Mental singing—"singing" a rhythmic song in your head—can improve measures of walking ability not only in people with Parkinson disease (PD), but also in healthy older adults, reports a study in The Journal of Neurologic Physical Therapy (JNPT). The journal is published in the Lippincott portfolio by Wolters Kluwer.

Mental singing (internal cueing) improves some gait measures that aren't affected by hearing music or singing aloud (external cueing), according to the new research by Elinor Harrison, PhD; Adam Horin, MA; and Gammon M. Earhart, PT, PhD, FAPTA, of the Program in Physical Therapy at the Washington University School of Medicine, St. Louis, MO. They write, "Optimizing the use of internal cues to facilitate movement is an important step towards more effectively meeting the needs of people with gait disorders related to aging or neurological disease."

Mental singing may have advantages for improving gait in PD

External cues—like music or metronome beats—are commonly recommended as a "pacemaker" to increase gait speed for people with PD. "Previously, we showed that internal cues (such as singing) produce similar motor benefits as external cues (such as listening to music) for people with PD," according to the authors. In the new study, they further explored how mental singing and singing aloud can improve measures of gait in older adults, with or without PD.

The study included 30 adults with PD and 30 healthy adults, aged 50 or older. Participants performed walking tests under three conditions: hearing music or singing aloud while walking (external cues) and singing in their heads while walking (internal cue).

All three trials used the same song: a rhythmic version of Row, Row, Row Your Boat. Participants were first asked to walk along to the beat of the song played aloud, then as they sang the song out loud or in their heads. The study also assessed the effects of hearing/singing the song at different tempos: at the person's preferred walking speed (cadence), 10% slower, or 10% faster.

As expected, people with PD walked slower, took shorter steps, and had higher levels of gait variability and asymmetry. The external cues—hearing music or singing aloud—led to improvements in gait performance, including velocity, cadence, and stride length. That was so for both the participants with PD and the healthy older adults.

However, only the internal cue—mental singing—led to reduced variability in gait measures, indicating increased stability. In both groups, tempos faster than the preferred cadence led to increased gait velocity and reduced variability.

The findings suggests that mental singing might be a more effective tool to increase walking speed in people with PD—counteracting the slow, shuffling gait characteristic of the disease. It's not clear why mental singing reduces gait variability, compared to hearing music or singing aloud. "Internal cues may pose less of a challenge compared to external cues," the researchers write.

The study adds new evidence that internal cueing may be more effective than commonly prescribed external cueing techniques. Mental singing also has an obvious advantage for people who would not feel comfortable walking down the street while singing aloud.

"Internal cues allow people to increase gait velocity while simultaneously reducing gait variability, which may ultimately contribute to enhanced gait stability and reduced fall risk," the authors conclude. They suggest that mental singing might also help to improve gait in other groups of patients, such as those with walking difficulties after a stroke.