by":"publisher","first-page":"2077","DOI":"10.1007\/s00221-021-06113-9","article-title":"The relation between falls risk and movement variability in Parkinson\u2019s disease","volume":"239","author":"Morrison","year":"2021","journal-title":"Exp. Brain Res."},{"key":"ref86","doi-asserted-by":"publisher","first-page":"5468","DOI":"10.3390\/s19245468","article-title":"Cueing paradigms to improve gait and posture in Parkinson\u2019s disease: a narrative review","volume":"19","author":"Muthukrishnan","year":"2019","journal-title":"Sensors"},{"key":"ref87","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1001\/jamaneurol.2019.0033","article-title":"Compensation strategies for gait impairments in Parkinson disease: a review","volume":"76","author":"Nonnekes","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref88","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/01616412.2025.2549042","article-title":"Investigation of changes in the choice reaction time with levodopa in patients with Parkinson\u2019s disease","author":"Onder","year":"2025","journal-title":"Neurol. Res."},{"key":"ref89","doi-asserted-by":"publisher","first-page":"pzab302","DOI":"10.1093\/ptj\/pzab302","article-title":"Physical therapist Management of Parkinson Disease: a clinical practice guideline from the American Physical Therapy Association","volume":"102","author":"Osborne","year":"2022","journal-title":"Phys. Ther."},{"key":"ref90","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1002\/mds.870130607","article-title":"Gait analysis in patients with Parkinson\u2019s disease and motor fluctuations: influence of levodopa and comparison with other measures of motor function","volume":"13","author":"O\u2019Sullivan","year":"1998","journal-title":"Mov. Disord."},{"key":"ref91","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1097\/00006842-200005000-00012","article-title":"Active music therapy in Parkinson\u2019s disease: an integrative method for motor and emotional rehabilitation","volume":"62","author":"Pacchetti","year":"2000","journal-title":"Psychosom. Med."},{"key":"ref92","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s10072-003-0130-2","article-title":"A paradoxical acute effect of levodopa in de novo parkinsonian patients: worsening of some bradykinetic components","volume":"24","author":"Pasetti","year":"2003","journal-title":"Neurol. Sci."},{"key":"ref93","doi-asserted-by":"publisher","first-page":"127","DOI":"10.3233\/JPD-2012-12077","article-title":"Effects of levodopa on vividness of motor imagery in Parkinson disease","volume":"2","author":"Peterson","year":"2012","journal-title":"J. Parkinsons Dis."},{"key":"ref94","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1002\/mdc3.12885","article-title":"The levodopa response varies in pathologically confirmed Parkinson\u2019s disease: a systematic review","volume":"7","author":"Pitz","year":"2020","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref95","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1159\/000546733","article-title":"Effects of on- and off-medication periods on walking performance in Parkinson\u2019s disease: insights from movement synergies","volume":"9","author":"Promsri","year":"2025","journal-title":"Digit Biomark"},{"key":"ref96","doi-asserted-by":"publisher","first-page":"901","DOI":"10.3390\/brainsci15090901","article-title":"Optimizing gait outcomes in Parkinson\u2019s disease: the effects of musical groove and familiarity","volume":"15","author":"Ready","year":"2025","journal-title":"Brain Sci."},{"key":"ref97","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1007\/s00213-002-1127-x","article-title":"Dopamine and human information processing: a reaction-time analysis of the effect of levodopa in healthy subjects","volume":"163","author":"Rihet","year":"2002","journal-title":"Psychopharmacology"},{"key":"ref98","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1590\/1807-55092014000400561","article-title":"Positive effects of auditory cue in locomotor pattern of people with Parkinson\u2019s disease (off and on medication)","volume":"28","author":"Rinaldi","year":"2014","journal-title":"Rev. Bras. Educ. F\u00eds. Esporte"},{"key":"ref99","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.clineuro.2014.06.026","article-title":"Effects of external cues on gait parameters of Parkinson\u2019s disease patients: a systematic review","volume":"124","author":"Rocha","year":"2014","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref100","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1002\/mds.23450","article-title":"Targeting dopa-sensitive and dopa-resistant gait dysfunction in Parkinson\u2019s disease: selective responses to internal and external cues: the influence of medication on cues in PD","volume":"26","author":"Rochester","year":"2011","journal-title":"Mov. Disord."},{"key":"ref101","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1017\/cjn.2018.21","article-title":"Effects of Antiparkinson medication on cognition in Parkinson\u2019s disease: a systematic review","volume":"45","author":"Roy","year":"2018","journal-title":"Can. J. Neurol. Sci."},{"key":"ref102","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.neuropsychologia.2016.09.027","article-title":"Sequence learning in Parkinson\u2019s disease: focusing on action dynamics and the role of dopaminergic medication","volume":"93","author":"Ruitenberg","year":"2016","journal-title":"Neuropsychologia"},{"key":"ref103","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.parkreldis.2019.07.031","article-title":"Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson\u2019s disease patients: results from the COPPADIS study cohort","volume":"66","author":"Santos Garc\u00eda","year":"2019","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref104","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/S0022-510X(03)00104-7","article-title":"Gait dynamics in Parkinson\u2019s disease: relationship to parkinsonian features, falls and response to levodopa","volume":"212","author":"Schaafsma","year":"2003","journal-title":"J. Neurol. Sci."},{"key":"ref105","doi-asserted-by":"publisher","first-page":"774","DOI":"10.3389\/fnhum.2014.00774","article-title":"Moving to music: effects of heard and imagined musical cues on movement-related brain activity","volume":"8","author":"Schaefer","year":"2014","journal-title":"Front. Hum. Neurosci."},{"key":"ref106","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.1002\/mdc3.70330","article-title":"Effects of levodopa on gait in people with Parkinson\u2019s disease with and without a history of falls","volume":"12","author":"Shah","year":"2025","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref107","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.parkreldis.2016.07.006","article-title":"Pharmacological treatment in Parkinson\u2019s disease: effects on gait","volume":"31","author":"Smulders","year":"2016","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref108","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/j.apmr.2012.10.026","article-title":"Cueing and gait improvement among people with Parkinson\u2019s disease: a meta-analysis","volume":"94","author":"Spaulding","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref109","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1002\/mds.20383","article-title":"Identification of motor and nonmotor wearing-off in Parkinson\u2019s disease: comparison of a patient questionnaire versus a clinician assessment","volume":"20","author":"Stacy","year":"2005","journal-title":"Mov. Disord."},{"key":"ref110","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1002\/mds.25383","article-title":"How to identify tremor dominant and postural instability\/gait difficulty groups with the movement disorder society unified Parkinson\u2019s disease rating scale: comparison with the unified Parkinson\u2019s disease rating scale","volume":"28","author":"Stebbins","year":"2013","journal-title":"Mov. Disord."},{"key":"ref111","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.cobeha.2018.01.004","article-title":"It\u2019s not (only) the mean that matters: variability, noise and exploration in skill learning","volume":"20","author":"Sternad","year":"2018","journal-title":"Curr. Opin. Behav. Sci."},{"key":"ref112","doi-asserted-by":"publisher","first-page":"e080952","DOI":"10.1136\/bmj-2024-080952","article-title":"Projections for prevalence of Parkinson\u2019s disease and its driving factors in 195 countries and territories to 2050: modelling study of global burden of disease study 2021","volume":"388","author":"Su","year":"2025","journal-title":"BMJ"},{"key":"ref113","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.neurom.2022.04.035","article-title":"Deep brain stimulation and levodopa affect gait variability in Parkinson disease differently","volume":"26","author":"Su","year":"2023","journal-title":"Neuromodulation"},{"key":"ref114","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1002\/mdc3.12552","article-title":"Handwriting analysis in Parkinson\u2019s disease: current status and future directions","volume":"4","author":"Thomas","year":"2017","journal-title":"Mov Disord Clin Pract"},{"key":"ref115","doi-asserted-by":"publisher","first-page":"e2253","DOI":"10.1212\/WNL.0000000000201159","article-title":"Evaluation of compensation strategies for gait impairment in patients with Parkinson disease","volume":"99","author":"Tosserams","year":"2022","journal-title":"Neurology"},{"key":"ref116","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.3233\/JPD-202176","article-title":"Perceptions of compensation strategies for gait impairments in Parkinson\u2019s disease: a survey among 320 healthcare professionals","volume":"10","author":"Tosserams","year":"2020","journal-title":"J Parkinsons Dis."},{"key":"ref117","doi-asserted-by":"publisher","first-page":"577435","DOI":"10.3389\/fnagi.2020.577435","article-title":"Gait progression over 6 years in Parkinson\u2019s disease: effects of age, medication, and pathology","volume":"12","author":"Wilson","year":"2020","journal-title":"Front. Aging Neurosci."},{"key":"ref118","doi-asserted-by":"publisher","first-page":"20120473","DOI":"10.1098\/rstb.2012.0473","article-title":"Action, time and the basal ganglia","volume":"369","author":"Yin","year":"2014","journal-title":"Philos. Trans. R. Soc. B"},{"key":"ref119","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1111\/j.1460-9568.2005.04298.x","article-title":"Dual tasking, gait rhythmicity, and Parkinson\u2019s disease: which aspects of gait are attention demanding?","volume":"22","author":"Yogev","year":"2005","journal-title":"Eur. J. Neurosci."},{"key":"ref120","doi-asserted-by":"publisher","first-page":"2641","DOI":"10.1002\/mds.70031","article-title":"Cortical and Corticomuscular Beta-gamma phase-amplitude coupling during different locomotion states and the effects of levodopa in Parkinson\u2019s disease","volume":"40","author":"Zhao","year":"2025","journal-title":"Mov. Disord."},{"key":"ref121","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1002\/mds.29762","article-title":"On-demand cueing for freezing of gait in Parkinson\u2019s disease: a randomized controlled trial","volume":"39","author":"Zoetewei","year":"2024","journal-title":"Mov. Disord."}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1808526\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:49:35Z","timestamp":1776836975000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1808526\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":121,"alternative-id":["10.3389\/fnhum.2026.1808526"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2026.1808526","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"article-number":"1808526"}}