CuePD: Investigating the effect of personalised auditory cueing on gait in Parkinson's Disease

Abstract

Parkinson’s Disease (PD) is a progressive neurological disorder that results in gait impairments, which increases fall risk. Auditory cueing, traditionally administered via a metronome, has been shown to improve/regulate gait, but lack of innovation limits engagement and scalability of the approach. Music cueing has been explored as an alternative but lacks personalisation which limits its effectiveness. This thesis presents CuePD, a smartphone application that leverages embedded inertial sensors to perform comprehensive gait assessment and delivery of personalised auditory cues to retrain gait and reduce fall risk. CuePD follows the V3 framework, which delineates three phases to ensure the app is fit for purpose. Verification confirmed that the CuePD provides inertial signals and algorithms suitable for assessing gait and delivery of personalised auditory cues. Analytical Validation in 60 healthy adults demonstrated good to excellent agreement to assess gait in comparison to a gold-standard wearable for (ICCs > 0.865). It also showed that vocal music (VM) was the most preferred and optimal personalised cueing modality to deliver the greatest gains to increase gait speed (+0.14 ms) and stride length (+7.8 cm) and reduce stride time variability (0.53%). Clinical Validation in 30 people with PD (PwPD) demonstrated VM maintains its advantage as a cueing modality. Personalised VM cueing in PwPD increased gait speed by 0.10 m/s, stride length by 5.3 cm and lowered stride time variability by 0.44%. 93% of PwPD preferred VM to metronome, with excellent usability also being reported. Moreover, personalised VM cueing led to the highest proportion of participants showing improvement across all gait outcomes (>86%). Musicality did not influence adherence or outcome, indicating broad accessibility of VM cueing. The findings show that personalised VM cueing, delivered through a pervasive technology, can produce immediate, clinically meaningful improvements in gait, while remaining acceptable to users. CuePD offers a scalable gait retraining tool, with potential to reduce fall risk in PwPD. Longitudinal studies assessing sustained use and real-world impact are now warranted.

Date of Award	30 Sept 2025
Original language	English
Awarding Institution	Northumbria University
Supervisor	Alan Godfrey (Supervisor) & Peter McMeekin (Supervisor)