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Effect of rhythmic auditory stimulation on controlling stepping cadence of individuals with mental retardation and cerebral palsy

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Abstract

One of the purposes of Rhythmic Auditory Stimulation (RAS) is to improve the control of dysfunctional movement patterns. This study aimed to extend the line of research by focussing on secondary students with mental retardation and cerebral palsy. According to the study’s assumption, cadence can be controlled through a stable and low signal cadence to the benefit of endurance during an aerobic exercise on a stair stepper. Two conditions (Do your best and RAS) were applied in a Latin square design. Results show that in the RAS condition, as compared to the Do your best condition, students significantly decreased their cadence, increased their training duration, kept their heart rate between the bounds suggested for aerobic exercise and decreased their intra-individual standard deviations in both cadence and heart rate per minute. The researchers suggest that a variable signal cadence could have an even greater effect on exercise duration.
INTERNATIONAL JOURNAL OF SPECIAL EDUCATION Vol 27, No: 3, 2012 pp 68-75
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International Journal
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INTERNATIONAL JOURNAL OF SPECIAL EDUCATION Vol 27, No: 3, 2012 pp 68-75
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EFFECT OF RHYTHMIC AUDITORY STIMULATION ON CONTROLLING STEPPING
CADENCE OF INDIVIDUALS WITH MENTAL RETARDATION AND CEREBRAL PALSY
Panagiotis Varsamis
Aristotle University of Thessaloniki
Konstantinos Staikopoulos
Lefkothea Kartasidou
University of Macedonia
One of the purposes of Rhythmic Auditory Stimulation (RAS) is to improve the control
of dysfunctional movement patterns. This study aimed to extend the line of research by
focussing on secondary students with mental retardation and cerebral palsy.
According to the study’s assumption, cadence can be controlled through a stable and
low signal cadence to the benefit of endurance during an aerobic exercise on a stair
stepper. Two conditions (Do your best and RAS) were applied in a Latin square
design. Results show that in the RAS condition, as compared to the Do your best
condition, students significantly decreased their cadence, increased their training
duration, kept their heart rate between the bounds suggested for aerobic exercise and
decreased their intra-individual standard deviations in both cadence and heart rate
per minute. The researchers suggest that a variable signal cadence could have an even
greater effect on exercise duration.
Rhythm is the most prominent component of music linked with individual’s motor behavior, indicating
the responsiveness of the sensorimotor system to auditory stimuli (e.g., Styns, van Noorden, Moelants, &
Leman, 2007; Thaut, Kenyon, Schauer, & McIntosh, 1999). Rhythmic Auditory Stimulation is described
as a …technique using the physiological effects of auditory rhythm on the motor system to improve the
control of movement… (Thaut, 2005, 139, as cited in Kwak, 2007, p. 199). More specifically, rhythmic
auditory cues synchronize motor responses into stable time relationships… via fast-acting physiological
entrainment mechanisms, while rhythm serves as an anticipatory and continuous time reference on
which movements are mapped within a stable temporal template (Thaut, Leins, Rice, Argstatter, Kenyon,
McIntosh, Bolay, & Fetter, 2007, p. 455). The present study focused on the function of musical rhythm
as a parameter of motor control. The aim was to determine the effect of Rhythmic Auditory Stimulation
(RAS) on cadence of individuals with Mental Retardation and Cerebral Palsy working out on a stair
stepper in order to increase workout duration. Physical exercise of this kind presupposes the choice and
supervision of the appropriate cadence.
Individuals with cerebral palsy and mental retardation are prone to have difficulty with rhythmic
perception and rhythmic performance of movement (e.g., Grant & LeCroy, 1986; Kwak, 2007). More
specifically, physical ability, cognitive function, social support and other individual characteristics may
affect these individuals’ response to rhythmic auditory stimuli (Kwak, 2007; McRorie & Cooper, 2004).
Concerning cognitive function, the difficulty in maintaining rhythmic pattern may be attributed to a
restriction of brain functions related to the perception and reproduction of a rhythmic pattern (Del Olmo
& Cudeiro, 2005, p. 31), while good mental ability is related to an efficient central nervous system
(McRorie & Cooper, 2004, p. 524). It is proposed, however, that individuals with cerebral palsy and
mental retardation can respond to RAS through adapted forms of instruction and practice (Kwak, 2007,
211).
So far RAS has rarely been applied in cases of individuals with cerebral palsy and mental retardation,
especially concerning walking. Kwak (2007) found that by setting the signal cadence at 5% to 15%
above the initial performance of individuals with cerebral palsy, stride length, gait velocity, and gait
symmetry increased. However, the real cadence during exercising remained relatively stable. Research
by Thaut, Hurt, Dragon, and McIntosh (1998) on individuals with cerebral palsy indicated an increase in
velocity, cadence, stride length, gait, symmetry as well as an improvement of kinematic components of
walking, such as increase in range of, motion for, knee and hip. In a similar target group, individuals with
INTERNATIONAL JOURNAL OF SPECIAL EDUCATION Vol 27, No: 3, 2012 pp 68-75
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traumatic brain injury (Hurt, Rice, McIntosh, & Thaut, 1998) increased through RAS their signal
cadence by 5% and managed to improve their gait velocity, step cadence and stride length.
The domain in which RAS has been most extensively applied to is the rehabilitation of the walking
ability in patients who develop neurological disorders at a relatively advanced age. For instance, in the
case of stroke patients, a number of positive effects were observed, such as an improvement in alternate
movement of lower limbs, symmetrical bilaterally coordinated gait, an increase in cadence, stride length,
velocity and endurance in therapy, in kinematic aspects of the legs, hands and body mass center (Ford,
Wagenaar, & Newell, 2007; Jeong & Kim, 2007; Prassas, Thaut, McIntosh, & Rice, 1997; Thaut, et al.,
2007; Thaut, McIntosh, & Rice, 1997). Similar results were recorded with individuals suffering from
Parkinson’s disease. In this case the following positive effects were observed: an increase in stride
length, gait velocity, cadence, as well as a reduction of suspension time and gait variability (Hausdorff,
Lowenthal, Herman, Gruendlinger, Peretz, & Giladi, 2007; Howe, Lövgreen, Cody, Ashton, & Oldham,
2003; McIntosh, Brown, Rice, & Thaut, 1997; Rochester, Hetherington, Jones, Nieuwboer, Willems,
Kwakkel, & Wegen, 2005; Suteerawattananon, Morris, Etnyre, Jankovic, & Protas, 2004).
In the majority of the studies mentioned above, RAS was used with a signal cadence consistently higher
than the cadence recorded in the initial evaluation of individuals. This indicates the general intention of
researchers to maximize all variables. Only in some cases was the influence of RAS examined with a
signal cadence lower than the initial one (Baker, Rochester, & Nieuwboer, 2007; Del Olmo & Cudeiro,
2005; Howe et al., 2003; Thaut, Miltner, Lange, Hurt, & Hoemberg, 1999; Willems, Nieuwboer,
Chavret, Desloovere, Dom, Rochester, Jones, Kwakkel, & van Wegen, 2006). In the latter studies, the
potential of RAS was tested to effectively control cadence to the benefit of other gait parameters such as
stride length.
The present study constituted an attempt to extend the line of research studying the effects of low signal
cadence RAS on populations of individuals with congenital disabilities, such as mental retardation and
cerebral palsy (Kwak, 2007, p. 200). The aim was to control, that is, to reduce cadence on a stair stepper
to the benefit of endurance during an aerobic exercise. This should keep pulse within the range
appropriate for aerobic exercise (between 50% and 70% of Maximum Heart Rate) for as long as possible
(e.g., Hand, Phillips, Dudgeon, Lyerly, Durstine, & Burgess, 2008) and thus should extend the duration
of the exercise. We chose to study individuals with mental retardation and cerebral palsy, because these
are two of the most frequent disabilities (e.g., Rapp & Torres, 2000) that coexist in the same special
education schools in Greece and follow the same educational program, particularly at the secondary
education level (Pedagogical Institute, 2004).
Method
Participants
The research sample consists of 18 secondary education students, 11 male and 7 female, aged 14-24
years (M = 18.28, S.D. = 3.86). Nine of the students have moderate mental retardation and the other nine
have mild mental retardation. Four of the participants also have cerebral palsy in the form of mild spastic
tetraplegia (see table 1). The selection of the sample was made after securing the essential permission
and voluntary participation, while all students could participate, without restriction, to different forms of
aerobic exercise following the medical advice of a cardiologist. Furthermore, the ability to understand
simple directions and respond to rhythmic auditory stimuli was assessed through an individual task. Each
student had to walk at signal cadences of 45 and 60 per minute for at least 15 seconds. The evaluation
key was dichotomous (can do it - cannot do it).
According to the criteria mentioned above, 18 out of the 38 students of a Special Vocational Education
and Training Secondary School in Thessaloniki (North Greece) were selected and voluntarily
participated in the proposed research. In other words a purposive sampling method was used (Patton,
1990).
Testing Procedure and Conditions
The research was conducted in May and June 2008 and during this time no other form of aerobic
exercise took place. During the first week the research variables were initially evaluated. The data served
as starting point for the goal setting in two research conditions (see table 2). The physical education
teacher specified his goals before the beginning of these two conditions. Subsequently, student
performance on the two experimental conditions was examined during the third and sixth week using a
Latin square design, allowing a two-week interval to avoid the transfer from one condition to another.
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Students took turns participating in each of these conditions in groups of three to four. From the two
meetings that took place in a week the best performance was recorded, that is the exercise that lasted the
longest (duration in minutes). Students were told to step keeping their hands on the handle and to
exercise on the stepper as long as possible. Stopping the exercise was up to the student and no student
reached his/her maximum heart rate.
Do your best condition: the physical education teacher was asked to improve his students’ performances
using the methods he was familiar with. He used strategies of goal setting and self-efficacy. He thus
prompted his students to step more slowly, verbalized positive outcome expectations and agreed with
them on performance goals, expressed in minutes of exercising. These goals were based on the first
measure and were visualized by means of shaded bars representing time. The goals were one or two
minutes more than the initial performance. Intended increase rate is estimated on average at 32.98%
(S.D. = 10.39%).
RAS condition: the physical education teacher decided on a signal cadence for every student, taking into
account the individual initial means on steps per minute and on heart rate. The goal was to have students
exercise as long as possible within the pulse range of aerobic exercising. In this way, a goal of a step
cadence average of 44.44 (S.D. = 10.83) per minute was set, which means a signal cadence lower than
the average initial performance by 78.67% (S.D. = 13.33). The signal cadence of each student was stable
throughout the exercise. The instruction given to the students was to step at the rhythm they listen to. If
the teacher noticed deviations from the personal goal after the first minute of the exercise, he accentuated
the rhythm by clapping at the signal of the electric metronome.
Apparatus
Metronome: The electronic metronome used was Weird Metronome (2004) installed in a portable P/C
(Acer Aspire 3630). The sound chosen was Low Conga. The rhythmic auditory stimuli were transmitted
to the students through wired headphones (PHILIPS SBC HL140). The precision of the electric
metronome was checked against a conventional metronome and no deviation was observed.
Stepper: An OEMMEBI ProFitness device was used featuring a heart rate and a step count indicator. It
also featured a manually adjustable resistance knob set at the easiest level for all students and in all
conditions. The physical education teacher checked the step count indicator’s precision for a minute;
with a pace of 60 steps a minute and the readings were found to be accurate. The heart rate indicator of
the stepper was checked by means of a POLAR FS1 heart rate monitor belt and no systematic deviations
were recorded.
Variables
Apart from an estimation of Maximum Heart Rate (Max HR = 220-age), for every student the
researchers estimated the heart rate threshold (50-70% of MaxHR) for aerobic exercise. At the end of
every minute of exercise, step count and heart rate were recorded. Of these data duration in minutes and
total step count were calculated. Dividing the latter by the former yields the average step cadence for
every student in steps per minute. In the same way average heart rate per minute was calculated. The last
two variables are particularly useful because exercise duration varied among students and among
conditions. On the measures recorded for every minute of exercise the researcher’s calculated within-
person, within-session variability both for the steps as well as for the heart rates, as a form of intra-
individual standard deviation (IISD, e.g., Nesselroade & Salthause, 2004).
Statistical Analysis
A statistical analysis for the normality of distribution of data using the Kolmogorov-Smirnov test
indicated that the data for the majority of variables do not follow normal distribution. We thus resorted to
the Wilcoxon non-parametric test on all variables in order to evaluate the differences between the two
conditions in the same sample of students.
Results Table 1. Frequencies for disability, intelligence and sex
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Table 1 presents the number of students on the basis of selected individual characteristics. Chi-square
tests run did not yield a significantly unequal distribution of the characteristics disability, gender and
mental retardation in the sample.
The average lowest bound for aerobic exercise was for the sample 100.86 (S.D. = 1.93) and the highest
141.21 (S.D. = 2.70) heartbeats per minute.
Table 2. Descriptive statistics of dependent variables and Wilcoxon tests for N=18
IISD = Intra Individual Standard Deviation
Table 2 shows the students’ performances on the initial measure and on both conditions. According to
the Wilcoxon test, the students were able to exercise significantly longer in the RAS rather than the Do
your best condition. The total step count was greater in the RAS condition but the difference from the Do
your best condition was not considered statistically significant. Furthermore, students produced a
significantly lower step cadence and a lower intra-individual standard deviation of step cadence in the
RAS condition as compared to the Do your best condition. It must be noted that in the RAS condition,
the average deviation of steps from the personal target of students ranged from -5.9 to 7.4 steps. In
absolute values, the average standard deviation was 2.69 (S.D. = 2.65) steps per minute, which
corresponds to a 6.6% margin of error. These results were reflected in the heart rate: statistically
significant decreases were observed in the average heart rate per minute as well as the intra-individual
standard deviation of heart rate.
A more in-depth analysis of the data can be obtained through the examination of every minute of
exercise. Such analyses were made for the first six minutes of exercise, because from the seventh minute
onwards the sample of observation pairs was so small (Ν 5) that not all categories of participants were
represented.
As can be seen in table 4 the impact of the RAS condition lies in the significant decrease of heart rate in
the first five minutes of exercise, while in the sixth minute the impact is not statistically significant.
Observing the values of heart rates under the Do your best condition, it becomes evident that from as
early as the third minute students exceed the 70% thresholds of maximum heart rate (≈141 heartbeats per
minute). In the RAS condition, and in all minutes of the exercise, the average heart rate lies within the
desirable limits for aerobic training.
Table 3. Descriptive statistics of steps in each minute and Wilcoxon tests
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Additional information about sample characteristics for N < 18
Regarding steps (see table 3), we observed a significantly decreased step count in the RAS condition as
opposed to the Do your best one in the first three minutes as well as the fifth.
Table 4. Descriptive statistics of Heart Rate in each minute and Wilcoxon tests
Discussion
In the present research the point of reducing step cadence through Rhythmic Auditory Stimulation (RAS)
was to increase the duration of the exercise on the stepper within the proposed limits for aerobic training.
This pilot study testing students from a Special Vocational Education and Training Secondary School
with mental retardation and cerebral palsy that was not free of limitations. The sample was relatively
small and non-homogeneous as to the disability involved. In addition, given the chosen research plan,
one cannot detect all aspects of long-term exercising to RAS.
What we did find was that RAS helped young students with mental retardation and cerebral palsy to
reduce their stepping cadence, that is, to gain control over their exercise tempo. Of course, the margin of
error for the reproduction of the rhythmic pattern was greater than those of other studies (Thaut
McIntosh, Rice, Miller, Rathbun, & Brault, 1996) and this was probably due to the cognitive and
INTERNATIONAL JOURNAL OF SPECIAL EDUCATION Vol 27, No: 3, 2012 pp 68-75
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psychomotor disorders of the students in our sample. While acknowledging these limitations, one cannot
question the potential of RAS to quickly affect the periodicity of motor patterns (Thaut, Kenyon, Hurt,
McIntosh, & Hoemberg, 2002). To this conclusion also points the fact that the students of the sample
decreased step variability within the RAS condition and worked out at a relatively more stable cadence.
In RAS the total step count did not increase significantly but the overall step count was distributed along
more minutes of exercise.
The dominant result was the decrease of step frequency per minute, which led to the increase of overall
exercise duration and the decrease of heart rate per minute. Apart from RAS, this can be attributed to two
more reasons. First, because the low intra-individual variability was considered a component of
psychomotor maturity (cf. Hausdorff, Zemany, Peng, & Goldberger, 1999) and second, maintaining a
relatively stable rhythm was a significant endurance factor (cf. Tenenbaum, Lidor, Lavyan, Morrow,
Tonnel, Gershgoren, Meis, & Johnson, 2004). The results produced by the RAS condition are
particularly significant because heart rate was maintained within desirable limits for enhancing aerobic
capacity.
The difference between RAS condition and Do your best condition was not statistically significant in the
last minute of the exercise as far as heart rate was concerned. This happened, because in both conditions
heart rate tended to rise as students reached the limits of their aerobic endurance. The same effect
occurred in the step frequency per minute. Concretely, students tended to reduce their step frequency in
the Do your best condition, as they became tired. Both of these phenomena stemmed from a cause
irrelevant to RAS and have no bearing on its established effectiveness.
Conclusion
In the present study, RAS was used to control (i.e., to decelerate) the stepping cadence of the students
with mild mental retardation and of the students with cerebral palsy, aiming at the increase of the
exercise duration. Furthermore, the signal cadence used was constant for all minutes of the exercise. We
believe that a variable signal cadence based on the actual heart rate can be even more effective, as long
as students with congenital disabilities have been trained in the reproduction and change of rhythms.
In conclusion, the use of RAS seemed to have a significant effect on the step frequency and on the heart
rate of the students with mild mental retardation and of the students with cerebral palsy. Thus, the
students can profit from RAS in an effort to enhance the efficiency of physical activity and exercise in
the context of Special Education. We suppose that a prolonged exercise program with RAS can have
positive long term effects on students’ rhythmic ability and aerobic capacity.
More research in Special Education is needed in order to explore the influence of RAS on more physical
activities that involve circular movements such as stepping, running and cycling. Moreover the
possibility should be considered of examining the influence of long-term exercise on RAS as well as the
possibility of complementing it with other techniques (e.g., goal setting). Specifically in educational
settings, it is important to study how RAS can best be implemented and also to determine its significant
impact on the motivation of students with disabilities.
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Disability and Rehabilitation, 28 (11), pp. 721-728.
... In intervention studies involving persons with mobility limitation it was observed that the use of music and rhythm programs activated the motor and auditory system and consistently, improved balance, walking and mental health conditions (Jeong & Kim, 2007;Kim et al., 2011). Moreover, it seemed to be of significant benefit as regards to coordination of movements and at the same time, improvement of gross and fine motor skills, enhancement of tactile sensation and improvement of emotional and social development, especially in the case individuals with CP participated in music and motor activities basically designed on the theory of rhythmic auditory stimulation (Rhythmic Auditory Stimulation-RAS) (Chung, 2002;Farrell, Bagley, Davids, Foti, & Moore, 1999;Jiang, 2013;Kim et al., 2011;Kim, Kwak, Park, & Cho, 2012;Kwak, 2007;Kwak & Kim, 2013;Thaut, Hurt, Dragon, & Mcintosh, 1998;Varsamis, Staikopoulos, & Kartasidou, 2012). ...
... 10 This study has demonstrated that an 8 week RAS music and movement intervention program can produce increased the gait, balance and psychological parameters of athletes with CP. Although the measurements of outcome have varied from one previous study to another, the findings of this study are consistent with previous music and movement intervention studies indicating that interventions incorporating the rhythmic elements of music can improve the function of the lower limb on the affected side, decrease the walking variances of the people with CP (Chung, 2002;Farrell, et al., 1999;Jiang, 2013;Kim, et al., 2011;Kim et al., 2012;Kwak, 2007;Kwak & Kim, 2013;Thaut ,et al., 1998;Varsamis, et al., 2012). On the other hand, the score of depression, fatigue and confusion of participants has not been statistically significantly increased by previous interventions. ...
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The purpose of this investigation was to examine the effect of a music and movement intervention program on gait, balance and psychological parameters of 10 male athletes in throwing events (ball and disc) with Cerebral Palsy (CP) (spastic hemiplegia), all coming from a sport club in Thessaloniki. Participants were divided randomly by methodical selection into two groups, the Intervention Group (IG) (n=5) and the Control Group (CG) (n=5). The IG participated in a music and movement program of 16 sessions (8 weeks, with a frequency of 2 times/week for 50 minutes per session), which designed on the base of the theory of Rhythmic Auditory Stimulation (RAS) method. Audit results showed differences on gait, balance and psychological parameters were statistically significant (p≤.05) prior and after the intervention program for the IG, but not for the CG (p>.05). In conclusion, the application of a music and movement program designed on the base of the theory of RAS method had a positive and significant influence in motor and psychological skills.
... Rhythmic Auditory Stimulation gait training has been examined to some extent in adults with spastic CP (Kim et al., 2011(Kim et al., , 2012Varsamis et al., 2012;Efraimidou et al., 2016), where deficits in independent walking, bilateral control, as well as pain and fatigue are often associated with a decline in mobility in the adult population. In a series of clinical studies, Kim and colleagues reported that a 3-week RAS training improved functional gait in measures such as cadence, stride length, and gait velocity, also promoting significant kinematic changes of the pelvic and hip movement (Kim et al., 2011(Kim et al., , 2012. ...
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Research in basic and clinical neuroscience of music conducted over the past decades has begun to uncover music's high potential as a tool for rehabilitation. Advances in our understanding of how music engages parallel brain networks underpinning sensory and motor processes, arousal, reward, and affective regulation, have laid a sound neuroscientific foundation for the development of theory-driven music interventions that have been systematically tested in clinical settings. Of particular significance in the context of motor rehabilitation is the notion that musical rhythms can entrain movement patterns in patients with movement-related disorders, serving as a continuous time reference that can help regulate movement timing and pace. To date, a significant number of clinical and experimental studies have tested the application of rhythm-and music-based interventions to improve motor functions following central nervous injury and/or degeneration. The goal of this review is to appraise the current state of knowledge on the effectiveness of music and rhythm to modulate movement spatiotemporal patterns and restore motor function. By organizing and providing a critical appraisal of a large body of research, we hope to provide a revised framework for future research on the effectiveness of rhythm-and music-based interventions to restore and (re)train motor function.
... Furthermore, it is imperative to underline the moderate test-retest reliability scores. Probable explanations for this phenomenon are (a) since goal setting activities are frequently used in adapted physical education (Kelly, 2011), linked interventions can alter the stability of the researched constructs; in this case, the pattern of low scores possibly depicts intervention effects, (b) neurologically challenged students usually demonstrate motor performance instability and/or high intra-individual variability (Varsamis, Kartasidou, & Staikopoulos, 2012;Waninge, Evenhuis, van Wijck, & van der Schans, 2011), and (c) the formulation of some items -perhaps in conjunction with the cognitive restrictions of some participants -may have played a negative role too. Taken altogether, further research is required in order to locate weaknesses of self-regulation items used in special education populations. ...
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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. Keywords: entrainment, spastic diplegia, hemiplegia, ataxia, rehabilitation, balance
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This article reports research on self-regulatory aspects (i.e., goal-setting, self-efficacy and self-evaluation) of secondary and post-secondary students with congenital motor disabilities, who performed a ball-throwing-at-a-target task. Participants were divided into four subgroups presenting distinct combinations of motor and cognitive abilities (i.e., normal cognitive development and mild physical disabilities, normal cognitive development and severe physical disabilities, mild-to-moderate intellectual disability and mild physical disabilities, and mild-to-moderate intellectual disability and severe physical disabilities). Results showed that students presenting mild motor disabilities exhibited a positive self-concept and self-regulation profile, irrespective of their cognitive functioning. Students with considerable motor disabilities, but without cognitive challenges, presented a negative, though realistic self-concept and self-regulation profile. Finally, students with considerable motor disabilities and mild-to-moderate cognitive disabilities showed a positive, though unrealistic, self-regulation profile. The nature of the diverse relationship of motor and cognitive (dis)abilities to specific self-regulatory aspects are discussed, and important instructional implications are mentioned.
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This study analyzed the ability of patients with Huntington's disease (HD) to modulate gait velocity without external sensory cues and in response to an auditory rhythmic cue within a frequency entrainment design. Uncued gait patterns of 27 patients were first assessed during normal, slower, and faster self-paced walking. During rhythmic trials, metronome and musical beat patterns were delivered at rates 10% slower and 10–20% faster than baseline cadence to cue gait patterns. After the rhythmic trials, patients were retested at normal gait speed without rhythm. Gait velocities in the patients with HD were below normal reference values in all ranges. Patients were able to significantly (p <0.05) modulate their gait velocity during self-paced and rhythmic metronome cueing but not during music. The ability to modulate gait velocity was retained regardless of the severity of the disease. Gait velocity declined with an increase in disability and chorea score. The disability score differentiated better between gait velocity of moderately and severe patients than chorea score. Slowness of gait was significantly correlated only with disability score and not with chorea. Patients had more difficulty producing adequate step rates than stride lengths during normal and fast walking speeds. After the rhythmic trials, unpaced gait velocity remained significantly (p <0.05) higher than baseline. This carry-over effect was not seen after the uncued trials. Synchronization ability was deficient in all patients, deteriorated with severity of disease, and was already compromised in patients with soft disease signs. Rhythmic tracking of music declined more with severity of disease than metronome tracking. In summary, patients were able to modulate velocity with and without external cues. Velocity adaptations to the external rhythm in music and metronome were achieved without exact synchronization between step cadence and rhythmic stimulus.
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The effectiveness of 2 different types of gait training in stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath- based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35). Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender, and lesion site. Motor function in both groups was pre-assessed by the Barthel Index and the Fugl-Meyer Scales. Pre- to posttest measures showed a significant improvement in the RAS group for velocity (P = .006), stride length (P = .0001), cadence (P = .0001) and symmetry (P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence. The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.
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The effect of rhythmic auditory stimulation (RAS) on gait velocity, cadence, stride length, and symmetry was studied in 31 patients with idiopathic Parkinson's disease, 21 of them on (ON) and 10 off medication (OFF), and 10 healthy elderly subjects. Patients walked under four conditions: (1) their own maximal speed without external rhythm; (2) with the RAS beat frequency matching the baseline cadence; (3) with RAS 10% faster than the baseline cadence; (4) without rhythm to check for carry over from RAS. Gait data were recorded via a computerised foot switch system. The RAS was delivered via a 50 ms square wave tone embedded in instrumental music (Renaissance style) in 2/4 metre prerecorded digitally on a sequencer for variable tempo reproduction. Patients on medication were tested in the morning 60-90 minutes after medication. Patients off medication were tested at the same time of day 24 hours after the last dose. Healthy elderly subjects were tested during the same time of day. Faster RAS produced significant improvement (P < 0.05) in mean gait velocity, cadence, and stride length in all groups. Close synchronisation between rhythm and step frequency in the controls and both Parkinson's disease groups suggest evidence for rhythmic entrainment mechanisms even in the presence of basal ganglia dysfunction. The results are consistent with and extend prior reports of rhythmic auditory facilitation in Parkinson's disease gait when there is mild to moderate impairment, and suggest a technique for gait rehabilitation in Parkinson's disease.
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This study tested the Eysenck/Jensen ‘speed of neural processing’ theory of general ability by examining the relationship between general mental ability and speed of performing a simple, repetitive movement. Seventy psychology students were tested for intelligence using Raven’s Advanced Progressive Matrices and the Wechsler Adult Intelligence Scale-III. Motor speed was assessed by means of a tapping task in which two fingers tapped alternately. The expected positive correlations between speed scores and cognitive measures were obtained, with significant associations demonstrated between tapping speed and traditional Full-scale IQ, Verbal IQ and Raven’s Matrices scores. There was little evidence however of any association between motor speed and Performance IQ. These findings are consistent with other research, although the lack of correlation with WAIS-III Performance scores is surprising.
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Evaluated the performance of 30 mildly mentally retarded Ss in rhythm pattern duplication tasks presented via tactile, auditory, auditory-visual, and auditory-visual-tactile conditions. Ss were grouped according to classroom assignments: primary (aged 6–8 yrs), intermediate (aged 9–12 yrs), and adolescent (aged 13–18 yrs). Results show a significant main effect for sensory condition and a significant interaction effect. All groups scored significantly lower on the tactile tasks, and the primary group scored significantly lower than the other 2 groups on the tactile tasks only. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The emotional and psychological benefits of musical experiences for human behavior are well documented by research in music therapy and psychology of music. It is also documented that music and rhythm have been utilized universally to accompany motor activity. The effect, however, of music and rhythm on motor activity including mechanics of hemiparetic gait has not been investigated. The purpose of this study was to investigate the effect of auditory rhythmic cuing on gait kinematic parameters of stroke patients. Eight subjects were studied over three trials. For each trial, a baseline walk without rhythm and a walk with rhythm as pacemaker, matched to the step cadence of the baseline walk, was videotaped with two 60 Hz videocameras. Three dimensional coordinates of ten body points were calculated by combining the images of the two cameras utilizing the direct linear transformation (DLT) method. The raw position data was digitally smoothed before being submitted to further analysis. Repeated measures ANOVA and paired t-tests revealed positive modifications in gait patterns due to musical rhythmic cues; specifically: (1) the stride lengths and hip joint range of motion (ROM) of the affected/non-affected sides became more symmetrical; and (2) center of mass (CM) vertical displacement decreased. These results support the presence of an entrainment effect of auditory rhythmic cuing on hemiparetic gait.
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Objectives. To examine: (a) the effect of music type on running time and on sensations and thoughts experienced by the runners under high physical exertion, and (b) the role that music plays in the use of two distinct self-regulation techniques during high exertion, namely dissociative and motivational.Design and procedure. Three studies were conducted. In Study 1 and Study 2, performed in the laboratory, participants ran at 90% of their maximal oxygen uptake on a motorized treadmill four times, once each with rock, dance, and inspirational music, and once without attending to music. Ratings of perceived exertion (RPE) and heart rate (HR) were monitored during the run, and discomfort symptoms and music-specific questions were examined. In Study 3, performed in the field, participants ran a hilly course eight times, four under a competitive-pair condition, and four under a single-mode condition. Running time was the dependent variable.Results. Music failed to influence HR, RPE, and sensations of exertion in the three studies. However, about 30% of the participants indicated that the music helped them at the beginning of the run. The participants stated that music both directed their attention to the music and motivated them to continue. Despite the heavy workload reported by the runners, running with music was perceived as beneficial by many.Conclusions: People engaged in high intensity running may benefit from listening to music, but may not increase their ability to sustain that effort longer than they could without music. Further research that incorporates personal music type and rhythm preferences should be carried out in order to advance this line of inquiry.
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Contenido: Parte I.Cuestiones conceptuales en la investigación cualitativa: Naturaleza de la investigación cualitativa; Temas estratégicos en la investigación cualitativa; Diversidad en la investigación cualitativa: orientaciones teóricas; Aplicaciones cualitativas particulares. Parte II. Diseños cualitativos y recolección de datos: Estudios de diseños cualitativos; Estrategias de trabajo de campo y métodos de observación; Entrevistas cualitativas. Parte III. Análisis, interpretación e informe: Análisis cualitativo e interpretación; Incrementar la calidad y la credibilidad del análisis cualitativo.
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Rhythmic auditory stimulation (RAS) was used as a pacemaker during a 3-week home-based gait-training program for Parkinson's disease (PD) patients (n = 15). Electromyogram (EMG) patterns and stride parameters were assessed before and after the test without RAS to evaluate changes in gait patterns. Data were compared with those of two control groups (n = 11), who either did not participate in any gait training or who participated in an internally self-paced training program. RAS consisted of audiotapes with metronome-pulse patterns embedded into the on/off beat structure of rhythmically accentuated instrumental music. Patients who trained with RAS significantly (p < 0.05) improved their gait velocity by 25%, stride length by 12%, and step cadence by 10% more than self-paced subjects who improved their velocity by 7% and no-training subjects whose velocity decreased by 7%. In the RAS-group, timing of EMG patterns changed significantly (p < 0.05) in the anterior tibialis and vastus lateralis muscles. Evidence for rhythmic entrainment of gait patterns was shown by the ability of the RAS group to reproduce the speed of the last training tape within a 2% margin of error without RAS.
Article
Experimental and control groups of 10 hemiparetic stroke patients each underwent a 6 week, twice daily gait training program. The control group participated in a conventional physical therapy gait program. The experimental group trained in the same basic program with the addition of rhythmic auditory stimulation (RAS). Patients entered the study as soon as they could complete 5 strides with hand-held assistance. The training program had to be completed within 3 months of the patients' stroke. In the experimental group RAS was used as a timekeeper to synchronize step patterns and gradually entrain higher stride frequencies. Study groups were equated by gender, lesion site, and age. Motor function was assessed at pretest using Barthel, Fugl-Meyer, and Berg Scales. Walking patterns were assessed during pre- and post-test without RAS present. Pre- vs post-test measures revealed a statistically significant (P<0.05) increase in velocity (164% vs 107%), stride length (88% vs 34%), and reduction in EMG amplitude variability of the gastrocnemius muscle (69% vs 33%) for the RAS-training group compared to the control group. The difference in stride symmetry improvement (32% in the RAS-group vs 16% in the control group) was statistically not significant. The data offer evidence that RAS is an efficient tool to enhance efforts in gait rehabilitation with acute stroke patients.