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279 VISUAL FEEDBACK TO IMPROVE POSTURAL CONTROL DURING LOCOMOTION IN THE HEALTHY ELDERLY
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
combined GPI/PPN DBS. Posture was assessed by the upper body tilt angle (UBTA) in left–right body side for stance phase; to depict gait ignition, maximal rotational angle while turning on the spot (MaxRAWTOTS), mean time for turning 45° (MTT45) and the range of motion for the centre of mass while turning (ROMCOM) were measured. Results: Results are given in table 1. Table 1
PPN DBS only GPI DBS only PPN and GPI DBS
UBTA [°]
MaxRAWTOTS [°]
MTT45 [s]
ROMCOM [mm]
22.3 22.3 16.2
59 29 217
7.2 8.1 1.7
62 200 37
Conclusions: Isolated GPI and PPN DBS had a similar impact on posture, but the combination of both significantly improved the upright posture. Gait ignition was worst with isolated GPI DBS and better with isolated PPN DBS. Again the combined stimulation yielded the biggest benefit. This combined approach may be useful in treating drug-resistant features of advanced PD and encourages future studies.
Rehabilitation – Cognitive 277 RELATION BETWEEN INHIBITORY CONTROL AND IMPROVEMENT IN POSTURAL STABILITY AFTER COGNITIVE DUAL-TASK TRAINING K. Li1,2 , E. Roudaia3 , M. Lussier4,5 , L. Bherer4,5 , A. Leroux6 , P. Mckinley7 . 1 Psychology, Concordia University, 2 Centre for Research in Human Development, Montreal, QC, 3 Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, 4 Psychologie, Universit´e de Qu´ebec a ` Montr´eal, 5 Institut Universitaire de G´eriatrie 6 de Montr´eal, Exercise Science, 7 Physical and Occupational Therapy, McGill University, Montreal, QC, Canada Background: The present study examined transfer effects of cognitive dual-task training to new pairings of concurrent cognitive and balance tasks. We previously reported group level trainingrelated improvements. Here, we examine the relationship between magnitude of pre–post improvements in cognition and balance and two measures of executive control: inhibition and switching. Methods: Twenty healthy older adults aged 70+ were assigned to either training or control groups. Training consisted of five sessions of computerized cognitive dual-task training spaced over 3 weeks. Subjects performed a color decision (Task A) or a letter identity decision (Task B) either alone or together. At pre- and post-training, we assessed single-leg balance with eyes open, eyes closed, alone or with a concurrent n-back cognitive load. Doublesupport balance was similarly measured. Neuropsychological tests of inhibition (Stroop interference) and task switching (Trail Making) were also assessed before and after training. Results: Pooled across groups, improvement in single-support balance with eyes closed, with 0-back cognitive load, was correlated with improvement in cognitive dual-task performance (r-values ranged from 0.48 to 0.70). Improvement in single-support balance was also positively correlated with improvement in double-support balance under 0-back and 2-back cognitive loads (rs = 0.504 and 0.515). Partialling out pre-to-post changes in inhibitory control, but not task switching, led to reductions in these correlations. Conclusions: These results are in line with current work implicating executive processes in balance control. The results suggest a more central role for inhibitory processes than for task switching in balance.
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278 THE THREE-DIMENSIONAL ANALYSIS OF KINEMATIC GAIT PARAMETERS OF SUBJECTS WITH GONARTHROSIS BEFORE AND AFTER TOTAL KNEE REPLACEMENT 2 K. Ogrodzka1 , T. Niedzwiedzki ´ , W. Chwała3 . 1 Department of Rehabilitation in Traumatology, Academy of Physical Education, 2 Orthopedics and Traumatology Clinic, Collegium Medicum UJ, 3 Department of Biomechanics, Academy of Physical Education, Cracow, Poland Background and Aims: The aim of the studies was an attempt to evaluate the variability of parameters of the lower limb joints of subjects before and after total knee replacement and its influence on ankle and hip joints. Angular values changes were studied in three planes of movement. Spatiotemporal parameters were also taken into consideration. Studies on the locomotion were carried out on 27 gonarthrosis subjects aged from 60 to 74. The control group consisted of 30 healthy persons aged 50–70, the so-called biomechanical norm. Methods: The gait was examined with the use of a computer system of three-dimensional movement analysis Vicon 250. Results: The limitations of extension in hip and knee joints have been observed. The varus arrangement and external rotation of knee joints has been visible. There have been no plantar flexion ankle joints at the beginning of swing phase. After total knee replacement the arrangement of hip and knee joints has improved insignificantly. The varus alignment has decreased but the external rotation has increased. There have been no changes in ankle joints function. The analysis of spatiotemporal parameters has shown diminished cadence and walking speed and shortened stride length. However the double support phase and stride time have been lengthened. After knee arthroplasty spatiotemporal parameters have been improved slightly. Conclusions: Before knee arthroplasty patients have unsettled gait pattern, which has slightly changed after operation. This is probably the result of compensatory gait mechanism which has arosen before knee arthroplasty due to pain ailments.
Rehabilitation – Physical 279 VISUAL FEEDBACK TO IMPROVE POSTURAL CONTROL DURING LOCOMOTION IN THE HEALTHY ELDERLY E. Anson, P. Agada, H. Fleming, T. Kiemel, J. Jeka. Kinesiology, University of Maryland, College Park, MD, USA Introduction: Visual biofeedback for rehabilitation of balance is well studied, with varied results depending on the outcome variable measured. Use of visual feedback for balance control during locomotion has not been reported. We developed a visual feedback system that provides center of mass position feedback while walking on a treadmill. Preliminary results indicate that in healthy young adults, visual feedback leads to reduced power at low frequencies of body sway compared to no-visual feedback conditions, suggesting that visual feedback is useful for improved control of body sway during locomotion. We demonstrate here that the same effect is not consistently preserved in healthy older adults. Methods: Unilateral kinematic data for 3 healthy older adults was collected during locomotion trials on a treadmill at their comfortable speed, determined as the average of the slowest and fastest speeds reported as comfortable by each subject. Each subject completed five repetitions of two conditions: feedback or nofeedback. Power spectral densities were computed to characterize movement at all frequencies of motion. Results: Preliminary results indicate few differences in the spectral power when comparing the feedback and no feedback conditions.
S80
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
Conclusion: Reduction of sway variance when visual position feedback is available does not appear to be as robust in older adults compared to young adults. Training to improve use of visual information during locomotion could be an avenue for rehabilitation for older adults and individuals with balance disorders. 280 ZEROG: DYNAMIC OVER-GROUND BODY-WEIGHT SUPPORT SYSTEM K. Brady1 , D. Nichols2 . 1 Research, 2 Physical Therapy, National Rehabilitation Hospital, District of Columbia, DC, USA Purpose: A pilot study to determine whether incorporating ZeroG, a dynamic over-ground body weight support (BWS) gait training system, into conventional rehabilitation programs leads to significant improvements in gait. Background: Providing intensive gait training early after neurological injuries is critical to the recovery of lower extremity function (DeJong et al., 2005). Using ZeroG, individuals with gait impairments can begin practicing walking early after their stroke in a safe, controlled manner. Subjects: Individuals within 30 days from stroke onset, able to stand with maximal assistance for at least one minute, 18 years of age or older, weight less than 300 pounds, no uncontrolled cardiac or pain issues and able to follow simple commands. Methods: Subjects were randomly assigned to a conventional or ZeroG track, both receiving ten one hour sessions in addition to their usual acute rehabilitation therapies. Improvement in walking ability and lower limb function were evaluated at weeks 0, 2 and 14. Tests include walking speed, level of walking assistance, endurance, balance, motor control, spasticity and trunk control assessment. The system is divided into over-ground and balance modes. The therapist can adjust the maximal walking speed, the amount of BWS, static versus dynamic BWS and allowable fall distance the subject can experience. Results: Preliminary results of patients using the ZeroG show improvements in balance, walking speed and distance. Conclusions and clinical relevence: We believe training with this system will result in higher returns in functional walking ability compared to subjects trained using conventional methods. 281 COGNITIVE CHANGES IN ADHD CHILDREN AFTER A 12 WEEK POSTURAL REHABILITATION PROGRAM F. Carrick1 , G. Leisman1,2,3 , R. Melillo1,4 . 1 Neurology, FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience, Cape Canaveral, FL, USA; 2 Faculty of Health, Leeds Metropolitan University, Leeds, UK; 3 Neurology, University of Haifa, Haifa, Israel; 4 Psychology, DeMontfort University, Leicester, UK Background and Aims: There is a relationship between postural motor and cognitive function in children with attention deficit/ hyperactivity disorder (ADHD), suggesting involvement of the frontostriatal–cerebellar networks. The majority of children and adolescents with ADHD exhibit cerebellar signs with associated cognitive and motor abnormalities that include altered balance and gait. We desired to see if a physical rehabilitative treatment program directed to promote an increase in function of the postural motor system in ADHD children might have an effect in both postural and cognitive functions. Methods: This study compared the outcomes of a 12 week structured postural and gait therapy program in children diagnosed with ADHD according to DSM IV-TR diagnostic criteria with cognitive scores obtained from the Brown Attention Deficit Disorder Scale (BADDS) and Wechsler Individual Achievement Test, 2nd ed. (WIAT-II) tests. Results: ADHD children who completed a 12 week postural and gait therapy program increased their postural stability and gait
performance. Significant relationships were found between an improvement in postural motor skills and increased performance on both the BADDS and WIAT-II tests. Conclusions: These findings support the utilization of a therapy program specific to posture stabilization in the treatment of children diagnosed with ADHD and further enforce a relationship between postural motor and cognitive function in ADHD children. 282 DEVELOPMENT AND UTILIZATION OF A FALLS PREVENTION BOOKLET FOR PEOPLE WITH PARKINSON’S M. Caunter, L. Grantier. Pacific Parkinson’s Research Centre, UBC, Vancouver, BC, Canada Falls are a major cause of premature death and morbidity in the Parkinson population. The likelihood of frequent falls and the risk of injury increase as Parkinson’s disease (PD) progresses. This poster shows the development and utilization of a falls prevention booklet, collaboratively produced with our local health authority and the Parkinson Society British Columbia. Our booklet, “Stay on your feet”, is written specifically for patients with Parkinson’s and addresses the specific mobility issues and multifactorial risk factors for falls in this client group. This booklet offers advice and education for both patients and caregivers and is an important component of our falls prevention program. Objective: Using this widely available resource, will a proactive approach prevent or reduce the frequency of falls, improve patients’ quality of life or reduce the burden on the caregiver and the health care system? 283 IS MUSIC A FEASIBLE AND EFFECTUAL CUEING TECHNIQUE FOR GAIT? N. de Bruin1 , C. Kempster1 , J. Doan1 , G. Turnbull2 , O. Suchowersky3,4 , B. Hu3 , L. Brown1,2 . 1 Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, 2 Faculty of Health Professions, Dalhousie University, Halifax, NS, 3 Department of Clinical Neurosciences, University of Calgary, 4 Department of Medical Genetics, University of Calgary, Calgary, AB, Canada Background and Aims: Rhythmic auditory cues, such as a metronome tone are commonly reported as a viable and effectual technique for improving pathological gait. The requisite monotony of these cueing strategies may, however, challenge the sustainability of these strategies in patient populations. The purpose of this study was to explore the feasibility of using music as a cueing technique for gait. Methods: Temporal measures of gait were assessed amongst healthy younger adults (n = 19). Subjects completed 16 trials in four different test conditions: no music (NM), metronome (MET), salient music (SM), and non-salient music (NSM). Metronome, SM and NSM tempo closely matched (±4 beats per minute) each subject’s preferred cadence. Music salience was assigned based on subject enjoyment and familiarity ratings. Gait velocity and stride time variability were obtained from footswitch and timing-light data. Results: Gait velocity and stride time variability did not differ between the NM and cue-accompanied conditions (MET, SM, NSM). A main effect of cue type for gait velocity however, revealed that gait velocity was slower with NSM when compared to MET and SM conditions (p < 0.05). Conclusions: Gait performance was preserved between NM and cued conditions, implying that music may be a viable cueing alternative to a metronome tone. The effectiveness of the cue modality may, however, be influenced by salience. This may be an important factor in effectively using music to improve gait in patients with movement disorders, such as Parkinson’s disease.
combined GPI/PPN DBS. Posture was assessed by the upper body tilt angle (UBTA) in left–right body side for stance phase; to depict gait ignition, maximal rotational angle while turning on the spot (MaxRAWTOTS), mean time for turning 45° (MTT45) and the range of motion for the centre of mass while turning (ROMCOM) were measured. Results: Results are given in table 1. Table 1
PPN DBS only GPI DBS only PPN and GPI DBS
UBTA [°]
MaxRAWTOTS [°]
MTT45 [s]
ROMCOM [mm]
22.3 22.3 16.2
59 29 217
7.2 8.1 1.7
62 200 37
Conclusions: Isolated GPI and PPN DBS had a similar impact on posture, but the combination of both significantly improved the upright posture. Gait ignition was worst with isolated GPI DBS and better with isolated PPN DBS. Again the combined stimulation yielded the biggest benefit. This combined approach may be useful in treating drug-resistant features of advanced PD and encourages future studies.
Rehabilitation – Cognitive 277 RELATION BETWEEN INHIBITORY CONTROL AND IMPROVEMENT IN POSTURAL STABILITY AFTER COGNITIVE DUAL-TASK TRAINING K. Li1,2 , E. Roudaia3 , M. Lussier4,5 , L. Bherer4,5 , A. Leroux6 , P. Mckinley7 . 1 Psychology, Concordia University, 2 Centre for Research in Human Development, Montreal, QC, 3 Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, 4 Psychologie, Universit´e de Qu´ebec a ` Montr´eal, 5 Institut Universitaire de G´eriatrie 6 de Montr´eal, Exercise Science, 7 Physical and Occupational Therapy, McGill University, Montreal, QC, Canada Background: The present study examined transfer effects of cognitive dual-task training to new pairings of concurrent cognitive and balance tasks. We previously reported group level trainingrelated improvements. Here, we examine the relationship between magnitude of pre–post improvements in cognition and balance and two measures of executive control: inhibition and switching. Methods: Twenty healthy older adults aged 70+ were assigned to either training or control groups. Training consisted of five sessions of computerized cognitive dual-task training spaced over 3 weeks. Subjects performed a color decision (Task A) or a letter identity decision (Task B) either alone or together. At pre- and post-training, we assessed single-leg balance with eyes open, eyes closed, alone or with a concurrent n-back cognitive load. Doublesupport balance was similarly measured. Neuropsychological tests of inhibition (Stroop interference) and task switching (Trail Making) were also assessed before and after training. Results: Pooled across groups, improvement in single-support balance with eyes closed, with 0-back cognitive load, was correlated with improvement in cognitive dual-task performance (r-values ranged from 0.48 to 0.70). Improvement in single-support balance was also positively correlated with improvement in double-support balance under 0-back and 2-back cognitive loads (rs = 0.504 and 0.515). Partialling out pre-to-post changes in inhibitory control, but not task switching, led to reductions in these correlations. Conclusions: These results are in line with current work implicating executive processes in balance control. The results suggest a more central role for inhibitory processes than for task switching in balance.
S79
278 THE THREE-DIMENSIONAL ANALYSIS OF KINEMATIC GAIT PARAMETERS OF SUBJECTS WITH GONARTHROSIS BEFORE AND AFTER TOTAL KNEE REPLACEMENT 2 K. Ogrodzka1 , T. Niedzwiedzki ´ , W. Chwała3 . 1 Department of Rehabilitation in Traumatology, Academy of Physical Education, 2 Orthopedics and Traumatology Clinic, Collegium Medicum UJ, 3 Department of Biomechanics, Academy of Physical Education, Cracow, Poland Background and Aims: The aim of the studies was an attempt to evaluate the variability of parameters of the lower limb joints of subjects before and after total knee replacement and its influence on ankle and hip joints. Angular values changes were studied in three planes of movement. Spatiotemporal parameters were also taken into consideration. Studies on the locomotion were carried out on 27 gonarthrosis subjects aged from 60 to 74. The control group consisted of 30 healthy persons aged 50–70, the so-called biomechanical norm. Methods: The gait was examined with the use of a computer system of three-dimensional movement analysis Vicon 250. Results: The limitations of extension in hip and knee joints have been observed. The varus arrangement and external rotation of knee joints has been visible. There have been no plantar flexion ankle joints at the beginning of swing phase. After total knee replacement the arrangement of hip and knee joints has improved insignificantly. The varus alignment has decreased but the external rotation has increased. There have been no changes in ankle joints function. The analysis of spatiotemporal parameters has shown diminished cadence and walking speed and shortened stride length. However the double support phase and stride time have been lengthened. After knee arthroplasty spatiotemporal parameters have been improved slightly. Conclusions: Before knee arthroplasty patients have unsettled gait pattern, which has slightly changed after operation. This is probably the result of compensatory gait mechanism which has arosen before knee arthroplasty due to pain ailments.
Rehabilitation – Physical 279 VISUAL FEEDBACK TO IMPROVE POSTURAL CONTROL DURING LOCOMOTION IN THE HEALTHY ELDERLY E. Anson, P. Agada, H. Fleming, T. Kiemel, J. Jeka. Kinesiology, University of Maryland, College Park, MD, USA Introduction: Visual biofeedback for rehabilitation of balance is well studied, with varied results depending on the outcome variable measured. Use of visual feedback for balance control during locomotion has not been reported. We developed a visual feedback system that provides center of mass position feedback while walking on a treadmill. Preliminary results indicate that in healthy young adults, visual feedback leads to reduced power at low frequencies of body sway compared to no-visual feedback conditions, suggesting that visual feedback is useful for improved control of body sway during locomotion. We demonstrate here that the same effect is not consistently preserved in healthy older adults. Methods: Unilateral kinematic data for 3 healthy older adults was collected during locomotion trials on a treadmill at their comfortable speed, determined as the average of the slowest and fastest speeds reported as comfortable by each subject. Each subject completed five repetitions of two conditions: feedback or nofeedback. Power spectral densities were computed to characterize movement at all frequencies of motion. Results: Preliminary results indicate few differences in the spectral power when comparing the feedback and no feedback conditions.
S80
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
Conclusion: Reduction of sway variance when visual position feedback is available does not appear to be as robust in older adults compared to young adults. Training to improve use of visual information during locomotion could be an avenue for rehabilitation for older adults and individuals with balance disorders. 280 ZEROG: DYNAMIC OVER-GROUND BODY-WEIGHT SUPPORT SYSTEM K. Brady1 , D. Nichols2 . 1 Research, 2 Physical Therapy, National Rehabilitation Hospital, District of Columbia, DC, USA Purpose: A pilot study to determine whether incorporating ZeroG, a dynamic over-ground body weight support (BWS) gait training system, into conventional rehabilitation programs leads to significant improvements in gait. Background: Providing intensive gait training early after neurological injuries is critical to the recovery of lower extremity function (DeJong et al., 2005). Using ZeroG, individuals with gait impairments can begin practicing walking early after their stroke in a safe, controlled manner. Subjects: Individuals within 30 days from stroke onset, able to stand with maximal assistance for at least one minute, 18 years of age or older, weight less than 300 pounds, no uncontrolled cardiac or pain issues and able to follow simple commands. Methods: Subjects were randomly assigned to a conventional or ZeroG track, both receiving ten one hour sessions in addition to their usual acute rehabilitation therapies. Improvement in walking ability and lower limb function were evaluated at weeks 0, 2 and 14. Tests include walking speed, level of walking assistance, endurance, balance, motor control, spasticity and trunk control assessment. The system is divided into over-ground and balance modes. The therapist can adjust the maximal walking speed, the amount of BWS, static versus dynamic BWS and allowable fall distance the subject can experience. Results: Preliminary results of patients using the ZeroG show improvements in balance, walking speed and distance. Conclusions and clinical relevence: We believe training with this system will result in higher returns in functional walking ability compared to subjects trained using conventional methods. 281 COGNITIVE CHANGES IN ADHD CHILDREN AFTER A 12 WEEK POSTURAL REHABILITATION PROGRAM F. Carrick1 , G. Leisman1,2,3 , R. Melillo1,4 . 1 Neurology, FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience, Cape Canaveral, FL, USA; 2 Faculty of Health, Leeds Metropolitan University, Leeds, UK; 3 Neurology, University of Haifa, Haifa, Israel; 4 Psychology, DeMontfort University, Leicester, UK Background and Aims: There is a relationship between postural motor and cognitive function in children with attention deficit/ hyperactivity disorder (ADHD), suggesting involvement of the frontostriatal–cerebellar networks. The majority of children and adolescents with ADHD exhibit cerebellar signs with associated cognitive and motor abnormalities that include altered balance and gait. We desired to see if a physical rehabilitative treatment program directed to promote an increase in function of the postural motor system in ADHD children might have an effect in both postural and cognitive functions. Methods: This study compared the outcomes of a 12 week structured postural and gait therapy program in children diagnosed with ADHD according to DSM IV-TR diagnostic criteria with cognitive scores obtained from the Brown Attention Deficit Disorder Scale (BADDS) and Wechsler Individual Achievement Test, 2nd ed. (WIAT-II) tests. Results: ADHD children who completed a 12 week postural and gait therapy program increased their postural stability and gait
performance. Significant relationships were found between an improvement in postural motor skills and increased performance on both the BADDS and WIAT-II tests. Conclusions: These findings support the utilization of a therapy program specific to posture stabilization in the treatment of children diagnosed with ADHD and further enforce a relationship between postural motor and cognitive function in ADHD children. 282 DEVELOPMENT AND UTILIZATION OF A FALLS PREVENTION BOOKLET FOR PEOPLE WITH PARKINSON’S M. Caunter, L. Grantier. Pacific Parkinson’s Research Centre, UBC, Vancouver, BC, Canada Falls are a major cause of premature death and morbidity in the Parkinson population. The likelihood of frequent falls and the risk of injury increase as Parkinson’s disease (PD) progresses. This poster shows the development and utilization of a falls prevention booklet, collaboratively produced with our local health authority and the Parkinson Society British Columbia. Our booklet, “Stay on your feet”, is written specifically for patients with Parkinson’s and addresses the specific mobility issues and multifactorial risk factors for falls in this client group. This booklet offers advice and education for both patients and caregivers and is an important component of our falls prevention program. Objective: Using this widely available resource, will a proactive approach prevent or reduce the frequency of falls, improve patients’ quality of life or reduce the burden on the caregiver and the health care system? 283 IS MUSIC A FEASIBLE AND EFFECTUAL CUEING TECHNIQUE FOR GAIT? N. de Bruin1 , C. Kempster1 , J. Doan1 , G. Turnbull2 , O. Suchowersky3,4 , B. Hu3 , L. Brown1,2 . 1 Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, 2 Faculty of Health Professions, Dalhousie University, Halifax, NS, 3 Department of Clinical Neurosciences, University of Calgary, 4 Department of Medical Genetics, University of Calgary, Calgary, AB, Canada Background and Aims: Rhythmic auditory cues, such as a metronome tone are commonly reported as a viable and effectual technique for improving pathological gait. The requisite monotony of these cueing strategies may, however, challenge the sustainability of these strategies in patient populations. The purpose of this study was to explore the feasibility of using music as a cueing technique for gait. Methods: Temporal measures of gait were assessed amongst healthy younger adults (n = 19). Subjects completed 16 trials in four different test conditions: no music (NM), metronome (MET), salient music (SM), and non-salient music (NSM). Metronome, SM and NSM tempo closely matched (±4 beats per minute) each subject’s preferred cadence. Music salience was assigned based on subject enjoyment and familiarity ratings. Gait velocity and stride time variability were obtained from footswitch and timing-light data. Results: Gait velocity and stride time variability did not differ between the NM and cue-accompanied conditions (MET, SM, NSM). A main effect of cue type for gait velocity however, revealed that gait velocity was slower with NSM when compared to MET and SM conditions (p < 0.05). Conclusions: Gait performance was preserved between NM and cued conditions, implying that music may be a viable cueing alternative to a metronome tone. The effectiveness of the cue modality may, however, be influenced by salience. This may be an important factor in effectively using music to improve gait in patients with movement disorders, such as Parkinson’s disease.