The Impact of Exercise Intervention with Rhythmic Auditory Stimulation to Improve Gait and Mobility in Parkinson Disease: An Umbrella Review.

Roberta Forte,Giuseppe De Vito,Nicoletta Tocci

doi:10.3390/brainsci11060685

Roberta Forte, Giuseppe De Vito + Show 1 more

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https://doi.org/10.3390/brainsci11060685

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Abstract

Difficulties in walking, controlling balance, and performing activities of daily living are common problems encountered by individuals affected by Parkinson disease. Scientific evidence suggests that exercise performed with music or auditory or rhythmical cues facilitates movement and improves balance, gait, mobility, and activities of daily living (ADL) performance in patients with PD. The aim of this umbrella review was to summarize available high-quality evidence from systematic reviews and meta-analyses on the effectiveness of rhythmically cued exercise to improve gait, mobility, and ADL performance in individuals with PD. PubMed, Cochrane, and Embase databases were searched from January 2010 to October 2020 for systematic reviews and meta-analyses which had to be (1) written in English, (2) include studies on populations of males and females with PD of any age, (3) analyze outcomes related to gait, mobility, and ADL, and (4) apply exercise interventions with music or auditory or rhythmical cues. Two independent authors screened potentially eligible studies and assessed the methodological quality of the studies using the AMSTAR 2 tool. Four studies, two systematic reviews and meta-analyses, one a systematic review, and one a meta-analysis, were selected. Overall results indicated positive effects for gait and mobility of the use of rhythmic auditory cueing with exercise and suggested that it should be incorporated into a regular rehabilitation program for patients affected by PD. Nonetheless, more primary level research is needed to address the identified gaps regarding the application of this method to physical exercise interventions.

Highlights

Parkinson disease (PD) is the second most-common age-related neurodegenerative disease present in modern societies
Significantly larger improvements on average for the UPDRS II were observed in the intervention group compared to the control group after treatment (p = 0.011)
The findings of this meta-analysis infer that auditory forms of cueing are effective in improving important kinematic gait parameters, as cadence, velocity, and stride length

Summary

Introduction

Parkinson disease (PD) is the second most-common age-related neurodegenerative disease present in modern societies. The most significant include tremor, rigidity, akinesia and bradykinesia, and postural instability, as well as freezing of gait, stooped posture, and reduced head and neck mobility. These are accompanied by significant psychological disorders of mood and cognition. All these manifestations significantly affect gait and general mobility in PD patients who typically show reduced gait speed, step length, increased gait asymmetry and double support time, and altered rhythmicity with increases in variability of step/stride time as well as step/stride length [4,5]. Gait problems clearly worsen with disease progression, resulting in a significant increase in the patient’s risk of falling and loss of the independence and quality of life [6]

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