Familiarity with music influences stride amplitude and variability during rhythmically-cued walking in individuals with Parkinson's disease

Enhancing gait cadence through rhythm-modulated music: A study on healthy adults

BACKGROUND AND OBJECTIVE

Gait disorders stemming from brain lesions or chemical imbalances, pose significant challenges for patients. Proposed treatments encompass medication, deep brain stimulation, physiotherapy, and visual stimulation. Music, with its harmonious structures, serves as a continuous reference, synchronizing muscle activities through neural connections between hearing and motor functions, can show promise in gait disorder management. This study explores the influence of heightened music rhythm on young healthy participants' gait cadence in three conditions: FeedForward (independent rhythm), FeedBack (cadence-synced rhythm), and Adaptive (cadence-controlled musical experience). The objective is to increase gait cadence through rhythm modulation during walking.

METHOD

The study involved 18 young healthy participants (13 males and 5 females) who did not have any gait or hearing disorders. Each participant completed the gait task in the three aforementioned conditions. Each condition was comprised of three sessions: 1) Baseline, where participants walked while listening to the original music; 2) Intervention, changing the music rhythm to affect the gait cadence; and 3) Realign, replaying the original music and measuring the durability of the effect of the Intervention session. The measurement tool was a pair of footwear equipped with push-button switches that transmited the foot-to-ground contact to the LabVIEW® software, all designed by the research team. Repeated measures of ANOVA was employed to evaluate the impact of the sessions and conditions.

RESULTS

In all three conditions, there was a significant effect of music on increasing gait cadence during Intervention and Realign sessions (p < 0.001). Additionally, the immediate impact of music on gait cadence in the Adaptive condition was superior to the other conditions.

CONCLUSION

The study findings indicate that increasing the rhythm of music during walking has a significant impact on gait cadence among young healthy participants. This effect remained significant even after realigning the music to normal. It could be harnessed to support the rehabilitation of individuals with movement disorders characterized by a decrease in movement speed, such as Parkinson's disease. Moreover, the results indicate that the Adaptive method showed promising outcomes, suggesting its potential for further exploration as an effective means to control gait cadence.

"It doesn't feel like exercise": a realist process evaluation of factors that support long-term attendance at dance classes designed for healthy ageing

Introduction

Dance can positively impact older people's health and wellbeing across cultures and socioeconomic groups, countering age-related physical, sensorimotor and cognitive decline.

Background/objectives

The RIPE (Really Is Possible for Everyone) Dance program aims to improve older people's physical, mental, cognitive and social wellbeing by integrating engaging dance sequences with evidence-based fall prevention exercises. We sought to identify what mechanisms support observed long-term participation in this program, including by people living with challenging health conditions.

Methods

Following a realist evaluation approach, we co-developed and tested program theories iteratively with participant interviewees (n = 20), dance teachers (n = 2) and via observation of a dance class. Initial data were dual-coded and emergent findings were interrogated by the research team. Findings were organised to express Program activities + Context + Mechanism = Process outcomes configurations.

Results

We identified four program theories comprising 14 mechanisms which explained long-term attendance: 1. RIPE Dance benefits my body and mind (trust in the program, belief in health benefits), 2. RIPE Dance helps me feel good about myself (self-efficacy, pride in achievement, psychological safety, defying expectations, feeling valued), 3. RIPE Dance creates camaraderie (social connection, mutual support, rapport with the teacher), and 4. RIPE Dance is uplifting (raised spirits, fun, synchrony, musical reactivity).

Conclusion

The RIPE Dance program provides effective and enjoyable 'exercise in disguise' for older people with diverse mobility profiles.

Significance/implications

This research confirms that participation in dance can contribute significantly to healthy, happy ageing. Findings detail program activities that were most strongly associated with process outcomes, offering guidance for further program development, implementation and scaling up.

Examining the capability for rhythmic synchronization and music production in vocal learning parrot species

Vocal production learning and beat perception and synchronization (BPS) share some common characteristics, which makes the vocal learning and rhythmic synchronization hypothesis (VLH) a reasonable explanation for the evolution of the capability for rhythmic synchronization. However, even in vocal learners, it is rare to see non-human animals demonstrate BPS to human music. Therefore, the first objective of this article is to propose some possible reasons why we do not see BPS in budgerigars, an excellent vocal learning species, while presenting some of my own findings. The second objective of this article is to propose a seamless bridge to connect the capability for vocal learning and BPS in locomotion. For this purpose, I present my own findings, wherein cockatiels spontaneously sang in synchrony with a melody of human music. This behavior can be considered a vocal version of BPS. Therefore, it can establish a connection between these two capabilities. This article agrees with the possibility that some mechanisms other than the vocal learning system may enable BPS, contrary to the original idea of VLH. Nevertheless, it is still reasonable to connect the capability for vocal learning and that for BPS. At the very least, the capability for vocal learning may contribute to the evolution of BPS. From these arguments, this article also proposes a scenario which includes vocalizing in synchrony as a driving force for the evolution of BPS and the capability for music production.

Music in the Middle: A Culture-Cognition-Mediator Model of Musical Functionality

Music is both universal, appearing in every known human culture, and culture-specific, often defying intelligibility across cultural boundaries. This duality has been the source of debate within the broad community of music researchers, and there have been significant disagreements both on the ontology of music as an object of study and the appropriate epistemology for that study. To help resolve this tension, I present a culture-cognition-mediator model that situates music as a mediator in the mutually constitutive cycle of cultures and selves representing the ways individuals both shape and are shaped by their cultural environments. This model draws on concepts of musical grammars and schema, contemporary theories in developmental and cultural psychology that blur the distinction between nature and nurture, and recent advances in cognitive neuroscience. Existing evidence of both directions of causality is presented, providing empirical support for the conceptual model. The epistemological consequences of this model are discussed, specifically with respect to transdisciplinarity, hybrid research methods, and several potential empirical applications and testable predictions as well as its import for broader ontological conversations around the evolutionary origins of music itself.

Music-based multicomponent exercise training for community-dwelling older adults with mild-to-moderate cognitive decline: a feasibility study

Introduction

This study explored the feasibility and preliminary efficacy of a music-based, multicomponent exercise intervention among community-dwelling older adults with mild-to-moderate cognitive impairment.

Methods

16 older adults aged 85±9 years with mild-to-moderate cognitive impairment received music-based multicomponent exercise training for 20 weeks at an independent living facility. Participants received aerobic, resistance, and balance training paired with beat-accentuated music stimulation. Participants' adherence to the training was tracked down and their cognitive and physical functioning and health-related quality of life were assessed at pre- and post-test.

Results

3 participants withdrew due to unexpected issues unrelated to the intervention and thus 13 participants (7 females) attended an average of 4.6 days/week over 20 weeks and reported high satisfaction with the intervention (90.6%). Participants showed significant improvement in global cognition, cognitive processing speed, and walking endurance/aerobic fitness at post-test.

Discussion

These findings support the feasibility of music-based, multicomponent exercise training for older adults in an independent living facility and set the stage for future studies to test the efficacy of music on physical activity and ensuing health outcomes. We conclude that music-based, multicomponent exercise training can be beneficial for community-dwelling older adults with mild-to-moderate cognitive decline. As a form of rhythmic auditory stimulation, beat-accentuated music can be combined with exercise training to manipulate exercise tempo and may provide a source of motivation to help older adults adhere to exercise.

Effect of Music Based Therapy Rhythmic Auditory Stimulation (RAS) Using Wearable Device in Rehabilitation of Neurological Patients: A Systematic Review

(1) Background: Even though music therapy is acknowledged to have positive benefits in neurology, there is still a lack of knowledge in the literature about the applicability of music treatments in clinical practice with a neurological population using wearable devices. (2) Methods: a systematic review was conducted following PRISMA 2020 guidelines on the 29 October 2022, searching in five databases: PubMed, PEDro, Medline, Web of Science, and Science Direct. (3) Results: A total of 2964 articles were found, including 413 from PubMed, 248 from Web of Science, 2110 from Science Direct, 163 from Medline, and none from PEDro. Duplicate entries, of which there were 1262, were eliminated. In the first screening phase, 1702 papers were screened for title and abstract. Subsequently, 1667 papers were removed, based on population, duplicate, outcome, and poor study design. Only 15 studies were considered after 35 papers had their full texts verified. Results showed significant values of spatiotemporal gait parameters in music-based therapy rhythmic auditory stimulation (RAS), including speed, stride length, cadence, and ROM. (4) Conclusions: The current findings confirm the value of music-based therapy RAS as a favorable and effective tool to implement in the health care system for the rehabilitation of patients with movement disorders.

Exploring the use of music to promote physical activity: From the viewpoint of psychological hedonism

Despite the global efforts to encourage people to regularly participate in physical activity (PA) at moderate-to-vigorous intensity, an inadequate number of adults and adolescents worldwide meet the recommended dose of PA. A major challenge to promoting PA is that sedentary or low-active people experience negative shifts in affective valence (feeling bad versus good) in response to moderate-to-vigorous intensity PA. Interestingly, empirical data indicate that listening to music during acute bouts of PA positively alters affective valence (feeling good versus bad), reduces perceived exertion, and improves physical performance and oxygen utilization efficiency. From the viewpoint of the ancient principle of psychological hedonism - humans have ultimate desires to obtain pleasure and avoid displeasure - we elaborate on three putative mechanisms underlying the affective and ergogenic effects of music on acute bouts of PA: (1) musical pleasure and reward, (2) rhythmic entrainment, and (3) sensory distraction from physical exertion. Given that a positive shift in affective valence during an acute bout of PA is associated with more PA in the future, an important question arises as to whether the affective effect of music on acute PA can be carried over to promote long-term PA. Although this research question seems intuitive, to our knowledge, it has been scarcely investigated. We propose a theoretical model of Music as an Affective Stimulant to Physical Activity (MASPA) to further explain the putative mechanisms underlying the use of music to promote long-term PA. We believe there have been important gaps in music-based interventions in terms of the rationale supporting various components of the intervention and the efficacy of these interventions to promote long-term PA. Our specification of relevant mechanisms and proposal of a new theoretical model may advance our understanding of the optimal use of music as an affective, ergogenic, and sensory stimulant for PA promotion. Future directions are suggested to address the gaps in the literature.

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.

Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting

BACKGROUND

Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input.

OBJECTIVE

To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting.

METHODS

Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion.

RESULTS

Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05).

CONCLUSIONS

Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.

Effect of music-based movement therapy on the freezing of gait in patients with Parkinson’s disease: A randomized controlled trial

Background

Progression of freezing of gait (FOG), a common pathological gait in Parkinson’s disease (PD), has been shown to be an important risk factor for falls, loss of independent living ability, and reduced quality of life. However, previous evidence indicated poor efficacy of medicine and surgery in treating FOG in patients with PD. Music-based movement therapy (MMT), which entails listening to music while exercising, has been proposed as a treatment to improve patients’ motor function, emotions, and physiological activity. In recent years, MMT has been widely used to treat movement disorders in neurological diseases with promising results. Results from our earlier pilot study revealed that MMT could relieve FOG and improve the quality of life for patients with PD.

Objective

To explore the effect of MMT on FOG in patients with PD.

Materials and methods

This was a prospective, evaluator-blinded, randomized controlled study. A total of 81 participants were randomly divided into music-based movement therapy group (MMT, n = 27), exercise therapy group (ET, n = 27), and control group (n = 27). Participants in the MMT group were treated with MMT five times (1 h at a time) every week for 4 weeks. Subjects in the ET group were intervened in the same way as the MMT group, but without music. Routine rehabilitation treatment was performed on participants in all groups. The primary outcome was the change of FOG in patients with PD. Secondary evaluation indicators included FOG-Questionnaire (FOG-Q) and the comprehensive motor function.

Results

After 4 weeks of intervention, the double support time, the cadence, the max flexion of knee in stance, the max hip extension, the flexion moment of knee in stance, the comprehensive motor function (UPDRS Part III gait-related items total score, arising from chair, freezing of gait, postural stability, posture, MDS-UPDRS Part II gait-related items total score, getting out of bed/a car/deep chair, walking and balance, freezing), and the FOG-Q in the MMT group were lower than that in the control group and ET group (p < 0.05). The gait velocity, the max ankle dorsiflexion in stance, ankle range of motion (ROM) during push-off, ankle ROM over gait cycle, the knee ROM over gait cycle, and the max extensor moment in stance (ankle, knee) in the MMT group were higher than that in the control group and ET group (p < 0.05). However, no significant difference was reported between the control group and ET group (p > 0.05). The stride length and hip ROM over gait cycle in the MMT group were higher than that in the control group (p < 0.05), and the max knee extension in stance in the MMT group was lower than that in the control group (p < 0.05). Nevertheless, there was no significant difference between the ET group and MMT group (p > 0.05) or control group (p > 0.05).

Conclusion

MMT improved gait disorders in PD patients with FOG, thereby improving their comprehensive motor function.

Respiratory Responses to Two Voice Interventions for Parkinson's Disease

PURPOSE

The purpose of this study was to examine the respiratory strategies used by persons with Parkinson's disease (PD) to support louder speech in response to two voice interventions. Contrasting interventions were selected to investigate the role of internal and external cue strategies on treatment outcomes. LSVT LOUD, which uses an internal cueing framework, and the SpeechVive prosthesis, which employs an external noise cue to elicit louder speech, were studied.

METHOD

Thirty-four persons with hypophonia secondary to idiopathic PD were assigned to one of three groups: LSVT LOUD (n = 12), SpeechVive (n = 12), or a nontreatment clinical control (n = 10). The LSVT LOUD and SpeechVive participants received 8 weeks of voice intervention. Acoustic and respiratory kinematic data were simultaneously collected at pre-, mid- and posttreatment during a monologue speech sample. Intervention outcomes included sound pressure level (SPL), utterance length, lung volume initiation, lung volume termination, and lung volume excursion.

RESULTS

As compared to controls, the LSVT LOUD and SpeechVive participants significantly increased SPL at mid- and posttreatment, thus confirming a positive intervention effect. Treatment-related changes in speech breathing were further identified, including significantly longer utterance lengths (syllables per breath group) at mid- and posttreatment, as compared to pretreatment. The respiratory strategies used to support louder speech varied by group. The LSVT LOUD participants terminated lung volume at significantly lower levels at mid- and posttreatment, as compared to pretreatment. This finding suggests the use of greater expiratory muscle effort by the LSVT LOUD participants to support louder speech. Participants in the SpeechVive group did not significantly alter their respiratory strategies across the intervention period. Single-subject effect sizes highlight the variability in respiratory strategies used across speakers to support louder speech.

CONCLUSIONS

This study provides emerging evidence to suggest that the LSVT LOUD and SpeechVive therapies elicit different respiratory adjustments in persons with PD. The study highlights the need to consider respiratory function when addressing voice targets in persons with PD.

Decomposing the Effects of Familiarity with Music Cues on Stride Length and Variability in Persons with Parkinson's Disease: On the Role of Covariates

This study aimed to determine the role of cognitive and affective responses to music cues in modulating the effects of familiarity with music on stride length and stride-to-stride variability in people with Parkinson's disease (PD). Using multilevel modeling, people with PD's spatiotemporal gait parameters and self-reported ratings of familiarity, enjoyment, cognitive and physical demand, beats salience of music cues after each walking trial, as well as music reward, were analyzed. Our findings indicate that (1) condition-varying perceived enjoyment and beat salience are positively associated with increased stride length; (2) participants with a greater music reward for mood regulation and emotion evocation show greater stride length changes compared with those with less music reward; (3) condition-varying perceived enjoyment is positively associated with decreases in stride-to-stride variability; and (4) participants with lower cognitive demand of walking with music cues and higher beat salience show lower stride-to-stride variability compared with those with higher cognitive demand and lower beat salience. These results provide behavioral evidence of independent and interactive influences of cognitive and affective responses to music cues on spatiotemporal gait parameters in people with PD.

Gait in younger and older adults during rhythmic auditory stimulation is influenced by groove, familiarity, beat perception, and synchronization demands

Music-based Rhythmic auditory stimulation (RAS) is a cueing intervention used to regulate gait impairments in conditions such as Parkinson's disease or stroke. Desire to move with music ('groove') and familiarity have been shown to impact younger adult gait while walking with music, and these effects appear to be influenced by individual rhythmic ability. Importantly, these factors have not been examined in older adults. The aim of this study was to determine how gait outcomes during RAS are influenced by musical properties (familiarity, 'groove') in both free and synchronized walking for younger and older adults with good and poor beat perception ability. To do this, participants were randomized to either free or synchronized walking groups. Each participant's gait was assessed on a pressure sensitive walkway during high versus low groove and high versus low familiarity music, as well as metronome, cueing trials. Individual beat perception ability was evaluated using the Beat Alignment Test. Results showed that the effects of synchronization and groove were mostly consistent across age groups. High groove music elicited faster gait in both age groups, with longer strides only among young adults, than low groove music; synchronizing maximized these effects. Older adults with poor beat perception were more negatively affected by unfamiliar stimuli while walking than younger adults. This suggests that older adults, like younger adults, may benefit from synchronized RAS to high groove cues but may be more vulnerable to cognitive demands associated with walking to unfamiliar stimuli. This should be accounted for in clinical implementations of RAS.

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives

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.

The Power of Musification: Sensor-Based Music Feedback Improves Arm Swing in Parkinson's Disease

Background

Reduction of arm swing during gait is an early and common symptom in Parkinson's disease (PD). By using the technology of a mobile phone, acceleration of arm swing can be converted into a closed‐loop musical feedback (musification) to improve gait.

Objectives

To assess arm swing in healthy subjects and the effects of musification on arm swing amplitude and other gait parameters in patients with PD.

Methods

Gait kinematics were analyzed in 30 patients during a 320 m walk in 3 different conditions comprising (1) normal walking; (2) focused swinging of the more affected arm; and (3) with musification of arm swing provided by the iPhone application CuraSwing. The acceleration of arm swing was converted into musical feedback. Arm swing range of motion and further gait kinematics were analyzed. In addition, arm swing in patients was compared to 32 healthy subjects walking at normal, slow, and fast speeds.

Results

Musification led to a large and bilateral increase of arm swing range of motion in patients. The increase was greater on the more affected side of the patient (+529.5% compared to baseline). In addition, symmetry of arm swing, sternum rotation, and stride length increased. With musical feedback patients with PD reached arm swing movements within or above the range of healthy subjects.

Conclusions

Musification has an immediate effect on arm swing and other gait kinematics in PD. The results suggest that closed‐loop musical feedback is an effective technique to improve walking in patients with PD.

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.