Can neurologic music therapy make the difference when using immersive virtual reality in Parkinson disease motor training? Promising findings from a secondary analysis

Background and purpose This study presents a secondary analysis of a quasi-randomized clinical trial exploring the effects of immersive virtual reality (VR) rehabilitation alone versus in combination with Neurologic Music Therapy (NMT) in individuals with Parkinson's disease (PD). Methods Twenty participants with idiopathic Parkinson's disease were allocated to two groups using a quasi-randomized procedure. One group received immersive VR-based gait training using the CAREN system (CAREN group), while the other received the same training protocol with the addition of NMT sensory-motor techniques delivered by a certified NMT therapist (CAREN-M group). Participants attended 12 rehabilitation sessions (three sessions per week over four weeks), each lasting approximately 45 min. Both groups underwent the same number, duration, and intensity of rehabilitation sessions. Clinical outcomes (BBS, Tinetti Scale, Barthel Index, 10-meter walking test, Timed-Up-Go) and biomechanical gait parameters (kinematic, kinetic, and electromyography data) were assessed for pre- and post-treatment. Results Both interventions led to significant improvements in motor function, but group-specific patterns emerged. The CAREN group showed greater gains in spatial parameters, such as gait speed and stride length, alongside increased muscle activation and improved joint kinematics. The CAREN-M group exhibited superior improvements in temporal parameters (e.g., cycle and swing duration), trunk stability, and postural control, suggesting that rhythmic auditory stimulation (RAS) may enhance motor timing and coordination. Between-group comparisons showed a greater reduction in Time Up and Go (TUG) times in the CAREN-M group. Discussion and conclusion These findings support the hypothesis that combining immersive VR (e.g., CAREN system) with NMT offers additive benefits by targeting distinct components of motor control through multisensory stimulation. The integration of rhythmic auditory cues into immersive VR environments can represent a promising direction for neurorehabilitation in PD, with the potential to improve functional mobility and gait quality. Trial Registration Number NCT07066137.