Effect of different music genres on gait patterns in Parkinson’s disease

Therapeutic use of music in neurological disorders: A concise narrative review

Background

Music elicits multifactorial benefits in emotional, social, cognitive, and academic aspects of human life. Music is clinically proven to reduce stress and anxiety, and improve mood and self-expression, particularly after traumatic events. Studies have also demonstrated that music promotes parasympathetic autonomic systems, suppresses hyperactivation of stress responses, and boosts immune functions. However, its ability to promote brain plasticity and signalling are only beginning to be realized. Moreover, its employment as a therapy for the treatment of specific aspects of other neurological disorders, including neurodevelopmental and neurodegenerative conditions and their comorbidities, is fast becoming an interesting field of research.

Objective

The aim of this review is to summarize some of the recent studies focused on evaluating the applications of music therapy. For this purpose, we have focused on disorders encompassing both temporal extremities of brain developmental stages, from developmental conditions of autism and attention deficit hyperactivity disorder (ADHD), to ageing-related pathologies of Parkinson's disease and dementias.

Results

The findings of the reviewed studies indicate potent utilities of music-based interventions in beneficially affecting multiple spheres of brain functions, such as sensorimotor, auditory, communication/language, psychological/emotional, behavioural, sleep and memory and cognitive attributes of patients diagnosed with diverse neuropathologies. Nevertheless, lack of standardized protocols for music provision as well as absence of information regarding key aspects, such as cultural and musical orientations of subjects and therapists'/caregivers' attitudes, have hindered the complete realization of music's therapeutic potential for neurological conditions. Further, while some studies have undertaken assessments of core neurophysiological mechanisms underlying music therapy, this information is largely lacking for most clinical studies.

Conclusion

While this is not an exhaustive review of literature, we do hope that it serves as a platform to promote future research for establishing music therapy as a relevant neurotherapeutic strategy.

Evaluation of physiological response and synchronisation errors during synchronous and pseudosynchronous stimulation trials

Rhythm perception and synchronisation is musical ability with neural basis defined as the ability to perceive rhythm in music and synchronise body movements with it. The study aimed to check the errors of synchronisation and physiological response as a reaction of the subjects to metrorhythmic stimuli of synchronous and pseudosynchronous stimulation (synchronisation with an externally controlled rhythm, but in reality controlled or produced tone by tapping) Nineteen subjects without diagnosed motor disorders participated in the study. Two tests were performed, where the electromyography signal and reaction time were recorded using the NORAXON system. In addition, physiological signals such as electrodermal activity and blood volume pulse were measured using the Empatica E4. Study 1 consisted of adapting the finger tapping test in pseudosynchrony with a given metrorhythmic stimulus with a selection of preferred, choices of decreasing and increasing tempo. Study 2 consisted of metrorhythmic synchronisation during the heel stomping test. Numerous correlations and statistically significant parameters were found between the response of the subjects with respect to their musical education, musical and sports activities. Most of the differentiating characteristics shown evidence of some group division in the undertaking of musical activities. The use of detailed analyses of synchronisation errors can contribute to the development of methods to improve the rehabilitation process of subjects with motor dysfunction, and this will contribute to the development of an expert system that considers personalised musical preferences.

The Effects of Listening to Music on Postural Balance in Middle-Aged Women

Listening to music has been found to influence postural balance in both healthy participants and certain patients, whereas no study investigates such effects among healthy middle-aged women. Thus, this study aimed to investigate the effect of music on postural balance in middle-aged women. Twenty-six healthy women aged between 50 and 55 years participated in this study. A stabilometric platform was used to assess their postural balance by recording the mean center of pressure velocity (VmCOP) in the eyes-opened (OE) and -closed (EC) conditions on both firm and foam surfaces. Our results showed that listening to an excerpt of Mozart's Jupiter significantly decreased the VmCOP values in two sensory conditions (firm surface/EO: (p < 0.01; 95% CI: 0.27 to 2.22); foam surface/EC: (p < 0.001; 95% CI: 0.48 to 2.44)), but not in the other two conditions (firm surface/EC and foam surface/EO). We concluded that listening to Mozart's symphony improved postural performance in middle-aged women, even in challenged postural conditions. These enhancements could offer great potential for everyday functioning.

The Influence of Listening to Preferred versus Non-Preferred Music on Static and Dynamic Balance in Middle-Aged Women

Although many women perform postural tasks while listening to music, no study has investigated whether preferred music has different effects than non-preferred music. Thus, this study aimed to explore the effects of listening to preferred versus non-preferred music on postural balance among middle-aged women. Twenty-four women aged between 50 and 55 years were recruited for this study. To assess their static balance, a stabilometric platform was used, recording the mean center of pressure velocity (CoPVm), whereas the timed up and go test (TUGT) was used to assess their dynamic balance. The results showed that listening to their preferred music significantly decreased their CoPVm values (in the firm-surface/eyes-open (EO) condition: (p < 0.05; 95% CI [-0.01, 2.17])). In contrast, when the women were listening to non-preferred music, their CoPVm values significantly (p < 0.05) increased compared to the no-music condition in all the postural conditions except for the firm-surface/EO condition. In conclusion, listening to music has unique effects on postural performance, and these effects depend on the genre of music. Listening to preferred music improved both static and dynamic balance in middle-aged women, whereas listening to non-preferred music negatively affected these performances, even in challenged postural conditions.

The effect of walking with reduced trunk motion on dynamic stability in healthy adults

BACKGROUND

Most people with Parkinson's disease (PD) walk with a smaller mediolateral base of support (BoS) compared to healthy people, but the underlying mechanisms remain unknown. Reduced trunk motion in people with PD might be related to this narrow-based gait. Here, we study the relationship between trunk motion and narrow-based gait in healthy adults. According to the extrapolated center of mass (XCoM) concept, a decrease in mediolateral XCoM excursion would require a smaller mediolateral BoS to maintain a constant margin of stability (MoS) and remain stable.

RESEARCH QUESTION

As proof of principle, we assessed whether walking with reduced trunk motion results in a smaller step width in healthy adults, without altering the mediolateral MoS.

METHODS

Fifteen healthy adults walked on a treadmill at preferred comfortable walking speed in two conditions. First, the 'regular walking' condition without any instructions, and second, the 'reduced trunk motion' condition with the instruction: 'Keep your trunk as still as possible'. Treadmill speed was kept the same in the two conditions. Trunk kinematics, step width, mediolateral XCoM excursion and mediolateral MoS were calculated and compared between the two conditions.

RESULTS

Walking with the instruction to keep the trunk still significantly reduced trunk kinematics. Walking with reduced trunk motion resulted in significant decreases in step width and mediolateral XCoM excursion, but not in the mediolateral MoS. Furthermore, step width and mediolateral XCoM excursion were strongly correlated during both conditions (r = 0.887 and r = 0.934).

SIGNIFICANCE

This study shows that walking with reduced trunk motion leads to a gait pattern with a smaller BoS in healthy adults, without altering the mediolateral MoS. Our findings indicate a strong coupling between CoM motion state and the mediolateral BoS. We expect that people with PD who walk narrow-based, have a similar mediolateral MoS as healthy people, which will be further investigated.

Experiment protocols for brain-body imaging of locomotion: A systematic review

Introduction

Human locomotion is affected by several factors, such as growth and aging, health conditions, and physical activity levels for maintaining overall health and well-being. Notably, impaired locomotion is a prevalent cause of disability, significantly impacting the quality of life of individuals. The uniqueness and high prevalence of human locomotion have led to a surge of research to develop experimental protocols for studying the brain substrates, muscle responses, and motion signatures associated with locomotion. However, from a technical perspective, reproducing locomotion experiments has been challenging due to the lack of standardized protocols and benchmarking tools, which impairs the evaluation of research quality and the validation of previous findings.

Methods

This paper addresses the challenges by conducting a systematic review of existing neuroimaging studies on human locomotion, focusing on the settings of experimental protocols, such as locomotion intensity, duration, distance, adopted brain imaging technologies, and corresponding brain activation patterns. Also, this study provides practical recommendations for future experiment protocols.

Results

The findings indicate that EEG is the preferred neuroimaging sensor for detecting brain activity patterns, compared to fMRI, fNIRS, and PET. Walking is the most studied human locomotion task, likely due to its fundamental nature and status as a reference task. In contrast, running has received little attention in research. Additionally, cycling on an ergometer at a speed of 60 rpm using fNIRS has provided some research basis. Dual-task walking tasks are typically used to observe changes in cognitive function. Moreover, research on locomotion has primarily focused on healthy individuals, as this is the scenario most closely resembling free-living activity in real-world environments.

Discussion

Finally, the paper outlines the standards and recommendations for setting up future experiment protocols based on the review findings. It discusses the impact of neurological and musculoskeletal factors, as well as the cognitive and locomotive demands, on the experiment design. It also considers the limitations imposed by the sensing techniques used, including the acceptable level of motion artifacts in brain-body imaging experiments and the effects of spatial and temporal resolutions on brain sensor performance. Additionally, various experiment protocol constraints that need to be addressed and analyzed are explained.

The golden ratio as an ecological affordance leading to aesthetic attractiveness

The golden ratio (GR) is an irrational number (close to 1.618) that repeatedly occurs in nature as well as in masterpieces of art. The GR has been considered a proportion perfectly representing beauty since ancient times, and it was investigated in several scientific fields, but with conflicting results. This study aims at investigating if this proportion is associated with a judgment of beauty independently of the type of the stimulus, and the factors that may affect this aesthetic preference. In Experiment 1, an online psychophysical questionnaire was administered to 256 volunteers asked to choose among three possible proportions between the parts of the same stimulus (GR, 1.5, and 1.8). In Experiment 2, we recorded eye movements in 15 participants who had to express an aesthetic judgment on the same stimuli of Experiment 1. The results revealed a slight overall preference for GR (53%, p < .001), with higher preferences for stimuli representing humans, anthropomorphic sculptures, and paintings, regardless of the cultural level. In Experiment 2, a shorter dwell time was significantly associated with a better aesthetic judgment (p = .005), suggesting the possibility that GR could be associated with easier visual processing, and it could be hence considered as a visual affordance.

Music Therapy and Parkinson's Disease: A Systematic Review from 2015-2020

Parkinson's disease can be approached from various points of view, one of which is music therapy-a complementary therapy to a pharmacological one. This work aims to compile the scientific evidence published in the last five years (2015-2020) on the effects of music therapy in patients with Parkinson's disease. A systematic review has been performed using the Web of Science and Scopus databases with the descriptors "music therapy" and "Parkinson's disease". A total of 281 eligible articles were identified, which, after applying the inclusion and exclusion criteria, were reduced to 58 papers. The results display a great diversity of evidence, confirming positive effects on various spheres. All mentioned patients with Parkinson's disease had experienced different music therapy programs. Some studies focused on the motor component, which can be addressed through listening, body rhythm, and rhythmic auditory stimulation. Other studies confirm effects on communication, swallowing, breathing, and the emotional aspect through programs that focus on singing, either individually or in groups, in order to improve the quality of life of people with PD. It was concluded that music therapy programs can achieve improvements in various areas of patients with Parkinson's.

Wearable inertial sensors for human movement analysis: a five-year update

INTRODUCTION

The aim of the present review is to track the evolution of wearable IMUs from their use in supervised laboratory- and ambulatory-based settings to their application for long-term monitoring of human movement in unsupervised naturalistic settings.

AREAS COVERED

Four main emerging areas of application were identified and synthesized, namely, mobile health solutions (specifically, for the assessment of frailty, risk of falls, chronic neurological diseases, and for the monitoring and promotion of active living), occupational ergonomics, rehabilitation and telerehabilitation, and cognitive assessment. Findings from recent scientific literature in each of these areas was synthesized from an applied and/or clinical perspective with the purpose of providing clinical researchers and practitioners with practical guidance on contemporary uses of inertial sensors in applied clinical settings.

EXPERT OPINION

IMU-based wearable devices have undergone a rapid transition from use in laboratory-based clinical practice to unsupervised, applied settings. Successful use of wearable inertial sensing for assessing mobility, motor performance and movement disorders in applied settings will rely also on machine learning algorithms for managing the vast amounts of data generated by these sensors for extracting information that is both clinically relevant and interpretable by practitioners.

Effects of cognitive workload on heart and locomotor rhythms coupling

Different physiological signals could be coupled under specific conditions, in some cases related to pathologies or reductions in system complexity. Cardiac-locomotor synchronization (CLS) has been one of the most investigating coupling. The influence of a cognitive task on walking was investigated in dual-task experiments, but how different cognitive tasks may influence CLS has poorly been investigated. Twenty healthy subjects performed a dual-task walking (coupled with verbal fluency vs calculation) on a treadmill at three different speeds (comfortable speed CS; fast-speed: CS + 2 km/h; slow-speed: CS-2 km/h) while cardiac and walking rhythms were recorded using surface electrodes and a triaxial accelerometer, respectively. According to previous studies, we found a cognitive-motor interference for which cognitive performance was affected by motor exercise, but not vice-versa. We found a CLS at the baseline condition, at fast speed in both cognitive tasks, while at comfortable speed only for the verbal fluency task. In conclusion, the cardiac and locomotor rhythms were not coupled at slow speed and at comfortable speed during subtraction task. Cognitive performances generally increased at faster speed, when cardiac locomotor coupling was stronger.

Music-based techniques and related devices in neurorehabilitation: a scoping review

Introduction:The music as a powerful, and versatile stimulus for the brain, is at the date sometimes used in neurorehabilitation and proposed as a promising complementary strategy provided in combination with other therapy in individuals with neurological disorders. Different techniques and devices have been developed in the field of the music-based neurorehabilitation.Areas covered:This scoping review analyzes the current scientific literature concerning the different techniques and devices used in the music-supported neurorehabilitation, also focusing on the devices used in music-based therapies in patients with neurological disorders: 46 studies met the inclusion criteria and were included.Expert opinion:Included studies, highlight the potentiality and the versatility of the music-based therapy in the rehabilitation of neurological disorders. The variety of existing techniques allow to applied the music-based therapy in different situations and conditions. Moreover, the wide range of used devices that ranging from the simple musical instruments to the more advanced technologies, allows to develop customized exercises based on the needs of the patient. This review may be considered as a starting point to better design future RCTs that would investigate the effectiveness of music therapy on neurological disorders.

Neural Entrainment Meets Behavior: The Stability Index as a Neural Outcome Measure of Auditory-Motor Coupling

Understanding rhythmic behavior in the context of coupled auditory and motor systems has been of interest to neurological rehabilitation, in particular, to facilitate walking. Recent work based on behavioral measures revealed an entrainment effect of auditory rhythms on motor rhythms. In this study, we propose a method to compute the neural component of such a process from an electroencephalographic (EEG) signal. A simple auditory-motor synchronization paradigm was used, where 28 healthy participants were instructed to synchronize their finger-tapping with a metronome. The computation of the neural outcome measure was carried out in two blocks. In the first block, we used Generalized Eigendecomposition (GED) to reduce the data dimensionality to the component which maximally entrained to the metronome frequency. The scalp topography pointed at brain activity over contralateral sensorimotor regions. In the second block, we computed instantaneous frequency from the analytic signal of the extracted component. This returned a time-varying measure of frequency fluctuations, whose standard deviation provided our "stability index" as a neural outcome measure of auditory-motor coupling. Finally, the proposed neural measure was validated by conducting a correlation analysis with a set of behavioral outcomes from the synchronization task: resultant vector length, relative phase angle, mean asynchrony, and tempo matching. Significant moderate negative correlations were found with the first three measures, suggesting that the stability index provided a quantifiable neural outcome measure of entrainment, with selectivity towards phase-correction mechanisms. We address further adoption of the proposed approach, especially with populations where sensorimotor abilities are compromised by an underlying pathological condition. The impact of using stability index can potentially be used as an outcome measure to assess rehabilitation protocols, and possibly provide further insight into neuropathological models of auditory-motor coupling.

Artificial Neural Network Analyzing Wearable Device Gait Data for Identifying Patients With Stroke Unable to Return to Work

A potential dramatic effect of long-term disability due to stroke is the inability to return to work. An accurate prognosis and the identification of the parameters inflating the possibility of return to work after neurorehabilitation are crucial. Many factors may influence it, such as mobility and, in particular, walking ability. In this pilot study, two emerging technologies have been combined with the aim of developing a prognostic tool for identifying patients able to return to work: a wearable inertial measurement unit for gait analysis and an artificial neural network (ANN). Compared with more conventional statistics, the ANN showed a higher accuracy in identifying patients with respect to healthy subjects (90.9 vs. 75.8%) and also in identifying the subjects unable to return to work (93.9 vs. 81.8%). In this last analysis, the duration of double support phase resulted the most important input of the ANN. The potentiality of the ANN, developed also in other fields such as marketing on social networks, could allow a powerful support for clinicians that today should manage a large amount of instrumentally recorded parameters in patients with stroke.

Music as Add-On Therapy in the Rehabilitation Program of Parkinson's Disease Patients-A Romanian Pilot Study

Music has been proven to have therapeutic potential in neurological disorders, especially Parkinson’s disease (PD), since rhythmic auditory cueing can partially replace the progressive loss of rhythmicity and automaticity. Several reports have highlighted improvements in motor outcomes in PD patients undergoing music therapy, but only a few studies have evaluated non-motor outcomes, such as quality of life (QoL), which deteriorates with disease progression. The current pilot study aims to examine the effects of a multimodal rehabilitation program centered on physical therapy combined with listening to music on self-reported QoL in people with PD, compared to the same rehabilitation program alone. The study was conducted on patients with idiopathic PD who attended a specific rehabilitation program with a duration of 2.5 h daily for 14 days. The patients were divided into the study group (16 patients), who listened to background music during the rehabilitation program sessions, and the control group who did not listen to music during sessions. The patients were assessed using the self-report Parkinson’s Disease Questionnaire (PDQ-39) at the beginning of the program and 1 month after its initiation. The patients in the study group registered greater improvements in five of the eight areas of life assessed by PDQ-39 compared to the control group. In conclusion, listening to music combined with a multimodal rehabilitation program centered on physical therapy may be beneficial for the patients’ quality of life.

Effectiveness of a dance-physiotherapy combined intervention in Parkinson's disease: a randomized controlled pilot trial

BACKGROUND

Physical therapies have been recommended as crucial components in Parkinson's disease (PD) rehabilitation.

OBJECTIVE

The study aims to examine the effectiveness of a new dance-physiotherapy combined intervention, called DArT method, in mild PD patients.

METHODS

A prospective, randomized, single-blind, controlled pilot trial was conducted on 38 mild PD patients under dopaminergic therapy. The intervention consisted in an add-on protocol: the control group received 1 h of conventional physiotherapy followed by 1 h of conventional physiotherapy each day, 3 times a week, for 5 weeks. The experimental group received 1 h of conventional physiotherapy followed by 1 h of dance class each day, 3 times a week, for 5 weeks. The week before and after the training period, patients were assessed for motor, cognitive, emotional, and sensory components of PD, with MDS-UPDRS-III as primary outcome measure.

RESULTS

DArT method was associated with a 2.72-point reduction in the post-treatment MDS-UPDRS-III total score compared to control group (95% CI - 5.28, - 0.16, p = 0.038, d = 0.71), and with a 2.16-point reduction in the post-treatment MDS-UPDRS-III upper body subscore (95% CI - 3.56, - 0.76, p = 0.003, d = 1.02). Conversely, conventional physiotherapy program was associated with a 2.95-point reduction in the post-treatment trait anxiety compared to the experimental group (95% CI 0.19, 5.71, p = 0.037, d = 0.70). Withdrawal and fall rates were equal to 0% in both groups.

CONCLUSION

DArT method showed to be safe, well accepted, and more effective than an intensive program of conventional physiotherapy in improving motor impairment in mild PD.

Auditory environmental enrichment prevents anxiety-like behavior, but not cortisol responses, evoked by 24-h social isolation in zebrafish

The zebrafish (Danio rerio) is widely used as a promising translational model organism for studying various brain disorders. Zebrafish are also commonly used in behavioral and drug screening assays utilizing individually tested (socially isolated) fish. Various sounds represent important exogenous factors that may affect fish behavior. Mounting evidence shows that musical/auditory environmental enrichment can improve welfare of laboratory animals, including fishes. Here, we show that auditory environmental enrichment mitigates anxiogenic-like effects caused by acute 24-h social isolation in adult zebrafish. Thus, auditory environmental enrichment may offer an inexpensive, feasible and simple tool to improve welfare of zebrafish stocks in laboratory facilities, reduce unwanted procedural stress, lower non-specific behavioral variance and, hence, collectively improve zebrafish data reliability and reproducibility.

The Michelangelo Effect: Art Improves the Performance in a Virtual Reality Task Developed for Upper Limb Neurorehabilitation

The vision of an art masterpiece is associated with brain arousal by neural processes occurring quite spontaneously in the viewer. This aesthetic experience may even elicit a response in the motor areas of the observers. In the neurorehabilitation of patients with stroke, art observation has been used for reducing psychological disorders, and creative art therapy for enhancing physical functions and cognitive abilities. Here, we developed a virtual reality task which allows patients, by moving their hand on a virtual canvas, to have the illusion of painting some art masterpieces, such as The Creation of Adam of Michelangelo or The birth of Venus of Botticelli. Twenty healthy subjects (experiment 1) and four patients with stroke (experiment 2) performed this task and a control one in which they simply colored the virtual canvas. Results from User Satisfaction Evaluation Questionnaire and the NASA Task Load Index highlighted an appropriate level of usability. Moreover, despite the motor task was the same for art and control stimuli, the art condition was performed by healthy subjects with shorter trajectories (p = 0.001) and with a lower perception of physical demand (p = 0.049). In experiment 2, only the patients treated with artistic stimuli showed a reduction in the erroneous movements performed orthogonally to the canvas (p < 0.05). This finding reminds the so-called Mozart effect that improves the performance of subjects when they listen to classic music. Thus, we called this improvement in the performance when interacting with an artistic stimulus as Michelangelo effect.

How may patients with MS benefit from using music assisted therapy? A case-control feasability study investigating motor outcomes and beyond

Motor impairment is the most common symptom in multiple sclerosis (MS), as gait and balance dysfunction are reported in more than 85% of the patients, with considerable consequences on the patient's activities of daily living and psychological status. This study aimed at evaluating the feasibility and potential efficacy of a novel treatment involving music plus treadmill in patients with MS. Ten patients affected by secondary progressive MS were submitted to a specific training using the Gait Trainer (GT) 3, a platform that integrates gait training via a treadmill and rhythmic auditory stimulation. The 30 minutes training was performed three times per week for eight weeks (24 sessions in total). The enrolled patients were compared with a control group (CG) of 10 patients with MS matched for age, gender, disease duration, and EDSS stage. The CG received the same amount of treatment, but using conventional overground gait training. All patients completed the training without reporting any side effects. At the end of the training, CG improved in static and dynamic balance and in mood. Instead, in the EG a significant improvement in static and dynamic balance, walking speed, and mobility, as well as in mood, and perception of quality of life (QoL), both for physical and mental well-being, was found. This exploratory study suggests that GT3 might be a feasible and potentially useful approach for MS gait rehabilitation, thanks to patients' high motivation and good acceptance of the music assisted therapy.