The Use of Rhythmic Auditory Stimulation in Gait Habilitation for Children with Cerebral Palsy

Abstract

While rehabilitation refers to the restoration of a skill that was previously learned, habilitation refers to learning a skill for the first time. Children with permanent and nonprogressive neurodevelopmental and congenital disorders such as cerebral palsy (CP) require medical treatment and habilitation (Kra geloh-Mann & Cans, 2009; Krigger, 2006). Because CP impacts the development of motor skills, children with CP require motor skill acquisition based on the concept of habilitation (Fasoli et al., 2008; Frascarelli et al., 2009).Deficits in gait function are a common problem for children with CP and reduced gait stability for this population is indicated by a stance-to-swing phase (Bell, Ounpuu, DeLuca, & Romness, 2002; Johnson, Damiano, & Abel, 1997) and an imbalance between skeletal growth and muscle length resulting in muscle tightness, contracture, or abnormal body torsions (Ziv, Backburn, & Rang, 1984). Traditional gait therapy with children with CP focuses on gait preparatory tasks (i.e., crawling, sitting, standing), stability, reduction of deformity, and abnormal gait patterns (Dodd, Taylor, & Damiano, 2002; Iosa, Marro, Paolucci, & Morelli, 2012; Wilson, 1987). Gait therapy is often based on neurodevelopmental therapy (NDT) (Hummelsheim, 1999) and commonly relies on task-oriented approaches such as treadmill exercise (Provost et al., 2007).As neurological research expands, rationales for new approaches to habilitation are developed. For example, rhythmic auditory cueing to repetition of gait movement is a newly developed approach that is gaining widespread usage. The effectiveness of using rhythmic aspects of music in the rehabilitation of adults with neurological disorders is now well researched and documented; however, the use of rhythm in the habilitation of children with cerebral palsy remains undefined. Drawing from the empirical evidence, this paper discusses the role of rhythm as a gait habilitation technique in facilitating gait movement for children with CP.Cerebral PalsyCerebral palsy is the most common neurodisability in childhood with a prevalence of 2.11 per 1000 births (Oskoui, Coutinho, Dykeman, Jette, & Pringsheim, 2013). The term CP encompasses various types of permanent and nonprogressive disturbances in the development of movement and posture. These impairments are secondary to lesions or malformations in the upper spinal cord, gray and/or white matter, and basal ganglia, as well as hypoxic-ischemic encephalopathy that occurs during prenatal and perinatal gestation or the postnatal period (Bax et al., 2005; Rosenbaum et al., 2007). As a result, individuals with CP often experience limitations in all facets of daily functioning (Kra geloh-Mann & Cans, 2009; Krigger, 2006). Cerebral Palsy is considered an umbrella term with some variation in the definition and classification occurring in different fields such as pediatrics, neuroradiology, and orthopedics (Rosenbaum et al., 2007). In this article, spastic diplegia CP, which is the most common type of CP and the most well-defined and well-documented variant of CP in the medical field, is the focus of the literature review that follows.Cerebral damage in CP is also known as upper motor neuron syndrome and it is related to spasticity, motor deficits, lack of coordination, and impaired voluntary movement with non-selective command. In this case, reflexes can be magnified (i.e., hyper-reflexia) or demonstrate a persistence of primitive movements such as the Babinski response (Blondis, 2004; Rosenbaum et al., 2007). It has been reported that the prevalence of spastic CP among children with CP is between 66% and 81% (Blondis, 2004; Kirby et al., 2011). The topographic classification of spastic CP commonly includes hemiplegia and diplegia/quadriplegia, depending on the affected areas (Blondis, 2004; Rosenbaum et al., 2007). Hemiplegia commonly describes total or partial paralysis of one side of the body that occurs on the side opposite the affected brain. …