Abstract
Background/Purpose: Although gait disorders occur early in the course of Alzheimer's disease (AD) and increase the risk of falling, methods to improve walking in the home setting are poorly understood. This study aimed to determine the feasibility of a home-based gait training program using rhythmic auditory cues for individuals living with mild to moderately severe AD.Methods: Participants had probable AD with no other major conditions affecting locomotion. The intervention consisted of eight progressively modified 45-min gait training sessions delivered during home visits over 4 weeks. Experienced physiotherapists provided the therapy that incorporated rhythmic music cues for a range of locomotor tasks and ambulatory activities. On the days when the physiotherapist did not attend, participants independently performed a seated music listening activity. Walking speed, cadence, stride length, double limb support duration, and gait variability (coefficient of variation) were measured using an 8-m GAITRite® computerized walkway immediately before and after the physiotherapy intervention. Participant satisfaction was also assessed using a purpose-designed questionnaire.Results: Eleven (median age, 77.0 years; median ACE III score, 66/100; 3 females and 8 males) community-dwelling adults living with AD participated. Wilcoxon signed rank tests revealed statistically significant increases in gait speed following the home-based physiotherapy intervention (baseline = 117.5 cm/s, post-intervention = 129.9 cm/s, z = −2.40, p < 0.05). Stride length also improved (baseline = 121.8 cm, post-intervention = 135.6 cm, z = −2.67, p < 0.05). There was no significant change in gait variability. The program was found to be feasible and safe, with no attrition. Participant satisfaction with the home-based music-cued gait training was high, and there were no adverse events.Conclusion: A progressively modified gait training program using rhythmic auditory cues delivered at home was feasible, safe, and enjoyable. Music-cued gait training can help to reduce the rate of decline in gait stride length and speed in some individuals living with AD.Trial Registration: http://www.anzctr.org.au/Default.aspx, ACTRN12616000851460.Universal Trial Number: U1111-1184-5735.
Highlights
Alzheimer’s disease (AD) is characterized by a gradual decline in walking speed and balance, as well as eventual cognitive impairment [1,2,3]
Eleven community-dwelling adults living with AD participated
The characteristic short-stepped, slowwalking pattern seen in people living with AD can be accompanied by increased variability of step timing and foot placement [3, 4], thought to be related to decreased executive function [5]
Summary
Alzheimer’s disease (AD) is characterized by a gradual decline in walking speed and balance, as well as eventual cognitive impairment [1,2,3]. Fall risk increases as AD progresses [6], when people are recently discharged home from hospital [7]. Despite recent reports of declining incidence of dementia in some areas, the number of people with dementia worldwide is still likely to increase, driven mainly by improved life expectancy [14]. In the absence of a cure, there is a need to develop a range of interventions, including home-based physical therapies, to reduce the physical burden of care. To improve walking and balance and prevent falls, growing attention has been directed toward community-based allied health interventions for AD, such as exercise and music cues [17, 18]
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