Music-Based Interventions for Gait Disturbances and Freezing of Gait in Parkinson’s Disease

Gait disturbance and freezing of gait (FOG) are common and disabling motor complications in Parkinson's disease (PD) that are often insufficiently controlled by dopaminergic medication or deep brain stimulation.As gait is regulated by multi-layered neural networks involving basal ganglia-thalamic-cortical (BGTC) and cerebello-thalamo-cortical (CTC) loops, music-based interventions have been proposed as compensatory strategies targeting these circuits.We summarize the neurophysiological mechanisms of normal gait and gait impairment in PD, and introduce music-based interventions for gait problems, in particular FOG, based on current evidence.These interventions include rhythmic auditory stimulation (RAS) and music-movement integrated therapies including music-based movement therapy (MMT) and therapeutic instrumental music performance (TIMP).Loss of dopaminergic signaling in the BGTC loop impairs internal timing and automatic gait generation, while maladaptive over-recruitment of the CTC loop increases gait variability and instability.RAS provides regular external rhythms that entrain the auditory-cerebellar-premotor network, compensating for impaired internal timing and modulating pathological beta synchrony in basal ganglia-cortical circuits.MMT and TIMP further combine rhythmic cues with multi-joint, task-specific movement training, promoting sensory-motor integration, balance control, and gait kinematic reorganization.Randomized trials suggest improvements in stride length, double-support time, FOG severity, and balance, but effect sizes vary and patient-level moderators remain unclear.Music-based interventions represent promising adjunctive strategies for PD-related gait disturbance and FOG.However, optimal cue complexity, cognitive load, and patient selection criteria are not yet established.Mechanism-based trials using