How to start walking with difficulties due to Parkinson’s disease?

Forward and with a song!
According to research, singing a rhythmic song to oneself helps patients with Parkinson’s disease improve their walking, making it more natural and stable [1]!

Background for conducting the research.

Some studies have previously shown that listening to music can improve gait in certain patients with Parkinson’s disease. In their earlier work, these researchers found that singing aloud improves walking and reduces gait variability compared to simply listening to a melody. People with Parkinson’s disease move more slowly and with less stability than healthy adults of the same age. It is believed that the decrease in walking speed is a result of shorter stride length and reduced step frequency, indicating a decline in overall health.

Listening to music (what scientists call an external auditory cue) helps normalize gait speed in patients with Parkinson’s disease by creating a pattern that people aim to align their steps with. Additionally, auditory cues impose a rhythm on walking, which seems to reduce reliance on internal synchronization mechanisms and increase motivation, thereby enhancing walking speed. External cues essentially set a pace that listeners respond to, restoring the rhythm of their gait and reducing its stiffness.

Researchers from the University of Washington ( WUSTL) previously reported that singing aloud (internal cue) leads to motor improvements in patients with Parkinson’s disease, similar to those observed in people listening to a rhythmic musical melody (external cue). In this study, scientists decided to compare the effects of singing aloud and singing to oneself on walking, based on the idea that internal repetition of a song uses the vocal-motor connection, aligning a person’s external movements with their own inner voice. A total of 60 people were included in the study: 30 men and 30 women. Half of the participants were diagnosed with Parkinson’s disease, and the other half were healthy elderly individuals. The average age was 65.8 years in the Parkinson’s disease group and 64.9 years in the control group

The participants’ reactions were assessed in three different situations: listening to a song, singing it aloud without musical accompaniment, and mentally singing it to themselves. All three tests were conducted at three different tempos: at the individual’s preferred walking speed (pedal rotation frequency), 10% slower, and 10% faster.

The instrumental version of the children’s song was used for evaluation « Row, Row, Row your Boat », developed with a distinctive rhythm that participants could easily remember. Everyone was familiar with the words and melody of the song and could sing it effortlessly. As expected, patients with Parkinson’s disease moved more slowly, took shorter steps, and exhibited a higher level of variability and asymmetry in gait than healthy participants.

Both in the group of healthy participants and in patients with Parkinson’s disease, an improvement in walking was observed when mentally singing a song to oneself compared to simply listening to music or singing aloud. “Only internal signals in the brain cause an improvement in gait,” the researchers concluded. In this study, they proved that mentally singing to oneself leads to a reduction in gait variability compared to regular singing and listening. Additionally, other lifestyle modifications, such as coffee consumption, vitamin D level control, and good sleep, affect the reduction of Parkinsonism symptoms.

In addition to the medication therapy prescribed by your neurologist, in cases of severe stiffness or complications due to a high dose of levodopa, you can consider MRI-guided focused ultrasound treatment. This is a cutting-edge, yet already widely accepted method for treating Parkinson’s disease.

Source:

Research “Mental Singing Improves Motor Activity More Than Simple Listening to Music in People with Parkinson’s Disease” // Journal of Neurological Physiotherapy Journal of Neurologic Physical Therapy). 09.2019. URL: https://journals.lww.com/jnpt/Abstract/publishahead/Mental_Singing_Reduces_Gait_Variability_More_Than.99757.aspx?PRID=JNPT_PR_082619