ORIGINAL RESEARCH article
Front. Rehabil. Sci.
Sec. Rehabilitation in Neurological Conditions
This article is part of the Research TopicInnovations in Exercise Prescription for Neurological Disorders: Mechanisms, Modalities, and OutcomesView all 7 articles
Can neurologic music therapy make the difference when using immersive virtual reality in Parkinson Disease motor training? Promising findings from a secondary analysis
Provisionally accepted
Paolo De Pasquale1
Mirjam Bonanno1*
Antonino Lombardo Facciale1
Maria Grazia Maggio1
Michael h Thaut2
Corene Patricia Thaut2Angelo Quartarone1
Federica Impellizzeri1Rocco Salvatore Calabrò1- 1Bonino Pulejo Neurology Center (IRCCS), Messina, Italy
- 2Music and Health Science Research Collaboratory, Faculty of Music, Faculty of Medicine, Institute of Medical Sciences and Rehabilitation Science Institute, University of Toronto, Toronto, Canada
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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 minutes. 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
Keywords: Biomechanics of gait, CAREN, gait analysis, Gait and Balance, Neurologic music therapy, Neurorehabilitation, Parkinson Disease, virtual reality
Received: 17 Sep 2025; Accepted: 05 Feb 2026.
Copyright: © 2026 De Pasquale, Bonanno, Lombardo Facciale, Maggio, Thaut, Thaut, Quartarone, Impellizzeri and Calabrò. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mirjam Bonanno
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