We comment on the recent publication by McIntosh et al 1 concerning rhythmic auditory motor facilitation of gait patterns in patients with Parkinson’s disease. These authors have shown a roughly 10% improvement in gait velocity as a result of entrainment of cadence with a metronome embedded in background music.

Although this study is interesting, the level of improvement in gait is therapeutically small and not directed to the amelioration of the basic deficit in parkinsonian gait. Other studies have clearly shown that the basic deficit in the control of parkinsonian gait is regulation of stride length. Cadence control is intact in Parkinson’s disease (Morris et al 2) and cadence is used as a compensatory mechanism for the defective control of stride length. This is done to increase gait velocity above normal and preset values for each individual patient. We see very little benefit in entraining patients whose cadence is already increased above normal values to improve velocity by values of only the order of 10%. This is particularly so when it is possible to restore normal gait …