Rhythmic Auditory Cueing May Improve Gait in People with Cerebral Palsy

A meta-analysis published in the 2018 edition of Neuropsychiatric Disease and Treatment suggests that rhythmic auditory cueing may be a valuable technique to improve gait in individuals with cerebral palsy (1).

Many people with cerebral palsy walk with what is known as “scissor gait,” a mobility pattern characterized by leg rigidity and an inward turn of the knees. Treatment options such as physical therapy and recreational therapy can help to improve gait and other coordination-related issues, and are often used as part of a comprehensive treatment program that includes medical care, speech therapy, and more. Previously shown to help better gait in stroke survivors and those with Parkinson’s disease, rhythmic auditory cueing may now be a worthwhile addition to pre-existing treatment regimens to help those who struggle with gait performance and stability related to cerebral palsy.

Rhythmic auditory cueing (also called rhythmic auditory entrainment) is a process that connects coordinated movement to the rhythmic patterns of music or a metronome. Both the body’s ability to perceive rhythmic patterns and the body’s ability to coordinate movement require precise timing, and therefore involve the use of overlapping brain areas. In fact, neuroimaging studies show that the brain areas necessary for motor function are activated simply by auditory perception of rhythmic stimuli. Due to this, researchers claim that the brain’s automated response to rhythmic sounds is a so-called “short-cut” to the neural mechanisms necessary to improve motor function (2).

Ghai et al. (2018) sought to apply the principles of rhythmic auditory cueing to improve gait in people with cerebral palsy. In an analysis of 227 participants (108 children, and 119 adults) across several relevant studies, Ghai et al. found that the presence of rhythmic auditory tones was associated with an overall qualitative gait improvement. In addition, they noted that improvements were also seen in gait dynamic index (a combined measurement of lower-limb motor performance), gait velocity, cadence, and stride length when rhythmic tones were present (1). Overall, investigators concluded that rhythmic auditory cueing could be an effective addition to current treatment protocols for gait and stability improvement in people with cerebral palsy.  

In addition to the physical benefits associated with rhythmic auditory cueing, researchers site the accessibility of this treatment as an additional advantage. Unlike many other treatments for gait improvement, rhythmic auditory cueing does not require extensive adaptive or therapeutic equipment, making it possible for families to practice this therapy at home. Researchers even suggest that something as usable as a smartphone app could function as a delivery tool for this type of therapy. In addition, the lack of equipment cuts down the cost of treatment; researchers postulate that rhythmic auditory cueing could be used in developing countries where cerebral palsy is rampant and treatment options are limited (1).

While there is still work to be done in order to optimize current rhythmic auditory cueing strategies to best benefit those with cerebral palsy, this research provides an optimistic foundation for a new, easy-to-use therapeutic technique to improve gait and stability in people with cerebral palsy.


  1. Ghai, S., Ghai, I., and Effenberg A. O. (2018). Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis. Neuropsychiatric Disease and Treatment 14(43-59), S148053. http://doi.org/10.2147/NDT.S148053
  2. Schaefer, R. S. (2014). Auditory rhythmic cueing in movement rehabilitation: findings and possible mechanisms. Philosophical Transactions of the Royal Society B: Biological Sciences, 369(1658), 20130402. http://doi.org/10.1098/rstb.2013.0402.
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