Walking impairments in Parkinson’s disease (PD), including reduced speed, cadence, and stride length, and increased variability, impair mobility and raise fall risk. Conventional treatments may fail to address these deficits, underscoring the need for complementary non-invasive alternatives. This study examined whether combining rhythmic auditory cueing with transcranial direct current stimulation (tDCS) over the supplementary motor area (SMA), a critical region for internally-generated movement, would enhance gait performance in PD. Thirty-three participants with PD and thirty-two healthy controls completed two sessions (anodal vs. sham tDCS) with gait assessed during stimulation, immediately after stimulation, and 15 minutes after stimulation under two auditory conditions: walking in silence and walking to music paced 10% faster than baseline cadence. Spatiotemporal, variability, and stability gait parameters were analyzed using linear mixed-effects models. Rhythmic auditory cueing significantly increased cadence and speed during, immediately after, and especially 15 minutes after stimulation, suggesting sustained effects of rhythmic entrainment. Anodal tDCS produced faster cadence, as well as lower stride time variability and stride width, particularly in individuals with PD. Although both music and anodal tDCS affected gait, no interaction was observed, indicating independent effects. Individuals with PD had greater gait variability overall, and adjusted temporal gait parameters less to music than healthy controls did. Anodal stimulation reduced walking variability in PD, reducing the group differences observed under sham conditions. These findings suggest that rhythmic cueing and SMA stimulation target complementary mechanisms, highlighting the promise of combined tDCS–music interventions for gait rehabilitation in PD.

The authors have declared no competing interest.

The study was designed as a mechanistic investigation of neuromodulation and auditory-motor coupling rather than a clinical efficacy trial. This study is a prospective interventional experiment using a within-subject crossover design to investigate the effects of tDCS and auditory cueing on gait in Parkinson's disease. It is not a clinical trial aimed at evaluating a therapeutic intervention for clinical use and therefore was not registered in a clinical trials registry.

This work was supported by the Natural Sciences and Engineering Research Council of Canada (NSERC) and by the Parkinson Society Southwestern Ontario-Mitacs Graduate Student Scholarship.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Western University Health Science Research Ethics Board (HSREB) has reviewed and approved this work. Project ID 123250.

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The data that support the findings of this study are available from the corresponding author upon reasonable request. Data are not publicly available in order to protect participant privacy.