Abstract
Introduction Rhythmic auditory stimulation (RAS) has successfully helped regulate gait for people with Parkinson's disease. However, the way in which different auditory cues and types of movements affect entrainment, synchronization, and pacing stability has not been directly compared in different aged people with and without Parkinson's. Therefore, this study compared music and metronomes (cue types) in finger tapping, toe tapping, and stepping on the spot tasks to explore the potential of RAS training for general use. Methods Participants (aged 18–78 years) included people with Parkinson's (n = 30, Hoehn and Yahr mean = 1.78), older (n = 26), and younger adult controls (n = 36), as age may effect motor timing. Timed motor production was assessed using an extended synchronization-continuation task in cue type and movement conditions for slow, medium, and fast tempi (81, 116, and 140 mean beats per minute, respectively). Results Analyses revealed main effects of cue and movement type but no between-group interactions, suggesting no differences in motor timing between people with Parkinson's and controls. Music supported entrainment better than metronomes in medium and fast tempi, and stepping on the spot enabled better entrainment and less asynchrony, as well as more stable pacing compared to tapping in medium and fast tempi. Age was not confirmed as a factor, and no differences were observed in slow tempo. Conclusion This is the first study to directly compare how different external auditory cues and movement types affect motor timing. The music and the stepping enabled participants to maintain entrainment once the external pacing cue ceased, suggesting endogenous mechanisms continued to regulate the movements. The superior performance of stepping on the spot suggests embodied entrainment can occur during continuous movement, and this may be related to emergent timing in tempi above 600 ms. These findings can be applied therapeutically to manage and improve adaptive behaviours for people with Parkinson's.
Highlights
Rhythmic auditory stimulation (RAS) has successfully helped regulate gait for people with Parkinson’s disease
Studies comparing people with and without Parkinson’s disease suggest it is the loss of the dopamine-producing cells in the substantia nigra in the basal ganglia that results in the impairment of time perception and internally generated timed motor production abilities [1,2,3,4,5,6,7]
Researchers in neurologic music therapy have operationalized this as rhythmic auditory stimulation (RAS [19]). e therapeutic strategy involves recruiting the connections between the auditory and motor systems by using metronomes or rhythmically enhanced familiar music to provide the external cues to improve gait. ese improvements are manifested in observable positive outcomes such as regulating cadence and increasing gait velocity and stride length (e.g., [20] and see [13, 17, 21, 22] for reviews). e phenomena enabling these beneficial changes include entrainment, synchronization, and pace stabilization
Summary
Rhythmic auditory stimulation (RAS) has successfully helped regulate gait for people with Parkinson’s disease. The way in which different auditory cues and types of movements affect entrainment, synchronization, and pacing stability has not been directly compared in different aged people with and without Parkinson’s. Is is the first study to directly compare how different external auditory cues and movement types affect motor timing. Medication regimens help manage symptoms, they are not necessarily effective for improving deficits in gait, such as shuffling, step irregularity, freezing, and postural instability, Parkinson’s Disease for example [8, 9]. Such difficulties with walking are detrimental to the quality of life experienced by people with Parkinson’s, not least because the deficits often lead to falls, which can in turn contribute to further physical and psychological health problems [10, 11]. Researchers in neurologic music therapy have operationalized this as rhythmic auditory stimulation (RAS [19]). e therapeutic strategy involves recruiting the connections between the auditory and motor systems by using metronomes or rhythmically enhanced familiar music (commonly a metronome embedded into the music) to provide the external cues to improve gait. ese improvements are manifested in observable positive outcomes such as regulating cadence and increasing gait velocity and stride length (e.g., [20] and see [13, 17, 21, 22] for reviews). e phenomena enabling these beneficial changes include entrainment, synchronization, and pace stabilization
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