Effectiveness of auditory and visual cues on Bradykinesia in individuals with Parkinsons disease: a comparative study


  • Dr. Snehal Joshi Professor, D.E. Society’s Brijlal Jindal College of Physiotherapy, Pune.
  • Dr. Arohi Deshpande Intern, D.E. Society’s Brijlal Jindal College of Physiotherapy, Pune.


Auditory cues, Bradykinesia, Parkinson’s disease, Visual cues


Introduction: Parkinsons disease (PD) is a neurodegenerative disorder affecting the physical, psychological, social, and functional status of an individual. Individuals with Parkinsons disease (PD) often demonstrate bradykinesia during mobility tasks. Due to bradykinesia; a person with Parkinsons may have difficulty performing everyday functions. This leads to activity limitation and participation restriction in these individuals. Hence different strategies are needed to overcome bradykinesia. Use of visual cues and auditory cues can be thought of improving this problem. Hence this study was conducted to find out the efficacy of auditory cues and visual cues and compare them.

Objectives 1)To assess the effectiveness of auditory cues on bradykinesia in Parkinsons patients 2) To assess the effectiveness of visual cues on bradykinesia in Parkinsons patients. 3) To compare the effectiveness of auditory and visual cues on bradykinesia in Parkinsons patients.

Methodology: After obtaining consent from the subjects, they were randomly divided into 3 groups in where they received either auditory cues (Metronome beats) or visual cues (video) or no cues for the selected functional activities. Reaction time was measured before and after intervention.

Conclusion: It was concluded that auditory cues are effective in improving bradykinesia.


Download data is not yet available.


1.Victoria A. Goodwin, Suzanne H. Richards, Rod S. Taylor, Adrian H. Taylor, and John L. Campbell. “The effectiveness of exercise interventions for people with Parkinson's disease: a systematic review and metaanalysis”. Mov Disord. 2008; 23(5).

2. Archibald N., Miller N., Rochester L. Neurorehabilitation in Parkinson disease. Handbook of Clinical Neurology. 2013;110:435–442. doi: 10.1016/ b978-0-444-52901-5.00037-x.

3. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181-4.

4. Sethi K. Levodopa unresponsive symptoms in Parkinson disease. Mov Disord. 2008;23 Suppl 3:S521- 33. doi: 10.1002/mds.22049.

5. Albin RL, Young AB, Penney JB. The functional anatomy of basal ganglia disorders. Trends Neurosci. 1989 Oct;12(10):366-75.

6. DeLong M. R. Primate models of movement disorders of basal ganglia origin. Trends in Neurosciences. 1990; 13(7): 281–285. doi: 10.1016/ 0166-2236 (90)90110-V

7. Obeso JA, Rodríguez-Oroz MC, Rodríguez M, Lanciego JL, Artieda J, Gonzalo N, Olanow CW. Pathophysiology of the basal ganglia in Parkinson's disease. Trends Neurosci.2000 Oct;23(10 Suppl):S8-19.

8. Benarroch E. E. Intrinsic circuits of the striatum. Complexity and clinical correlations. Neurology. 2016;86(16):1531–1542. doi: 10.1212/wnl. 0000000000002599.

9. Oorschot D. E. Total number of neurons in the neostriatal, pallidal, subthalamic, and substantia nigral nuclei of the rat basal ganglia: a stereological study using the cavalieri and optical disector methods. Journal of Comparative Neurology. 1996;366(4): 580–599.

10. Obeso JA, Rodriguez-Oroz MC, Rodriguez M, DeLong MR, Olanow CW. Pathophysiology of levodopa-induced dyskinesias in Parkinson's disease: problems with the current model. Ann Neurol. 2000 Apr; 47(4 Suppl 1):S22-32; discussion S32-4.

11. Berardelli A., Rothwell J. C., Thompson P. D., Hallett M. Pathophysiology of bradykinesia in parkinson's disease. Brain. 2001;124(11):2131–2146. doi: 10.1093/brain/124.11.2131.

12. Espay AJ, Beaton DE, Morgante F, Gunraj CA, Lang AE, Chen R. Impairments of speed and amplitude of movement in Parkinson's disease: a pilot study. Mov Disord. 2009 May 15; 24(7):1001-8. doi: 10.1002/ mds.22480.

13. Evarts E. V., Teräväinen H., Calne D. B. Reaction time in Parkinson's disease. Brain. 1981;104(1):167– 186. doi: 10.1093/brain/104.1.167.

14. Jahanshahi M., Brown R. G., Marsden C. D. Simple and choice reaction time and the use of advance information for motor preparation in Parkinson's disease. Brain. 1992;115(2):539–564. doi: 10.1093/ brain/115.2.539.

15. A. Pascual-Leone, J. Valls-Solé, J. P. Brasil-Neto, L. G. Cohen, and M. Hallett, “Akinesia in Parkinson's disease. I. Shortening of simple reaction time with focal, single-pulse transcranial magnetic stimulation,” Neurology, 44(5). pp. 884–891, 1994.

16. Dibble LE, Hale TF, Marcus RL, Gerber JP, LaStayo PC. High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson's disease: a preliminary study. Parkinsonism Relat Disord. 2009 Dec;15(10):752-7. doi:10.1016/j.parkreldis.2009.04.009. Epub 2009 Jun 3.

17. Dietz MA, Goetz CG, Stebbins GT. Evaluation of a modified inverted walking stick as a treatment for parkinsonian freezing episodes. Mov Disord. 1990;5 (3):243-7.

18. Jahanshahi M, Jenkins IH, Brown RG, Marsden CD, Passingham RE, Brooks DJ. Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson's disease subjects. Brain. 1995 Aug;118 (Pt 4): 913-33.

19. Freedland RL, Festa C, Sealy M, Capan A. he effects of pulsed auditory stimulation on various gait measurements in persons with Parkinson's Disease. neuroRehabilitation 2002; 17(1): 81-7.

20. Suteerawattananon M, Morris GS, Etnvre BR, Jankovic J, Protas EJ. . Effects of visual and auditory cues on gait in individuals with Parkinson's disease. Journal of neurosciences April 2004; 15:219 (1-2): 63-9.

21. Griffin HJ, Greenlaw R, Limousin P, Bhatia K, Quinn NP, Jahanshahi M. The effect of real and virtual visual cues on walking in Parkinson's disease. J Neurol. 2011 Jun;258(6):991-1000. doi: 10.1007/s00415-010-5866-z. Epub 2011 Jan 9.

22. Chong RK, Mills B, Dailey L, Lane E, Smith S, Lee KH. Specific interference between a cognitive task and sensory organization for stance balance control in healthy young adults: visuospatial effects. Neuropsychologia. 2010 Jul;48(9):2709-18. doi: 10.1016/j. neuropsychologia.2010.05.018. Epub 2010 May 15.

23. Kemps E, Szmalec A, Vandierendonck A, Crevits L (2005) Visuo-spatial processing in Parkinson's disease: evidence for diminished visuo-spatial sketch pad and central executive resources. Parkinsonism Relat Disord 11: 181-186.

24. Chong RKY, Gibson B, Horton S, Lee A, Mellinger J, et al. (2011) Spatial orientation during eyes closed versus open in the dark: Are they the same? : In review.

25. Devinsky O, Morrell MJ, Vogt BA Contributions of anterior cingulate cortex to behaviour. Brain (1995) 118: 279-306.

26. Kobayashi Y, Inoue Y, Isa T Pedunculo-pontine control of visuallyguided saccades. Prog Brain Res (2004) 143: 439-445.

27. Mathot S, Theeuwes J Visual attention and stability. Philos Trans RSoc Lond B Biol Sci (2011)366: 516-527.

28. Sawamoto N, Honda M, Hanakawa T, Fukuyama H, Shibasaki H Cognitive slowing in Parkinson’s disease: a behavioral evaluation independent of motor slowing. J
Neurosci (2002)22: 5198-5203.

29. Sohn YH, Kim GW, Huh K, Kim JS. Dopaminergic influences on the P300 abnormality in Parkinson's disease. J Neurol Sci. 1998 Jun 11;158(1): 83-7.

30. Steinmetz MA, Constantinidis C. Neurophysiological evidence for a role of posterior parietal cortex in redirecting visual attention. Cereb Cortex 1995;5: 448-456.

31. Hayes AE, Davidson MC, Keele SW, Rafal RD. Toward a functional analysis of the basal ganglia. J Cogn Neurosci. 1998 Mar;10(2):178-98.

32. van Schoor NM, Smit JH, Pluijm SM, Jonker C, Lips P. Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. J Clin Epidemiol. 2002 Sep; 55(9):855-62.

33. Richards M, Cote LJ, Stern Y (1993) The relationship between visuospatial ability and perceptual motor function in Parkinson’s disease. J Neurol, Neurosurg Psychiatry 56: 400-406.

34. Rochester L, Nieuwboer A, Baker K, Hetherington V, Willems AM, et al.(2007) The attentional cost of external rhythmical cues and their impact on gait in Parkinson’s disease: effect of cue modality and task complexity. J Neural Transm 114: 1243- 1248.

35. Rossignol S, Dubuc R, Gossard JP. Dynamic sensorimotor interactions in locomotion. Physiol Rev. 2006 Jan; 86(1):89-154.

36. Sherk H, Fowler GA. Neural analysis of visual information during locomotion. Prog Brain Res. 2001;134:247-64.

37. Shi LH, Luo F, Woodward DJ, Chang JY. Neural responses in multiple basal ganglia regions during spontaneous and treadmill locomotion tasks in rats. Exp Brain Res. 2004 Aug;157(3):303-14. Epub 2004 Apr 6.

38. rats. Exp Brain Res 157: 303-314. 69Ferrarin M, Brambilla M, Garavello L, Di Candia A, Pedotti A, et al. (2004) Microprocessor-controlled optical stimulating device to improve the gait of patients with Parkinson's disease. Med Biol Eng Comput 42: 328-332.

39. Closed-Loop VR-Based Interaction to Improve Walking in Parkinson's Disease Chong, J Nov Physiother 2011, 1:1,

40. Thaut M. H., Kenyon G. P., Schauer M. L., McIntosh G. C.. The connection between rhythmicity and brain function: implications for therapy of movement disorders. Eng. Med. Biol 1999a. Mag. 18, 101–108 [PubMed]

41.DeBruin,N.,Doan,J.B.,Turnbull,G.,Suchowersky, O., Bonfield, S.,Hu,B.,etal.Walking with music is as a safe and viable tool for gait training in Parkinson’s Disease: the effect of a 13-week feasibility study on single and dual task walking. Parkinson’s disease 9:483530.doi :4061/2010/483530

42. Pastor et al., 1992 M.A. Pastor, J. Artieda, M. Jahanshahi, J.A. Obeso Time estimation and reproduction is abnormal in Parkinson's diseaseBrain: A Journal of eurology, 1 (115 Pt) (1992), pp. 211-225

43. Journal of Neural Transmission February 2006, Volume 113, Issue 2, pp 175–185204.10. 3109/ 09638288.2013.774060.

44. Benoit CE, Dalla Bella S, Farrugia N, Obrig H, Mainka S, Kotz SA. Musically cued gait-training improves both perceptual and motor timing in Parkinson's disease. Front Hum Neurosci. 2014 Jul 7;8: 494. doi: 10.3389/fnhum.2014.00494. eCollection 2014.

45. Jahanshahi M, Jenkins IH, Brown RG, Marsden CD, Passingham RE, Brooks DJ. Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson's disease subjects. Brain. 1995 Aug;118 (Pt 4): 913-33.

46. Nombela C, Hughes LE, Owen AM, Grahn JA. Into the groove: can rhythm influence Parkinson’s disease? Neurosci Biobehav Rev (2013) 37:2564–70.10. 1016/j. neubiorev.2013.08.003.

47. Benjamin WE. A theory of musical meter. Music Percept (1984) 1:355–413.10.2307/40285269.]

48. Jackendoff RS. A Generative Theory of Tonal Music. Cambridge, IN: MIT Press; (1983).

49. Palmer C, Krumhansl CL. Mental representations for musical meter. J Exp Psychol Hum Percept Perform. 1990 Nov;16(4):728-41.

50. Alfredo Raglio Music Therapy Interventions in Parkinson’s Disease: The State-of-the-Art,*Front Neurol. Aug 2015 Published online 2015; 6: 185.




How to Cite

Dr. Snehal Joshi, Dr. Arohi Deshpande. Effectiveness of auditory and visual cues on Bradykinesia in individuals with Parkinsons disease: a comparative study. Biomed Rev: J Basic Appl Med Sci [Internet]. 2016Jun.30 [cited 2021Dec.7];4(1):25-32. Available from: https://biomedicalreview.in/index.php/jbams/article/view/36



Original Article