Parkinson's disease (PD) is a progressive neurodegenerative disorder commonly associated with gait disturbances, balance impairments, and freezing of gait, which significantly increase the risk of falls and reduce functional independence. Conventional physical therapy improves mobility in individuals with PD; however, persistent gait deficits often remain. Rhythmic Auditory Stimulation (RAS) is an emerging, evidence-based intervention that uses external auditory cues to enhance gait timing, stride length, and movement initiation.

This randomized controlled trial aims to evaluate the effectiveness of rhythmic auditory stimulation using personalized music therapy combined with conventional physical therapy compared to conventional physical therapy alone in individuals with Parkinson's disease. The primary outcomes include freezing of gait, gait velocity, and balance performance. Forty-two clinically diagnosed Parkinson's disease patients will be randomly allocated into two groups. Group A will receive conventional physical therapy, while Group B will receive rhythmic auditory stimulation using personalized music in addition to conventional therapy over an 8-week intervention period.

The findings of this study may provide clinical evidence supporting the integration of personalized rhythmic auditory stimulation into rehabilitation programs for improving gait and balance in individuals with Parkinson's disease.

Parkinson's disease is characterized by progressive impairments in motor control, including bradykinesia, rigidity, postural instability, and freezing of gait. Among these, freezing of gait and balance dysfunction are particularly disabling, as they interfere with safe ambulation and daily activities. Despite pharmacological management, gait and balance impairments often persist, necessitating effective rehabilitative strategies.

Rhythmic Auditory Stimulation (RAS) is a neurologic music therapy technique that provides rhythmic external cues to facilitate movement coordination through auditory-motor entrainment. Auditory cues, particularly when synchronized with an individual's natural walking cadence, have been shown to improve gait initiation, stride length, walking speed, and movement regularity in patients with Parkinson's disease. Personalized music-based RAS may further enhance adherence, motivation, and motor performance compared to non-personalized auditory cues.

This randomized controlled trial will be conducted at University of Lahore Teaching Hospital and Shadman Medical Center, Lahore, over a duration of nine months following ethical approval. A total of 42 patients diagnosed with Parkinson's disease according to Queen Square Brain Bank criteria will be recruited using a purposive sampling technique and randomly allocated into two equal groups through computer-generated randomization.

Both groups will receive treatment three times per week for eight weeks (24 sessions). Group A will undergo a conventional physical therapy program focusing on warm-up activities, stretching, balance training, gait training, and strengthening exercises. Group B will receive rhythmic auditory stimulation using personalized music synchronized to the participant's walking cadence in addition to the same conventional physical therapy protocol.

Outcome measures will be assessed at baseline and at the end of the 8-week intervention period. The primary outcome variables include freezing of gait, gait velocity, and balance management. Data will be analyzed using SPSS version 24, with appropriate parametric or non-parametric statistical tests applied based on data distribution. A p-value of ≤ 0.05 will be considered statistically significant.

This study aims to provide high-quality clinical evidence regarding the effectiveness of rhythmic auditory stimulation using personalized music therapy as an adjunct to conventional physical therapy in improving gait and balance outcomes in individuals with Parkinson's disease.

Inclusion Criteria:

• According to the Queen Square Brain Bank standard , clinical diagnosed patients of PD Both male and females ages 45-55 The mini mental state examination scale MMSE screening without severe cognitive impairment,can cooperate with this study > 23 Mild bergs balance scale BBS score (21-40 ) score

Exclusion Criteria:

• A history of neoplasms; severe cardiovascular, respiratory, visual, auditory, andmuscular-skeletal disease; other neurological conditions; and neurologic music therapy inthelast3 months.

Other disorders that could potentially influence balance and walking.