Abstract
The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SP. The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 ± 8.6 years, mean time between stroke and start of study 42.1 ± 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F(2, 34) = 3.864, p = 0.032; partial η2 = 0.205] and cadence [F(2, 34) = 7.656, p = 0.002; partial η2 = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training.Clinical Trial Registration: https://www.drks.de/drks_web/, identifier DRKS00014603
Highlights
About 60% of all stroke patients (SP) have difficulties with walking [1]
For rhythmic auditory stimulation (RAS)-Treadmill training (TT), we found significant pre-post-changes that corresponded with moderate to strong effect sizes
The gains in velocity and cadence were not confirmed in the apparatus based gait analysis, where cadence only showed a tendency for higher values in favor of the RAS and treadmill training (RAS-TT) group
Summary
About 60% of all stroke patients (SP) have difficulties with walking [1]. These are often caused by hemiparesis and/or sensory deficits of the lower extremity and/or trunk and are due to uncoordinated movements. Treadmill training (TT) with and without body weight support has been shown to improve functional gait in stroke patients effectively. A meta-analysis comparing 44 trials (n = 2,658 patients) revealed clear therapeutic effects on gait velocity and walking endurance, the latter only for TT with body weight support [1]. The improvements were identified only for independent walkers while patients who walked with assistance did not show an additional benefit from TT [1]. Lee’s work [4] provided evidence that TT with a high walking velocity at the beginning of training is more effective when compared to a stepwise increase in velocity
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