The possible price of auditory cueing: influence on obstacle avoidance in Parkinson's disease.

BACKGROUND: Under carefully controlled conditions, rhythmic auditory cueing can improve gait in patients with Parkinson's disease (PD). In complex environments, attention paid to cueing might adversely affect gait, for example when a simultaneous task-such as avoiding obstacles-has to be executed. We primarily examined whether concurrent auditory cueing interferes with an obstacle avoidance task in patients with PD. The secondary aim was to study differences between patients with and without freezing of gait. METHODS: Nineteen patients with PD (8 with freezing) were examined on a treadmill in 4 conditions: normal walking; walking with auditory cueing; walking with an obstacle avoidance task; and walking with auditory cueing and obstacle avoidance. Outcome measures included kinematic gait parameters and obstacle crossing parameters. RESULTS: Auditory cueing improved gait in PD, without negative effects on concurrent obstacle avoidance. Additionally, freezers avoided obstacles less efficiently than non-freezers. CONCLUSIONS: PD patients are able to successfully execute an obstacle avoidance task, when auditory cueing is administered simultaneously. The different obstacle avoidance behavior in freezers may contribute to their higher fall risk