Purpose: Rhythmic auditory stimulation such as listening to music can alleviate gait bradykinesia in people with Parkinson disease (PD) by increasing spatiotemporal gait features. However, evidence about what specific kinematic alterations lead to these improvements is limited, and differences in responsiveness to cueing likely affect individual motor strategies. Self-generated cueing techniques, such as singing or mental singing, provide similar benefits but no evidence exists about how these techniques affect lower limb joint movement. In this study, we assessed immediate effects of external and self-generated cueing on lower limb movement trajectories during gait.Methods: Using 3D motion capture, we assessed sagittal plane joint angles at the hip, knee, and ankle across 35 participants with PD, divided into responders (n = 23) and non-responders (n = 12) based on a clinically meaningful change in gait speed. Joint motion was assessed as overall range of motion as well as at two key time points during the gait cycle: initial contact and toe-off.Results: Responders used both cue types to increase gait speed and induce increases in overall joint ROM at the hip while only self-generated cues also increased ROM at the ankle. Increased joint excursions for responders were also evident at initial contact and toe-off.Conclusions: Our results indicate that self-generated rhythmic cues can induce similar increases in joint excursions as externally-generated cues and that some people may respond more positively than others. These results provide important insight into how self-generated cueing techniques may be tailored to meet the varied individual needs of people with PD.

中文翻译：

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帕金森步态运动学的变化与自我生成和外部生成的线索：反应者和非反应者的比较。

目的：听音乐等有节奏的听觉刺激可以通过增加时空步态特征来缓解帕金森病（PD）患者的步态运动迟缓。然而，关于哪些特定运动学改变导致这些改进的证据有限，对提示的反应差异可能会影响个体运动策略。自我生成的提示技术，如唱歌或心理歌唱，提供类似的好处，但没有证据表明这些技术如何影响下肢关节运动。在这项研究中，我们评估了外部和自生提示对步态过程中下肢运动轨迹的直接影响。根据步态速度的临床意义变化分为响应者 (n = 23) 和无响应者 (n = 12)。关节运动被评估为整体运动范围以及步态周期中的两个关键时间点：初始接触和脚趾离地。 结果：响应者使用两种提示类型来增加步态速度并诱导髋部整体关节 ROM 的增加而只有自我生成的线索也增加了脚踝的 ROM。在初始接触和脚趾离地时，响应者的关节偏移增加也很明显。结论：我们的结果表明，自生成的节奏提示可以像外部生成的提示一样诱导关节偏移的类似增加，并且有些人可能比其他人做出更积极的反应。