Preferred Walking Cadence Research Articles

The effect of auditory cues on gait variability in people with Parkinson's disease and older adults: a systematic review.

Aim: The goal of this study was to analyze the effects of external rhythmic auditory stimulation (RAS) on gait variability in older adults and people with Parkinson's disease (PD). Methods: Academic databases searched included PubMed, Web of Science, PEDro and Cochrane, from inception to September 2021. Eligible articles scored a minimum of 4 on the PEDro scale. Results: Twenty-three papers were included. People with PD show varied responses in gait variability to RAS during cued walking trials. Healthy older adults tended to increase variability during cued trials. Cue rates below preferred walking cadence tend to increase gait variability. Conclusion: Gait variability is closely associated with fall risk and an important consideration in development of gait rehabilitation techniques.

Immediate effects of rhythmic auditory stimulation on gait kinematics in Parkinson’s disease ON/OFF medication

ObjectiveGait impairment is a highly disabling symptom for Parkinson’s disease (PD) patients. Rhythmic auditory stimulation (RAS), has shown to improve spatio-temporal gait parameters in PD, but only a few studies have focused on their effects on gait kinematics, and the ideal stimulation frequency has still not been identified. MethodsWe enrolled 30 PD patients and 18 controls. Patients were evaluated under two conditions (with (ON), and without (OFF) medications) with three different RAS frequencies (90%, 100%, and 110% of the patient’s preferred walking cadence). Spatial-temporal parameters, joint angles and gait phases distribution were evaluated. A novel global index (GPQI) was used to quantify the difference in gait phase distribution. ResultsAlong with benefits in spatial-temporal parameters, GPQI improved significantly with RAS at a frequency of 110% for both ON and OFF medication conditions. In the most severe patients, the same result was observed also with RAS at 100%. ConclusionsRAS administration, at a frequency of 110% of the preferred walking frequency, can be beneficial in improving the gait pattern in PD patients. SignificanceWhen rhythmic auditory stimulation is provided to patients with PD, the selection of an adequate frequency of stimulation can optimize their effects on gait pattern.

Walking to Music and Metronome at Various Tempi in Persons With Multiple Sclerosis: A Basis for Rehabilitation

Background. Mobility dysfunctions are prevalent in persons with multiple sclerosis (PwMS), thus novel rehabilitation mechanisms are needed toward functional training. The effect of auditory cueing is well-known in Parkinson’s disease, yet the application of different types of auditory stimuli at different tempi has not been investigated yet. Objectives. Investigating if PwMS, compared with healthy controls (HC), can synchronize their gait to music and metronomes at different tempi during walking and the effects of the stimuli on perceived fatigue and gait. Additionally, exploring if cognitive impairment would be a factor on the results. Methods. The experimental session consisted of 2 blocks, music and metronomes. Per block, participants walked 3 minutes per tempi, with instructions to synchronize their steps to the beat. The tempi were 0%, +2%, +4% +6%, +8%, +10% of preferred walking cadence (PWC). Results. A total of 28 PwMS and 29 HC participated. On average, participants were able to synchronize at all tempi to music and metronome. Higher synchronization was obtained for metronomes compared with music. The highest synchronization for music was found between +2% and +8% of PWC yet pwMS perceived less physical and cognitive fatigue walking to music compared with metronomes. Cognitive impaired PwMS (n = 9) were not able to synchronize at tempi higher than +6%. Conclusion. Auditory-motor coupling and synchronization was feasible in HC and PwMS with motor and cognitive impairments. PwMS walked at higher tempi than their preferred walking cadence, and lower fatigue perception with music. Coupling walking to music could be a promising functional walking training strategy.

A model of different cognitive processes during spontaneous and intentional coupling to music in multiple sclerosis.

Evidence for using auditory-motor coupling in neurological rehabilitation to facilitate walking is increasing. However, the distinction between spontaneous and intended coupling and its underlying mechanisms is yet to be investigated. In this study, we include 30 persons with multiple sclerosis and 30 healthy controls (HCs) in an experiment with two sessions in which participants were asked to walk to music with various tempi, matching their preferred walking cadence (PWC) up to 10% above in incremental steps of 2%. In the first session, no instructions were given to synchronize. In the second, participants were instructed to synchronize steps to the beats. Spontaneous synchronization was possible at 0% and +2% of the PWC, and fewer persons with multiple sclerosis were able to do so compared with HCs. Instruction was needed to synchronize at above +2% tempo in all participants. In the instructed session, the +6% condition marked a cutoff for cognitively impaired persons, as they were no longer able to synchronize. Based on our findings, we constructed a model illustrating that spontaneous entrainment is limited, operating during spontaneous coupling at only 0% and +2% of the PWC, and that at a higher tempo, entrainment requires intentional synchronization, with an active cognitive control mechanism.

Rhythmic priming across effector systems: A randomized controlled trial with Parkinson’s disease patients

This study investigated the immediate effects of auditory-motor entrainment across effector systems by examining whether Rhythmic Auditory Stimulation training of arm or finger movements would modulate gait speed. Forty-one participants with idiopathic Parkinson’s Disease were randomly assigned to 3 groups. Participants in the finger-tapping group tapped in synchrony with a metronome set to 20% faster pace than the pre-training walking cadence, whereas participants in the other group were asked to swing both arms in an alternating motion in synchrony with the metronome. Participants in the control condition did not receive training. To assess gait parameters pre- and post-training, participants walked on a 14-meter flat walkway at his/her preferred walking cadence with no auditory cueing. Results indicated that there was a significant increase in gait velocity after the finger tapping training (p < .005), whereas no differences were observed in the arm swing (p = .802) and in the control conditions (p = .525). Similarly, there were significant changes in gait cadence post-training in the finger tapping group (p < .005), but not after arm swing training (p = .879) or control (p = .759). There were no significant changes in stride length post-training in none of the groups. These findings suggest that auditory-motor entrainment in one effector system may prime a second effector system. Interestingly, however, the priming effect on gait was only observed in the finger tapping condition and not with synchronized arm swing movements. These findings have significant implications for motor rehabilitation and open new avenues for further investigation of the mechanisms underlying cross-effector coupling.

Influence of Stride Length Alteration Training on the Energy Cost and Efficiency of Walking

The effect of stride length alteration training on preferred walking cadence and energy efficiency during exercise was examined. Ten men (23.6 ± 1.5 yrs, 177.2 ± 5.3 cm, 72.5 ± 8.7 kg) underwent three walking trials: 1) at preferred stride (SR), 2) at 10% longer length of SR, and 3) at 20% longer length of SR. All subjects walked at five different speeds: 2.5, 4, 5, 6, and 7.5 km/h (pre-testing). Then, they participated in a training program consisting of fast walking with an extended stride length on a graded treadmill at 6.4 km/h as well as leg strength training for 8 weeks. After the training program, the subject’s preferred SR was measured and they were retested (post-testing). After the training, the freely chosen SR decreased by 11.8, 9.9, 8.0, and 8.6% from pre-testing levels at 4, 5, 6, and 7.5 km/h, respectively (p < .05). At these SR, heart rate, oxygen uptake, and energy cost per walking distance did not change compared to the pre-testing rates. At the SR used in pre-testing, no changes in heart rate, oxygen uptake, or energy efficiency at all walking speed and stride length conditions were observed. Stride length alteration training lowered the self-selecting preferred stride rate during walking at speeds ≥ 4 km/h. Despite changes in the preferred stride rate, physiological responses and walking economy at a given stride rate used in pre-training were not changed or shifted by the training.

Walking Is Not Like Reaching: Evidence from Periodic Mechanical Perturbations

The control architecture underlying human reaching has been established, at least in broad outline. However, despite extensive research, the control architecture underlying human locomotion remains unclear. Some studies show evidence of high-level control focused on lower-limb trajectories; others suggest that nonlinear oscillators such as lower-level rhythmic central pattern generators (CPGs) play a significant role. To resolve this ambiguity, we reasoned that if a nonlinear oscillator contributes to locomotor control, human walking should exhibit dynamic entrainment to periodic mechanical perturbation; entrainment is a distinctive behavior of nonlinear oscillators. Here we present the first behavioral evidence that nonlinear neuro-mechanical oscillators contribute to the production of human walking, albeit weakly. As unimpaired human subjects walked at constant speed, we applied periodic torque pulses to the ankle at periods different from their preferred cadence. The gait period of 18 out of 19 subjects entrained to this mechanical perturbation, converging to match that of the perturbation. Significantly, entrainment occurred only if the perturbation period was close to subjects' preferred walking cadence: it exhibited a narrow basin of entrainment. Further, regardless of the phase within the walking cycle at which perturbation was initiated, subjects' gait synchronized or phase-locked with the mechanical perturbation at a phase of gait where it assisted propulsion. These results were affected neither by auditory feedback nor by a distractor task. However, the convergence to phase-locking was slow. These characteristics indicate that nonlinear neuro-mechanical oscillators make at most a modest contribution to human walking. Our results suggest that human locomotor control is not organized as in reaching to meet a predominantly kinematic specification, but is hierarchically organized with a semi-autonomous peripheral oscillator operating under episodic supervisory control.

Effect of Rhythmic Auditory Stimulation on Gait in Parkinsonian Patients with and without Freezing of Gait

Freezing of gait (FOG) in Parkinson's disease (PD) rises in prevalence when the effect of medications decays. It is known that auditory rhythmic stimulation improves gait in patients without FOG (PD-FOG), but its putative effect on patients with FOG (PD+FOG) at the end of dose has not been evaluated yet. This work evaluates the effect of auditory rhythmic stimulation on PD+FOG at the end of dose. 10 PD+FOG and 9 PD-FOG patients both at the end of dose periods, and 10 healthy controls were asked to perform several walking tasks. Tasks were performed in the presence and absence of auditory sensory stimulation. All PD+FOG suffered FOG during the task. The presence of auditory rhythmic stimulation (10% above preferred walking cadence) led PD+FOG to significantly reduce FOG. Velocity and cadence were increased, and turn time reduced in all groups. We conclude that auditory stimulation at the frequency proposed may be useful to avoid freezing episodes in PD+FOG.

Effects of rhythmic sensory stimulation (auditory, visual) on gait in Parkinson’s disease patients

This study has focused on how sensory stimulation affects gait in Parkinson's disease (PD). The kinematic parameters of gait [cadence, step amplitude, velocity, coefficient of variation of stride time (CV(stride-time)), and the coefficient of variation of the step amplitude (CV(step-amplitude))] were analysed in 25 PD patients and 10 control subjects. Step amplitude, velocity and CV(stride-time) were altered in the patients with PD. However, when kinematic parameters were analysed as a function of disease severity, none of the parameters differed between early PD (I-II Hoehn and Yahr) and the controls. Nevertheless, more severely affected PD patients (III-IV Hoehn and Yahr) walked with a reduced step amplitude, lower velocity, higher CV(stride-time), and higher CV(step-amplitude) than the controls. The administration of auditory stimulation at a frequency matching the preferred walking cadence led to a decrease in the CV(stride-time) in PD(III-IV) patients, and to an increase in step amplitude in PD(III-IV )and controls. Visual stimulation at the same frequency did not modify any of the altered kinematic parameters in PD(III-IV )patients. When different stimulation frequencies were utilised, auditory stimulation significantly changed some of the altered walking parameters in Parkinson patients. Frequencies matching preferred walking cadence or above this, up to the fastest walking, were those that seem to interact most effectively with the abnormal kinematic parameters in PD(III-IV )patients. Visual stimulation negatively modulated cadence in PD(III-IV) in the frequency range used. Sensory stimulation facilitates gait in PD. Studies using sensory stimulation as a tool to facilitate walking should take into account the grade of disability of the patients.