Effects Of Rhythmic Auditory Cueing Research Articles

Effects of rhythmic auditory cueing on gait variability and voluntary control of walking -a cross-sectional study.

Temporal gait variability is strongly associated with motor function and falls in the context of numerous diseases. Rhythmic auditory cueing (RAC) can influence stride-to-stride time, although its effects on temporal gait variability remain unclear. Therefore, the aim of the present cross-disease study was to examine the effects of RAC on stride time variability (STV), as well as the factors affecting changes in STV during walking with RAC. Participants with post-stroke (n=12) and orthopedic disease (n=23) performed a random block design under four conditions: comfortable walking speed (CWS) and walking with RAC (RAC 0%, RAC +10%, RAC -10%). STV was measured along with co-contraction and inter-muscular coherence of the shank muscles during walking for each condition. The contributions of the muscle activity pattern and voluntary control to the change in STV between the CWS and RAC 0% conditions were examined using hierarchical multiple regression analysis. STV was significantly lower in the RAC 0% condition than in the CWS condition (p=0.03). Hierarchical multiple regression analysis revealed that the change in STV was explained by STV in the CWS condition (β=-0.36) and by changes in co-contraction (β=0.43) and inter-muscular coherence (β=0.38) during the stance phase between the CWS and RAC 0% conditions (R2=0.56, p<0.001). These findings indicate that walking training with RAC is effective in reducing gait variability and immediately improves muscle activity patterns and excessive corticospinal activity.

Effects of rhythmic auditory cueing on stepping in place in patients with Parkinson's disease.

Background:Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease(PD).Methods:Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition).Results:In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023).Conclusions:Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.

The Effect of Rhythmic Auditory Cueing on Functional Gait Performance in Parkinson's Disease Patients

Purpose: Parkinson’s disease is a progressive neurological movement disorder. Gait and its related dysfunctions cause a lot of disability to the patient. The common objective for all therapeutic intervention aims to preserve a patient’s independence and quality of life. There are established benefits of exercises to maintain functional independence including gait, prevent falls and decrease disease progression. External cueing such as rhythmic auditory cueing is a strategy that can be used in adjunct with traditional gait training intervention to facilitate movement, gait initiation and continuation. The external auditory cue training rerouted the movement through a non-automatic pathway, removing it from automatic basal ganglia pathway. There has been some evidence which suggests the positive effect of application of rhythmic auditory cueing on gait and balance performance of Parkinson’s patient, but it still remains ambiguous, hence, this study is planned to gather more evidence, on the effect of external auditory cues on gait performance in Parkinson’s disease patients. Aim: To study the effects of rhythmic auditory cueing on functional gait performance in individuals diagnosed with Parkinson’s disease. Objectives: To assess and compare the effect of conventional rehabilitation exercises combined with rhythmic auditory cueing and conventional rehabilitation exercises on functional gait performance using freezing of gait questionnaire(FOGQ), modified gait efficacy scale(MGES) and figure of eight walk test(FO8WT) in Parkinson’s disease patients. METHOD- Prospective randomized controlled trial. Results: The study results show that there is a significant improvement in functional gait performance in Parkinson’s disease patients after auditory cueing reflected by the significant p values of respective tests. Conclusion: The above study concludes that application of rhythmic auditory cueing has beneficial effects on the functional gait performance primarily on freezing of gait, MGES and the time component of FO8WT in Parkinson’s disease patients.

Music and movement: Towards a translational approach

Rhythmic abilities are highly widespread in the general population. Most people can extract the regular beat of music, and align their movements with it. The aim of a translational approach for music and movement is to build on current fundamental research and theories of beat perception and synchronization to devise music-based interventions, which are informed by theory. To illustrate this approach, Parkinson's disease is taken as a model, with a focus on the positive effects of rhythmic auditory cueing on walking. In Parkinson's disease, a relation is found between the success of this music-based intervention and individual differences in rhythmic abilities. Patients with relatively spared rhythmic abilities are the most likely to benefit from cueing. Moreover, rhythmic auditory cueing can be optimized by using mobile technologies (tablets and smartphones), in the form of dedicated apps or serious games. A similar translational approach to the study of music, rhythm, and movement can be extended to remediation of cognitive, speech and language functions in other patient populations, such as children and adults with neurodevelopemental disorders.

Rhythmic abilities and musical training in Parkinson's disease: Do they help?

Rhythmic auditory cues can immediately improve gait in Parkinson's disease. However, this effect varies considerably across patients. The factors associated with this individual variability are not known to date. Patients’ rhythmic abilities and musicality (e.g., perceptual and singing abilities, emotional response to music, and musical training) may foster a positive response to rhythmic cues. To explore this hypothesis, we measured gait at baseline and with rhythmic cues in 39 non-demented patients with Parkinson's disease and 39 matched healthy controls. Cognition, rhythmic abilities and general musicality were assessed. A response to cueing was qualified as positive when the stimulation led to a clinically meaningful increase in gait speed. We observed that patients with positive response to cueing ( n = 17) were more musically trained, aligned more often their steps to the rhythmic cues while walking, and showed better music perception as well as poorer cognitive flexibility than patients with non-positive response ( n = 22). Gait performance with rhythmic cues worsened in six patients. We concluded that rhythmic and musical skills, which can be modulated by musical training, may increase beneficial effects of rhythmic auditory cueing in Parkinson's disease. Screening patients in terms of musical/rhythmic abilities and musical training may allow teasing apart patients who are likely to benefit from cueing from those who may worsen their performance due to the stimulation.

Effects of Rhythmic Auditory Cueing in Gait Rehabilitation for Multiple Sclerosis: A Mini Systematic Review and Meta-Analysis.

Rhythmic auditory cueing has been shown to enhance gait performance in several movement disorders. The “entrainment effect” generated by the stimulations can enhance auditory motor coupling and instigate plasticity. However, a consensus as to its influence over gait training among patients with multiple sclerosis is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing in studies gait performance in patients with multiple sclerosis. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until Dec 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 602 records, five studies (PEDro score: 5.7 ± 1.3) involving 188 participants (144 females/40 males) met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e., velocity (Hedge's g: 0.67), stride length (0.70), and cadence (1.0), and reduction in timed 25 feet walking test (−0.17). Underlying neurophysiological mechanisms, and clinical implications are discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance gait performance in the multiple sclerosis community.

Rhythmic abilities and musical training in Parkinson\u2019s disease: do they help?

Rhythmic auditory cues can immediately improve gait in Parkinson’s disease. However, this effect varies considerably across patients. The factors associated with this individual variability are not known to date. Patients’ rhythmic abilities and musicality (e.g., perceptual and singing abilities, emotional response to music, and musical training) may foster a positive response to rhythmic cues. To examine this hypothesis, we measured gait at baseline and with rhythmic cues in 39 non-demented patients with Parkinson’s disease and 39 matched healthy controls. Cognition, rhythmic abilities and general musicality were assessed. A response to cueing was qualified as positive when the stimulation led to a clinically meaningful increase in gait speed. We observed that patients with positive response to cueing (n = 17) were more musically trained, aligned more often their steps to the rhythmic cues while walking, and showed better music perception as well as poorer cognitive flexibility than patients with non-positive response (n = 22). Gait performance with rhythmic cues worsened in six patients. We concluded that rhythmic and musical skills, which can be modulated by musical training, may increase beneficial effects of rhythmic auditory cueing in Parkinson’s disease. Screening patients in terms of musical/rhythmic abilities and musical training may allow teasing apart patients who are likely to benefit from cueing from those who may worsen their performance due to the stimulation.

Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis

The use of rhythmic auditory cueing to enhance gait performance in parkinsonian patients’ is an emerging area of interest. Different theories and underlying neurophysiological mechanisms have been suggested for ascertaining the enhancement in motor performance. However, a consensus as to its effects based on characteristics of effective stimuli, and training dosage is still not reached. A systematic review and meta-analysis was carried out to analyze the effects of different auditory feedbacks on gait and postural performance in patients affected by Parkinson’s disease. Systematic identification of published literature was performed adhering to PRISMA guidelines, from inception until May 2017, on online databases; Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE and PROQUEST. Of 4204 records, 50 studies, involving 1892 participants met our inclusion criteria. The analysis revealed an overall positive effect on gait velocity, stride length, and a negative effect on cadence with application of auditory cueing. Neurophysiological mechanisms, training dosage, effects of higher information processing constraints, and use of cueing as an adjunct with medications are thoroughly discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance motor performance and quality of life in the parkinsonian community.

Effect of Rhythmic Auditory Cueing on Aging Gait: A Systematic Review and Meta-Analysis.

Rhythmic auditory cueing has been widely used in gait rehabilitation over the past decade. The entrainment effect has been suggested to introduce neurophysiological changes, alleviate auditory-motor coupling and reduce cognitive-motor interferences. However, a consensus as to its influence over aging gait is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal gait parameters among healthy young and elderly participants. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until May 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 2789 records, 34 studies, involving 854 (499 young/355 elderly) participants met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e. gait velocity (Hedge’s g: 0.85), stride length (0.61), and cadence (1.1), amongst both age groups. This review, for the first time, evaluates the effects of auditory entrainment on aging gait and discusses its implications under higher and lower information processing constraints. Clinical implications are discussed with respect to applications of auditory entrainment in rehabilitation settings.

Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis.

Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge’s g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy.

Rhythmic Auditory Cueing in Motor Rehabilitation for Stroke Patients: Systematic Review and Meta-Analysis.

Given the increasing evidence demonstrating the effects of rhythmic auditory cueing for motor rehabilitation of stroke patients, this synthesized analysis is needed in order to improve rehabilitative practice and maximize clinical effectiveness. This study aimed to systematically analyze the literature on rhythmic auditory cueing for motor rehabilitation of stroke patients by highlighting the outcome variables, type of cueing, and stage of stroke. A systematic review with meta-analysis of randomized controlled or clinically controlled trials was conducted. Electronic databases and music therapy journals were searched for studies including stroke, the use of rhythmic auditory cueing, and motor outcomes, such as gait and upper-extremity function. A total of 10 studies (RCT or CCT) with 356 individuals were included for meta-analysis. There were large effect sizes (Hedges's g = 0.984 for walking velocity; Hedges's g = 0.840 for cadence; Hedges's g = 0.760 for stride length; and Hedges's g = 0.456 for Fugl-Meyer test scores) in the use of rhythmic auditory cueing. Additional subgroup analysis demonstrated that although the type of rhythmic cueing and stage of stroke did not lead to statistically substantial group differences, the effect sizes and heterogeneity values in each subgroup implied possible differences in treatment effect. This study corroborates the beneficial effects of rhythmic auditory cueing, supporting its expanded application to broadened areas of rehabilitation for stroke patients. Also, it suggests the future investigation of the differential outcomes depending on how rhythmic auditory cueing is provided in terms of type and intensity implemented.

Effect of rhythmic auditory cueing over conventional physical therapy among hemiparetic stroke patients on functional improvement of upper extremity

Effect of rhythmic auditory cueing over conventional physical therapy among hemiparetic stroke patients on functional improvement of upper extremity

Auditory rhythmic cueing in movement rehabilitation: findings and possible mechanisms.

Moving to music is intuitive and spontaneous, and music is widely used to support movement, most commonly during exercise. Auditory cues are increasingly also used in the rehabilitation of disordered movement, by aligning actions to sounds such as a metronome or music. Here, the effect of rhythmic auditory cueing on movement is discussed and representative findings of cued movement rehabilitation are considered for several movement disorders, specifically post-stroke motor impairment, Parkinson's disease and Huntington's disease. There are multiple explanations for the efficacy of cued movement practice. Potentially relevant, non-mutually exclusive mechanisms include the acceleration of learning; qualitatively different motor learning owing to an auditory context; effects of increased temporal skills through rhythmic practices and motivational aspects of musical rhythm. Further considerations of rehabilitation paradigm efficacy focus on specific movement disorders, intervention methods and complexity of the auditory cues. Although clinical interventions using rhythmic auditory cueing do not show consistently positive results, it is argued that internal mechanisms of temporal prediction and tracking are crucial, and further research may inform rehabilitation practice to increase intervention efficacy.

Non-linear dynamics of human locomotion: effects of rhythmic auditory cueing on local dynamic stability

It has been observed that times series of gait parameters [stride length (SL), stride time (ST), and stride speed (SS)], exhibit long-term persistence and fractal-like properties. Synchronizing steps with rhythmic auditory stimuli modifies the persistent fluctuation pattern to anti-persistence. Another non-linear method estimates the degree of resilience of gait control to small perturbations, i.e., the local dynamic stability (LDS). The method makes use of the maximal Lyapunov exponent, which estimates how fast a non-linear system embedded in a reconstructed state space (attractor) diverges after an infinitesimal perturbation. We propose to use an instrumented treadmill to simultaneously measure basic gait parameters (time series of SL, ST, and SS from which the statistical persistence among consecutive strides can be assessed), and the trajectory of the center of pressure (from which the LDS can be estimated). In 20 healthy participants, the response to rhythmic auditory cueing (RAC) of LDS and of statistical persistence [assessed with detrended fluctuation analysis (DFA)] was compared. By analyzing the divergence curves, we observed that long-term LDS (computed as the reverse of the average logarithmic rate of divergence between the 4th and the 10th strides downstream from nearest neighbors in the reconstructed attractor) was strongly enhanced (relative change +73%). That is likely the indication of a more dampened dynamics. The change in short-term LDS (divergence over one step) was smaller (+3%). DFA results (scaling exponents) confirmed an anti-persistent pattern in ST, SL, and SS. Long-term LDS (but not short-term LDS) and scaling exponents exhibited a significant correlation between them (r = 0.7). Both phenomena probably result from the more conscious/voluntary gait control that is required by RAC. We suggest that LDS and statistical persistence should be used to evaluate the efficiency of cueing therapy in patients with neurological gait disorders.

Effect of Rhythmic Auditory Cueing on Gait in People With Alzheimer Disease

ObjectiveTo determine whether rhythmic music and metronome cues alter spatiotemporal gait measures and gait variability in people with Alzheimer disease (AD). DesignA repeated-measures study requiring participants to walk under different cueing conditions. SettingUniversity movement laboratory. ParticipantsOf the people (N=46) who met study criteria (a diagnosis of probable AD and ability to walk 100m) at routine medical review, 30 (16 men; mean age ± SD, 80±6y; revised Addenbrooke's Cognitive Examination range, 26–79) volunteered to participate. InterventionsParticipants walked 4 times over an electronic walkway synchronizing to (1) rhythmic music and (2) a metronome set at individual mean baseline comfortable speed cadence. Main Outcome MeasuresGait spatiotemporal measures and gait variability (coefficient of variation [CV]). Data from individual walks under each condition were combined. A 1-way repeated-measures analysis of variance was used to compare uncued baseline, cued, and retest measures. ResultsGait velocity decreased with both music and metronome cues compared with baseline (baseline, 110.5cm/s; music, 103.4cm/s; metronome, 105.4cm/s), primarily because of significant decreases in stride length (baseline, 120.9cm; music, 112.5cm; metronome, 114.8cm) with both cue types. This was coupled with increased stride length variability compared with baseline (baseline CV, 3.4%; music CV, 4.3%; metronome CV, 4.5%) with both cue types. These changes did not persist at (uncued) retest. Temporal variability was unchanged. ConclusionsRhythmic auditory cueing at comfortable speed tempo produced deleterious effects on gait in a single session in this group with AD. The deterioration in spatial gait parameters may result from impaired executive function associated with AD. Further research should investigate whether these instantaneous cue effects are altered with more practice or with learning methods tailored to people with cognitive impairment.

Music and metronome cues produce different effects on gait spatiotemporal measures but not gait variability in healthy older adults

Rhythmic auditory cues including music and metronome beats have been used, sometimes interchangeably, to improve disordered gait arising from a range of clinical conditions. There has been limited investigation into whether there are optimal cue types. Different cue types have produced inconsistent effects across groups which differed in both age and clinical condition. The possible effect of normal ageing on response to different cue types has not been reported for gait. The aim of this study was to determine the effects of both rhythmic music and metronome cues on gait spatiotemporal measures (including variability) in healthy older people. Twelve women and seven men (>65 years) walked on an instrumented walkway at comfortable pace and then in time to each of rhythmic music and metronome cues at comfortable pace stepping frequency. Music but not metronome cues produced a significant increase in group mean gait velocity of 4.6cm/s, due mostly to a significant increase in group mean stride length of 3.1cm. Both cue types produced a significant but small increase in cadence of 1step/min. Mean spatio-temporal variability was low at baseline and did not increase with either cue type suggesting cues did not disrupt gait timing. Study findings suggest music and metronome cues may not be used interchangeably and cue type as well as frequency should be considered when evaluating effects of rhythmic auditory cueing on gait. Further work is required to determine whether optimal cue types and frequencies to improve walking in different clinical groups can be identified.

Comparing the effects of rhythmic auditory cueing and visual cueing in acute hemiparetic stroke

Introduction: Every individual requires proper upper limb functions as well as proper walking balance to meet day-to-day demands. Some of the most common problems faced after stroke are balance problems, which, in turn affect the recovery of activities of daily living (ADL), mobility, and lead to an increased risk of falls. In addition, about 80% of all stroke survivors have an upper limb paresis immediately after stroke affecting gross motor and fine motor problems. Objective: To evaluate the effectiveness of rhythmic auditory stimulation and conventional treatment on gross motor, fine motor activities, and walking imbalance; to evaluate the effectiveness of visual cues and conventional treatment on gross motor, fine motor activities, and walking imbalance; and to compare the effectiveness of rhythmic auditory stimulation and visual cueing with conventional treatment on gross motor, fine motor activities, and walking imbalance. Methodology: Design-a randomised controlled trial of 45 participants in acute stage were recruited. The subjects selected for the study were randomly allocated using sealed envelopes into three groups Group A-rhythmic auditory stimulation and conventional treatment, Group B-visual cueing and conventional treatment, Group C-conventional treatment. Outcome measures: Dynamic gait index and upper extremity Fugl Meyer motor score. Result: After one month of therapy a comparison of the groups showed a statistically significant improvement in all three groups independently (P=&lt;0.05 in Group A, B, and C). On comparing post scores between the groups, a statistically significant difference was found between group A and C, and group B and C data (P=&lt;0.05). Conclusion: Both the therapies were effective for gross motor, fine motor, and gait imbalance in acute hemiparetic stroke.