Sensorimotor cortex activity during cued gait differs in Parkinson's freezers and non-freezers
- 1University of California, Los Angles, David Geffen School of Medicine, Department of Neurology, Los Angeles, CA, USA
Abstract
Gait impairments are a major contributor to disability in patients with Parkinsons disease despite dopaminergic and neuromodulation therapies. External cues (e.g., visual targets, rhythmic auditory sounds) are commonly used to improve gait quality and reduce freezing of gait (FOG), yet their effectiveness varies across patients and contexts. Improved understanding of the neural mechanisms of cueing benefits is essential to personalize rehabilitation strategies and improve outcomes. We use mobile electroencephalography (EEG) to test the hypothesis that cues improve gait through engagement of voluntary motor control mechanisms to compensate for impaired gait automaticity. In addition, we investigate whether this mechanism is related to cueing benefits or freezing status. Eighteen PD patients with a history of freezing (PD-F), 21 patients without freezing (PD-NF) and 19 age-matched healthy controls (HC) walked overground under three conditions: normal walking, synchronizing to auditory cues, and stepping over visual cues. Stride-locked beta band (13-30 Hz) power dynamics in sensorimotor cortex were used to measure cortical control of stepping. Spatiotemporal gait parameters improved with cues in all groups. However, PD-F had smaller cue-related gains in speed and stride length when compared with PD-NF for both cue types, and did not improve gait speed with visual cues. EEG revealed greater contralateral sensorimotor cortex swing-phase beta suppression in PD-F than PD-NF patients, with visual cues eliciting the most robust response. In contrast, beta suppression with cues was less pronounced in PD-NF and HC, despite greater behavioral gains. In addition, engagement of sensorimotor cortex during visual cueing was associated with divergent gait effects across PD subgroups: In PD-NF greater beta suppression was associated with less gait improvement, whereas in PD-F the opposite was observed. These findings suggest distinct sensorimotor control mechanisms for cue utilization in PD-F and PD-NF, and indicate that engagement of voluntary motor control circuits may underlie cueing benefits primarily in PD-F.
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BibTeX
@misc{ma2026sensorimotor,
title = {{Sensorimotor cortex activity during cued gait differs in Parkinson's freezers and non-freezers}},
author = {L. Ma and M. Miura and I. Talu and K. A. Cross},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.19.26365651},
url = {https://www.medrxiv.org/content/10.64898/2026.10.19.26365651v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Sensorimotor cortex activity during cued gait differs in Parkinson's freezers and non-freezers
AU - L. Ma
AU - M. Miura
AU - I. Talu
AU - K. A. Cross
PY - 2026
DA - 2026/10/19
PB - medRxiv
DO - 10.64898/2026.10.19.26365651
UR - https://www.medrxiv.org/content/10.64898/2026.10.19.26365651v1
AB - Gait impairments are a major contributor to disability in patients with Parkinsons disease despite dopaminergic and neuromodulation therapies. External cues (e.g., visual targets, rhythmic auditory sounds) are commonly used to improve gait quality and reduce freezing of gait (FOG), yet their effectiveness varies across patients and contexts. Improved understanding of the neural mechanisms of cueing benefits is essential to personalize rehabilitation strategies and improve outcomes. We use mobile electroencephalography (EEG) to test the hypothesis that cues improve gait through engagement of voluntary motor control mechanisms to compensate for impaired gait automaticity. In addition, we investigate whether this mechanism is related to cueing benefits or freezing status. Eighteen PD patients with a history of freezing (PD-F), 21 patients without freezing (PD-NF) and 19 age-matched healthy controls (HC) walked overground under three conditions: normal walking, synchronizing to auditory cues, and stepping over visual cues. Stride-locked beta band (13-30 Hz) power dynamics in sensorimotor cortex were used to measure cortical control of stepping. Spatiotemporal gait parameters improved with cues in all groups. However, PD-F had smaller cue-related gains in speed and stride length when compared with PD-NF for both cue types, and did not improve gait speed with visual cues. EEG revealed greater contralateral sensorimotor cortex swing-phase beta suppression in PD-F than PD-NF patients, with visual cues eliciting the most robust response. In contrast, beta suppression with cues was less pronounced in PD-NF and HC, despite greater behavioral gains. In addition, engagement of sensorimotor cortex during visual cueing was associated with divergent gait effects across PD subgroups: In PD-NF greater beta suppression was associated with less gait improvement, whereas in PD-F the opposite was observed. These findings suggest distinct sensorimotor control mechanisms for cue utilization in PD-F and PD-NF, and indicate that engagement of voluntary motor control circuits may underlie cueing benefits primarily in PD-F.
ER -