The Effect of External Rhythmic Cues (Auditory and Visual) on Walking During a Functional Task in Homes of People With Parkinson’s Disease

VU University Amsterdam, Amsterdamo, North Holland, Netherlands
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 06/2005; 86(5):999-1006. DOI: 10.1016/j.apmr.2004.10.040
Source: PubMed


To evaluate (1) the influence of rhythmic cues on gait interference during a functional activity and (2) the relationship of clinical symptoms to gait interference.
Repeated-measures study.
Participants' homes.
Twenty subjects with idiopathic Parkinson's disease (PD) and a control group of 10 age-, sex-, and education-matched subjects.
Subjects performed a simple functional task that included a walking component and a dual-motor task. The functional task was performed with and without external rhythmic (auditory and visual) cues.
Walking speed, mean step length, and step frequency were compared during trials of the tasks. In addition, tests of cognitive executive function (Hayling and Brixton tests), anxiety and depression (Hospital Anxiety and Depression Scale), and fatigue (Multidimensional Fatigue Inventory) were undertaken.
The use of auditory cues during a dual task involving gait reduced the interference effect on the task; significant increases in step length were observed in PD subjects ( P =.018), representing an increase of 19%.
External auditory cues may be useful in reducing interference and maintaining gait performance during more complicated functional activities. Clinical symptoms, such as depression and fatigue, could influence the ability to focus attention and may increase gait interference during the performance of complex tasks, with subsequent implications for functional walking and safety.

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Available from: Erwin van Wegen, Jun 24, 2015
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    • "Following the 60th tap, the TC stopped automatically, and the participant attempted to maintain the tapping cadence previously provided by the TC for 30 additional taps (continuation). Each participant completed six trials, two of which were cued at CSI e one of those conducted with a secondary task, holding a tray with two cups of water [19] [20] e and the other four at two faster and two slower intervals. The order of trials was randomized. "
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    ABSTRACT: Introduction: Visual and auditory cueing improve functional performance in Parkinson's disease (PD) patients. However, audiovisual processing shares many cognitive resources used for attention-dependent tasks such as communication, spatial orientation, and balance. Conversely, tactile cues (TC) may be processed faster, with minimal attentional demand, and may be more efficient means for modulating motor-cognitive performance. In this study we aimed to investigate the efficacy and limitations of TC for modulating simple (heel tapping) and more complex (walking) motor tasks (1) over a range of cueing intervals, (2) with/without a secondary motor task (holding tray with cups of water). Methods: Ten PD patients (71 ± 9 years) and 10 healthy controls (69 ± 7 years) participated in the study. TCs was delivered through a smart phone attached to subjects' dominant arm and were controlled by a custom-developed Android application. Results: PD patients and healthy controls were able to use TC to modulate heel tapping (F(3.8,1866.1) = 1008.1, p < 0.001), and partially modulate walking (F(3.5,1448.7) = 187.5, p < 0.001) tasks. In the walking task, PD patients modulated performance over a narrower range of cueing intervals (R(2) = 0.56) than healthy controls (R(2) = 0.84; group difference F(3.5,1448.7) = 8.6, p < 0.001). TC diminished synchronization error associated with performance of secondary motor task during walking in PD patients and healthy controls (main effect of Task (F(1,494) = 0.4; p = 0.527), Task X Group interaction (F(1,494) = 0.5; p = 0.493)). Conclusion: This study expands modalities of TC usage for movement modulation and motor-cognitive integration in PD patients. The smartphone TC application was validated as a user-friendly movement modulation aid.
    Full-text · Article · Nov 2015 · Parkinsonism & Related Disorders
    • "In the presence of tempo-to-cadence-matched salient music, gait velocity, stride length, and cadence increased in a manner statistically comparable to when participants were listening to a simple metronome tone. This finding is in accordance with previous work, which has demonstrated improvements in gait performance among healthy and older adults with neurological disorders with a cadence-matched auditory cue (Arias & Cudeiro, 2008; Bryant et al., 2009; de Bruin et al., 2010; de l'Etoile, 2008; del Olmo & Cudeiro, 2005; Nieuwboer et al., 2007; Rochester et al., 2005; Thaut et al., 1993; Thaut et al., 1996; Thaut et al., 2007; Willems et al., 2006). Conversely, non-salient music failed to modify gait when compared to uncued walking. "
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    ABSTRACT: The presence of a rhythmic beat in the form of a metronome tone or beat-accentuated original music can modulate gait performance; however, it has yet to be determined whether gait modulation can be achieved using commercially available music. The current study investigated the effects of commercially available music on the walking of healthy young adults. Specific aims were (a) to determine whether commercially available music can be used to influence gait (i.e., gait velocity, stride length, cadence, stride time variability), (b) to establish the effect of music salience on gait (i.e., gait velocity, stride length, cadence, stride time variability), and (c) to examine whether music tempi differentially effected gait (i.e., gait velocity, stride length, cadence, stride time variability). Twenty-five participants walked the length of an unobstructed walkway while listening to music. Music selections differed with respect to the salience or the tempo of the music. The genre of music and artists were self-selected by participants. Listening to music while walking was an enjoyable activity that influenced gait. Specifically, salient music selections increased measures of cadence, velocity, and stride length; in contrast, gait was unaltered by the presence of non-salient music. Music tempo did not differentially affect gait performance (gait velocity, stride length, cadence, stride time variability) in these participants. Gait performance was differentially influenced by music salience. These results have implications for clinicians considering the use of commercially available music as an alternative to the traditional rhythmic auditory cues used in rehabilitation programs. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail:
    No preview · Article · Sep 2015 · Journal of music therapy
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    • "We were interested in how gait changed during the different music and metronome conditions compared to uncued walking. Hence, we obtained change scores of each gait parameter by subtracting the average gait parameters in each stimulus condition from the average gait parameters in uncued walking (Rochester et al., 2005). Then, to enable comparisons across individuals to be made on the same scale (e.g., a long-legged participant who takes long steps may have a greater absolute difference in step length than a shortlegged participant who takes short steps), we normalized these change scores to gait parameters obtained from uncued walking. "
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    ABSTRACT: Rhythmic auditory stimulation (RAS) is a gait rehabilitation method in which patients synchronize footsteps to a metronome or musical beats. Although RAS with music can ameliorate gait abnormalities, outcomes vary, possibly because music properties, such as groove or familiarity, differ across interventions. To optimize future interventions, we assessed how initially familiar and unfamiliar low-groove and high-groove music affected synchronization accuracy and gait in healthy individuals. We also experimentally increased music familiarity using repeated exposure to initially unfamiliar songs. Overall, familiar music elicited faster stride velocity and less variable strides, as well as better synchronization performance (matching of step tempo to beat tempo). High-groove music, as reported previously, led to faster stride velocity than low-groove music. We propose two mechanisms for familiarity's effects. First, familiarity with the beat structure reduces cognitive demands of synchronizing, leading to better synchronization performance and faster, less variable gait. Second, familiarity might have elicited faster gait by increasing enjoyment of the music, as enjoyment was higher after repeated exposure to initially low-enjoyment songs. Future studies are necessary to dissociate the contribution of these mechanisms to the observed RAS effects of familiar music on gait. © 2015 New York Academy of Sciences.
    Full-text · Article · Mar 2015 · Annals of the New York Academy of Sciences
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