Auditory rhythmic cueing in movement rehabilitation: findings and possible mechanisms

Motivation and music interventions in adults: A systematic review

ABSTRACTMusic is increasingly used in a wide array of settings, from clinical recovery to sports or well-being interventions. Motivation related to music is often considered as a possible working mechanism for music to facilitate these processes, however this has not previously been systematically evaluated. The current systematic review considered studies that involved music (therapy) interventions, together with motivation-related measures such as wanting to practise, liking the musical activities, or patient adherence to an intervention. Our objective was to examine whether music is related to increased motivation in task performance and/or rehabilitation settings, and whether this is in turn related to better clinical or training outcomes. Seventy-nine studies met the inclusion criteria, the majority of which (85%) indicated an increased level of motivation with music as compared to without. Moreover, in those studies where motivation was increased, clinical or other outcomes were improved in most cases (90%). These results support the notion of motivation as an underlying mechanism of music-based interventions, but more robust evidence is needed to ascertain which mechanisms are crucial in increasing motivation from a behavioural, cognitive, and neurobiological point of view, as well as how motivational mechanisms relate to other factors of effectiveness in music-based paradigms.

Postural balance control interventions in autism spectrum disorder (ASD): A systematic review

BACKGROUND

Postural control (PC) disturbances in autism spectrum disorder (ASD) are associated with its severity. Varied sensorimotor interventions have been used for the management of these symptoms. However, there is a lack of a review elucidating all the available postural control interventions in ASD.

RESEARCH QUESTION

To comprehensively present the variety of interventions targeted at improving PC in ASD and to provide future research recommendations.

METHODS

PubMed, SCOPUS, Embase, Cochrane, ScienceDirect and Web of Science databases were searched for publications examining the effects of PC targeting interventions in those with ASD. Included articles were in English, published after 2000 in the peer-reviewed journals with full text available and used intervention targeted at improving PC or balance with a predefined objective outcome measure for accessing PC or balance. Initial database search yielded 1022 studies and 21 articles were included in this review after screening.

RESULTS

We identified diverse PC interventions including animal assisted therapies, karate/martial arts, aquatic exercises, virtual reality-based training, standard and customized exercises, and physical activity programs. The effect of long- and short-term interventions on PC improvement in children and adults with ASD is mixed. Future research should focus on undertaking randomized controlled trials with large sample size and participants with varying severity of ASD to improve generalizability of the study findings. The lack of population-specific, reliable, and validated motor outcome measures including neuro-imaging techniques should be addressed.

SIGNIFICANCE

While many of the interventions improved PC in those with ASD, the sample size and methodological quality of the studies was highly variable. There are limited studies exploring the long-term effects of the interventions. Rigorous study methods with population-specific objective outcome measures are warranted to draw generalizable conclusions regarding the PC interventions in individuals with ASD.

Creative therapy in health and disease: Inner vision

Can we better understand the unique mechanisms of de novo abilities in light of our current knowledge of the psychological and neuroscientific literature on creativity? This review outlines the state-of-the-art in the neuroscience of creativity and points out crucial aspects that still demand further exploration, such as brain plasticity. The progressive development of current neuroscience research on creativity presents a multitude of prospects and potentials for furnishing efficacious therapy in the context of health and illness. Therefore, we discuss directions for future studies, identifying a focus on pinpointing the neglected beneficial practices for creative therapy. We emphasize the neglected neuroscience perspective of creativity on health and disease and how creative therapy could offer limitless possibilities to improve our well-being and give hope to patients with neurodegenerative diseases to compensate for their brain injuries and cognitive impairments by expressing their hidden creativity.

Effectiveness of Rhythmic Auditory Stimulation on Gait in Parkinson Disease: A Systematic Review and Meta-analysis

Parkinson disease is a neurodegenerative disease present in approximately 2% of the population older than 65 years. Rhythmic auditory stimulation in the early 1990s aimed to improve individual mobility in terms of gait speed, stride length, and cadence. Our systematic review and meta-analysis aimed to summarize and evaluate the evidence of the effects of rhythmic auditory stimulation on gait speed, stride length, and cadence in patients with Parkinson disease. A systematic review and meta-analysis of randomized controlled trials was conducted to determine the efficacy of rhythmic auditory stimulation in patients with Parkinson disease. Five studies were included in the review (209 patients). Rhythmic auditory stimulation resulted, on average, a gait speed improvement of 0.53 standard deviation (SD) units (95% CI, 0.23 to 0.83; P = .0005), a stride length improvement of 0.51 SD units (95% CI, 0.18 to 0.84; P = .003) greater than that in the control group. All trials contained a risk of bias due to a lack of blinding. The quality of evidence was low. No adverse events were identified. Rhythmic auditory stimulation may have a beneficial effect on gait speed and stride length in patients with Parkinson disease. Future studies should consider a power analysis to recruit an adequate number of subjects and minimize the risk of sample bias. Further research should provide the additional results required for an acceptable estimate of the effects of rhythmic auditory stimulation on gait in patients with Parkinson disease.

Auditory Cue Effects on Gait-Phase-Dependent Electroencephalogram (EEG) Modulations during Overground and Treadmill Walking

Walking rehabilitation following injury or disease involves voluntary gait modification, yet the specific brain signals underlying this process remains unclear. This aim of this study was to investigate the impact of an auditory cue on changes in brain activity when walking overground (O) and on a treadmill (T) using an electroencephalogram (EEG) with a 32-electrode montage. Employing a between-group repeated-measures design, 24 participants (age: 25.7 ± 3.8 years) were randomly allocated to either an O (n = 12) or T (n = 12) group to complete two walking conditions (self-selected speed control (sSC) and speed control (SC)). The differences in brain activities during the gait cycle were investigated using statistical non-parametric mapping (SnPM). The addition of an auditory cue did not modify cortical activity in any brain area during the gait cycle when walking overground (all p > 0.05). However, significant differences in EEG activity were observed in the delta frequency band (0.5-4 Hz) within the sSC condition between the O and T groups. These differences occurred at the central frontal (loading phase) and frontocentral (mid stance phase) brain areas (p < 0.05). Our data suggest auditory cueing has little impact on modifying cortical activity during overground walking. This may have practical implications in neuroprosthesis development for walking rehabilitation, sports performance optimization, and overall human quality-of-life improvement.

Pilot study of a high-intensity interval training program in older adults: Safety, feasibility, functional fitness and cognitive effects

Exercise can boost physical and cognitive health in older adults. However, there are a lack of accessible exercise programs that foster adherence among older adults. In this study, we aimed to establish the safety and feasibility of APEX, a new exercise program designed to optimize fitness and cognitive gains for older adults, in addition to evaluating its acute physiological effects, and assessing its possible effects on functional fitness and cognition among healthy older adults. APEX utilizes a multimodal progressive high-intensity interval training (HIIT) design, with high-intensity intervals focused on enhancing cardiovascular fitness and muscle strength, and recovery intervals that incorporate balance and mobility exercises. The APEX training was tested in healthy older adults (n=4) over the course of four weeks. Ultimately, APEX was found to be safe and feasible, with no adverse events and high adherence. Participants met heart rate targets for all of the high-intensity exercises, and all intervals had a significant difference in heart rates between high-intensity and recovery periods in linear effects models (p<0.001). Improvements in functional fitness were observed in aerobic endurance, lower body strength, and balance. The intervention was also associated with positive trends in the cognitive domains of information processing, working memory, executive control, and attention. APEX offers a promising alternative to traditional cardiovascular exercise modalities for older adults with additional benefits for functional fitness and cognition. These results encourage further testing of the APEX program in older adults and different clinical populations.

HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study

BACKGROUND

Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD.

OBJECTIVE

The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation.

METHODS

The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12).

RESULTS

The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users' performance levels using gamification, and future scale-up to reach a wide range of interested users.

CONCLUSIONS

Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol.

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.

Auditory cueing strategy for stride length and cadence modification: a feasibility study with healthy adults

People with Parkinson's Disease experience gait impairments that significantly impact their quality of life. Visual, auditory, and tactile cues can alleviate gait impairments, but they can become less effective due to the progressive nature of the disease and changes in people's motor capability. In this study, we develop a human-in-the-loop (HIL) framework that monitors two key gait parameters, stride length and cadence, and continuously learns a person-specific model of how the parameters change in response to the feedback. The model is then used in an optimization algorithm to improve the gait parameters. This feasibility study examines whether auditory cues can be used to influence stride length in people without gait impairments. The results demonstrate the benefits of the HIL framework in maintaining people's stride length in the presence of a secondary task.Clinical relevance- This paper proposes a gait rehabilitation framework that provides a personalized cueing strategy based on the person's real-time response to cues. The proposed approach has potential application to people with Parkinson's Disease.

Sustained effect of auditory entrainment on sequential tapping: The role of movement path complexity

The effects of auditory-motor entrainment have generally been investigated with periodic movements. Previous research has focused on how auditory-motor entrainment is influenced by the temporal structure of rhythms. The present study aimed to investigate whether auditory entrainment improved timing performance of sequential movements with varied path structures, and whether path complexity would affect any possible sustained effect of auditory entrainment. We also investigated whether the sustained effect was moderated by hearing single- vs. multiple-pitch audio prompts. Thirty participants were enrolled to perform a sequential finger-tapping task with discrete targets, in which the algebraic ratio relation of path lengths was manipulated as path complexity. Participants completed three stages per trial: initiation (to introduce the path sequence), entrainment (tapping along with the auditory and visual cues), and timekeeping (repeating the sequence without cues). We found timing improvement in terms of mean asynchronies and absolute interval error decrease after auditory entrainment. Only interval accuracy performance during timekeeping and entrainment was affected by path complexity. Moreover, no clear difference was observed between the rhythm sets in terms of single vs. multiple pitches. In conclusion, we found that phase and interval duration accuracy of predefined isochronous sequential movements with varied path complexity can be improved by auditory entrainment, and that auditory entrainment affects our performance beyond the actual presence of the auditory cue.

Does Music Therapy Improve Gait after Traumatic Brain Injury and Spinal Cord Injury? A Mini Systematic Review and Meta-Analysis

There is a growing body of research examining the potential benefits of music therapy-based auditory stimulation (MT) for individuals with movement disorders in improving gait performance. However, there is limited knowledge about the effects of MT on gait outcomes in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). A previous review of MT's impact on gait in TBI had limitations, and there are no studies on its effects on gait in SCI. In this study, we conducted a meta-analysis to more thoroughly evaluate the impact of MT on gait outcomes in individuals with TBI and SCI. We systematically searched through eight databases and found six studies on MT in TBI and four on SCI. Our meta-analysis showed that MT has positive medium effect improvements on spatiotemporal aspects of gait in individuals with TBI (Hedge's g: 0.52) and SCI (0.53). These findings suggest that MT could be a practical intervention for enhancing different aspects of gait in these populations, although the limited number and "fair" quality of the studies included in the meta-analysis may affect the generalizability of the outcomes. Further research is needed to fully understand the mechanisms by which MT may influence gait and determine the optimal parameters for its use.

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.

Rhythmic training, literacy, and graphomotor skills in kindergarteners

Introduction

The aim of this manuscript is twofold: first, to investigate the relationship between rhythmic, phonological and graphomotor skills in kindergarten children; and second, to evaluate the possible impact of rhythmic training on the two other skills.

Methods

To that end, we selected a sample of 78 children in Québec. Forty-two children received rhythmic training (experimental group) and 34 arts training (active control group) during the same period (10 weeks). Before and after training, children in both groups were assessed for general skills (forward and backward memory span, vocabulary, non-verbal ability), rhythmic skills (synchronization and discrimination tasks), literacy skills (phonological skills - syllable counting, syllable deletion, rhyme discrimination - and invented spelling skills) and graphomotor skills (legibility of letter writing, quality of copying of geometric shapes).

Results

Results showed correlations between the child's rhythmic and literacy skills, as well as between rhythm synchronization and pen pressure. In addition, rhythmic training showed improvement in rhythmic abilities, but this did not transfer to literacy or graphomotor development (apart from a significant increase in the duration of pauses in both groups at post-test, with a larger improvement for the rhythm group).

Discussion

These results are discussed in terms of duration and intensity of learning, and they highlight the possible benefits of informal rhythm practices in the classroom.

Auditory Stimulation Improves Gait and Posture in Cerebral Palsy: A Systematic Review with Between- and Within-Group Meta-Analysis

The past decade has seen an increased interest in the implementation of auditory stimulation (AStim) for managing gait and postural deficits in people with cerebral palsy. Although existing reviews report beneficial effects of AStim on the spatiotemporal and kinematic parameters of gait, there are still numerous limitations that need to be addressed to correctly interpret these results. For instance, existing reviews have failed to characterize the effects of AStim by conducting separate between and within-group meta-analyses, these reviews have not evaluated the influence of AStim on postural outcomes, and nor have included several high-quality existing trials. In this study, we conducted between- and within-group meta-analyses to establish a state of evidence for the influence of AStim on gait and postural outcomes in people with cerebral palsy. We searched the literature according to PRISMA-P guidelines across 10 databases. Of 1414 records, 14 studies, including a total of 325 people with cerebral palsy, met the inclusion criterion. We report a significant enhancement in gait speed, stride length, cadence, and gross motor function (standing and walking) outcomes with AStim compared to conventional physiotherapy. The findings from this analysis reveal the beneficial influence of AStim on the spatiotemporal and kinematic parameters of gait and postural stability in people with cerebral palsy. Furthermore, we discuss the futurized implementation of smart wearables that can deliver person-centred AStim rehabilitation in people with cerebral palsy.

Rhythmic auditory cueing in atypical parkinsonism: A pilot study

Rhythmic auditory cueing (RAC) can improve gait parameters in neurological disorders such as Parkinson's disease and stroke. However, there is a lack of research on the effects of RAC in patients with atypical parkinsonian disorders (APD). Using a smartphone metronome application, we aimed to investigate the immediate effects of RAC in patients with clinically diagnosed APD, namely Progressive Supranuclear Palsy (PSP-Richardson Syndrome and other variants, PSP-nonRS), Corticobasal Syndrome (CBS), Multiple System Atrophy (MSA), and Dementia with Lewy Bodies (DLB). A total of 46 APD participants (25 PSP, 9 CBS, 8 MSA and 4 DLB; age: mean = 70.17, standard deviation = 7.15) walked at their preferred pace for 2 min without any rhythmic auditory cueing (RAC). Participants then walked the same path for another 2 min with RAC set at a tempo 10% faster than the baseline cadence of each participant. After a 10–15-min break, participants walked the same path for another 2 min without RAC to observe for carryover effects. Gait parameters [cadence (steps/minute), gait velocity (meters/minute), and stride length (centimeters)] were collected at baseline, during RAC, and post-RAC. There was a significant improvement in cadence in all participants from baseline to during RAC and post-RAC (corrected p-values = 0.009 for both). Gait velocity also improved from baseline to during RAC and post-RAC in all participants, although this improvement was not significant after correcting for multiple comparisons. The changes in cadence and gait velocity were most pronounced in PSP. In addition, our exploratory analysis showed that the cadence in the suspected TAU group (PSP+CBS) showed a significant improvement from baseline to during RAC and post-RAC (corr. p-value = 0.004 for both). This pilot study using short-term RAC in APD patients demonstrated improvements in cadence and velocity. There is an urgent need for effective gait rehabilitation modalities for patients with APD, and rhythmic cueing can be a practical and useful intervention to improve their gait pattern.

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.

Parkinsonics: A Randomized, Blinded, Cross-Over Trial of Group Singing for Motor and Nonmotor Symptoms in Idiopathic Parkinson Disease

Introduction

Parkinson's disease (PD) frequently causes communication difficulties due to various voice impairments and there are few treatment options for vocal/communication complaints. We assessed the effects of weekly group singing on PD patients' objective vocal and motoric function, cognition, mood, self-efficacy, and quality of life.

Methods

Thirty-two participants were randomly assigned to either a singing group or a facilitated discussion group weekly over 12 weeks. After 12 weeks, participants crossed over for an additional 12 weeks. Evaluations were performed at baseline and every six weeks for 30 weeks. Objective voice measures included volume/loudness (decibels), held vowel duration, jitter, shimmer, and harmonic-to-noise ratio. Additional outcome measures included patient-centered quality of life, voice-related quality of life, MDS-UPDRS, Montreal Cognitive Assessment, and questionnaires assessing depression, self-efficacy, and overall well-being.

Results

Twenty-six participants (16 M/10F; Hoehn & Yahr stage 2.3 (range 2–3); and age 68.6 (55–89)) completed the study. Across participants in both groups (intention-to-treat analyses), there was significant improvement from baseline in average loudness on the Cookie Theft picture description at 24 weeks (end of interventions), corresponding with improved minimal reading volumes at 24 weeks and 30 weeks (end of study). Similarly, there were improvements in minimal loudness on Rainbow passage reading at 24 and 30 weeks. There were improvements observed in the Emotional Well-Being (mean delta −12.7 points, p = 0.037) and Body Discomfort (mean delta −18.6 points, p = 0.001) domains of the PDQ-39 from baseline to week 24 in the overall cohort and greater improvement in the Communication domain for Group S than Group D after 12 weeks of singing (delta −12.9 points, p = 0.016). Baseline differences between the participant groups (age, gender, Hoehn & Yahr stage, and several voice loudness measures) and observed improvements during the weekly discussion group period limited our ability to attribute all of the above results specifically to singing (per-protocol analyses). No significant changes in other assessed outcome measures were found.

Conclusions

Weekly group singing may improve some aspects of conversational voice volume and quality of life in PD. Some improvements were sustained at least six weeks after interventions ended. Further investigations of the mechanism of benefit and randomized controlled studies (without crossover) to assess the longitudinal effects of singing in PD are necessary.

Musical feedback system Jymmin® leads to enhanced physical endurance in the elderly—A feasibility study

Background and objectives

Active music-making in combination with physical exercise has evoked several positive effects in users of different age groups. These include enhanced mood, muscular effectivity, pain threshold, and decreased perceived exertion. The present study tested the applicability of this musical feedback system, called Jymmin^®, in combination with strength-endurance exercises in a population of healthy older adults.

Research design and methods

Sixteen healthy, physically inactive older adults (5 males, 11 females) at the mean age of 70 years performed physical exercise in two conditions: A conventional work-out while listening passively music and a Jymmin^® work-out, where musical sounds were created with one's work-out movements. According to the hypothesis that strength-endurance is increased during musical feedback exercise, parameters relating to strength-endurance were assessed, including exercise duration, number of repetitions, perceived exertion (RPE), and participants' mental state (Multidimensional Mood State Questionnaire; MDMQ).

Results

Results show that participants exercised significantly longer while doing Jymmin^® (Mdn = 248.75 s) as compared to the conventional work-out (Mdn = 182.73 s), (Z = 3.408, p = 0.001). The RPE did not differ between conventional work-out and the Jymmin^® condition, even though participants worked out significantly longer during the Jymmin^® condition (Mdn = 14.50; Z = −0.905; p = 0.366). The results of the MDMQ showed no significant differences between both conditions (Z = −1.037; p = 0.300).

Discussion and implications

Results show that participants could work out longer while showing the same perceived exertion, relating to increased physical endurance. Music feedback work-out encouraged a greater degree of isometric contractions (muscle actively held at fixed length) and, therefore, less repetitions in this condition. In addition to the previously described effect on muscle effectivity, this non-stereotypic contraction pattern during music feedback training may have enhanced endurance in participants supporting them to better proportion energetic reserves during training (pacing).

Clinical trial registration

Identifier: DRKS00023645.

Research Progress of Music Therapy on Gait Intervention in Patients with Parkinson’s Disease

Music therapy is an effective way to treat the gait disorders caused by Parkinson’s disease. Rhythm music stimulation, therapeutic singing, and therapeutic instrument performance are often used in clinical practice. The mechanisms of music therapy on the gait of patients with Parkinson’s disease include the compensation mechanism of cerebellum recruitment, rhythm entrainment, acceleration of motor learning, stimulation of neural coherence, and increase of cortical activity. All mechanisms work together to complete the intervention of music therapy on patients’ gait and help patients to recover better. In this paper, the effect of music therapy on gait disorders in Parkinson’s disease patients was reviewed, and some suggestions were put forward.

Synchronization performance affects gait variability measures during cued walking

BACKGROUND

Incorporating variability within gait rehabilitation offers a promising approach to restore functional capacity. However, it's success requires adequate synchronization, a parameter that lacks report in most of the literature regarding cued gait training.

RESEARCH QUESTION

How changes to synchronization performance during fractal-like and isochronous cueing impacts gait variability measures?

METHODS

We asked twelve young male participants to walk in synchronization to two different temporally structure cueing (isochronous [ISO] and fractal [FRC]). We have also manipulated the cueing's tempo by increasing and decreasing it by 5% to manipulate synchronization, resulting in six conditions (stimuli [ISO,FRC] x tempo [SLOW, NORMAL, FAST]). The normal condition was set from an uncued trial through the participant's self-paced stride time. Synchronization performance (ASYNC) and gait variability (fractal scaling and coefficient of variation) were calculated from stride time data ( -ISIs,CV-ISIs). Repeated measures analysis of variance or Aligned Rank Transform were conducted to determine significant differences between metronome tempo and stimuli for the dependent variables RESULTS: Our results showed a FAST tempo decreases synchronization performance (ASYNC) and leads to lower -ISIs, for both ISO and FRC stimuli. This indicates that when an individual exhibits poor synchronization during cued gait training, his/her gait variability patterns will not follow the temporal structure of the presented metronome. Specifically, if the individual poorly synchronizes to the cues, the gait patterns become more random, a condition typically observed in older adults and neurological patients, which runs contrary to the hypothesis when using fractal-like metronomes.

SIGNIFICANCE

This study provides supporting evidence that measuring synchronization performance in cued training is fundamental for a proper clinical interpretation of its effects. This is particularly relevant for the recent and ongoing clinical research using fractal-like metronomes since the expected gait patterns are dependent on the synchronization performance. Randomized control trials must incorporate synchronization performance related measures.

A brief and efficient stimulus set to create the inverted U-shaped relationship between rhythmic complexity and the sensation of groove

When listening to music, we often feel a strong desire to move our body in relation to the pulse of the rhythm. In music psychology, this desire to move is described by the term groove. Previous research suggests that the sensation of groove is strongest when a rhythm is moderately complex, i.e., when the rhythm hits the sweet spot between being too simple to be engaging and too complex to be interpretable. This means that the relationship between rhythmic complexity and the sensation of groove can be described by an inverted U-shape (Matthews 2019). Here, we recreate this inverted U-shape with a stimulus set that was reduced from 54 to only nine rhythms. Thereby, we provide an efficient toolkit for future studies to induce and measure different levels of groove sensations. Pleasure and movement induction in relation to rhythmic complexity are emerging topics in music cognition and neuroscience. Investigating the sensation of groove is important for understanding the neurophysiological mechanisms underlying motor timing and reward processes in the general population, and in patients with conditions such as Parkinson’s disease, Huntington’s disease and motor impairment after stroke. The experimental manipulation of groove also provides new approaches for research on social bonding in interpersonal movement interactions that feature music. Our brief stimulus set facilitates future research on these topics by enabling the creation of efficient and concise paradigms.

The Effect of Music-Based Rhythmic Auditory Stimulation on Balance and Functional Outcomes after Stroke

Purpose: the purpose of this paper was to evaluate the effects of music-based rhythmic auditory stimulation on balance and motor function after stroke and whether there are differences depending on the affected hemisphere, lesion site and age. Materials and Methods: This study was an observational and longitudinal study. Adult stroke survivors (n = 28), starting no later than 3 weeks after a stroke, conducted 90 min sessions of music-based rhythmic auditory stimulation 3 days a week, in addition to 60 min a day of conventional physiotherapy. Balance ability was evaluated using the Mini Best Test and the Tinetti Test; motor function was evaluated using the Motor Assessment Scale. Results: All of the participants significantly improved their balance ability and motor function variables upon comparing scores at discharge and admission. Intragroup differences were observed upon comparing subgroups of patients by lesion site and by the degree of motor impairment. Age, stroke type and affected hemisphere seemed not to be directly related to the amount of improvement. Conclusions: This study suggests that the effects of music-based rhythmic auditory stimulation (RAS) on balance ability and motor function varies depending on the scale or test used for evaluation and on the variables that the tests measure. Patients with hemiparesis seemed to improve more than those with hemiplegia.

Acceptability and deliverability of an auditory rhythmical cueing (ARC) training programme for use at home and outdoors to improve gait and physical activity post-stroke

BACKGROUND

Although laboratory studies demonstrate that training programmes using auditory rhythmical cueing (ARC) may improve gait post-stroke, few studies have evaluated this intervention in the home and outdoors where deployment may be more appropriate. This manuscript reports stakeholder refinement of an ARC gait and balance training programme for use at home and outdoors, and a study which assessed acceptability and deliverability of this programme.

METHODS

Programme design and content were refined during stakeholder workshops involving physiotherapists and stroke survivors. A two-group acceptability and deliverability study was then undertaken. Twelve patients post-stroke with a gait related mobility impairment received either the ARC gait and balance training programme or the gait and balance training programme without ARC. Programme provider written notes, participant exercise and fall diaries, adverse event monitoring and feedback questionnaires captured data about deliverability, safety and acceptability of the programmes.

RESULTS

The training programme consisted of 18 sessions (six supervised, 12 self-managed) of exercises and ARC delivered by a low-cost commercially available metronome. All 12 participants completed the six supervised sessions and 10/12 completed the 12 self-managed sessions. Provider and participant session written records and feedback questionnaires confirmed programme deliverability and acceptability.

CONCLUSION

An ARC gait and balance training programme refined by key stakeholders was feasible to deliver and acceptable to participants and providers.

TRIAL REGISTRATION

ISCTRN 12/03/2018.

Multilevel rhythms in multimodal communication

It is now widely accepted that the brunt of animal communication is conducted via several modalities, e.g. acoustic and visual, either simultaneously or sequentially. This is a laudable multimodal turn relative to traditional accounts of temporal aspects of animal communication which have focused on a single modality at a time. However, the fields that are currently contributing to the study of multimodal communication are highly varied, and still largely disconnected given their sole focus on a particular level of description or their particular concern with human or non-human animals. Here, we provide an integrative overview of converging findings that show how multimodal processes occurring at neural, bodily, as well as social interactional levels each contribute uniquely to the complex rhythms that characterize communication in human and non-human animals. Though we address findings for each of these levels independently, we conclude that the most important challenge in this field is to identify how processes at these different levels connect. This article is part of the theme issue 'Synchrony and rhythm interaction: from the brain to behavioural ecology'.

Rhythmic and non-rhythmic auditory precues: Multiple mechanisms mediating movement performance

Rhythmic auditory stimuli presented before a goal-directed movement have been found to improve temporal and spatial movement outcomes. However, little is known about the mechanisms mediating these benefits. The present experiment used three types of auditory stimuli to probe how improved scaling of movement parameters, temporal preparation and an external focus of attention may contribute to changes in movement performance. Three types of auditory stimuli were presented for 1200 ms before movement initiation; three metronome beats (RAS), a tone that stayed the same (tone-same), a tone that increased in pitch (tone-change) and a no sound control, were presented with and without visual feedback for a total of eight experimental conditions. The sound was presented before a visual go-signal, and participants were instructed to reach quickly and accurately to one of two targets randomly identified in left and right hemispace. Twenty-two young adults completed 24 trials per blocked condition in a counterbalanced order. Movements were captured with an Optotrak 3D Investigator, and a 4(sound) by 2(vision) repeated measures ANOVA was used to analyze dependant variables. All auditory conditions had shorter reaction times than no sound. Tone-same and tone-change conditions had shorter movement times and higher peak velocities, with no change in trajectory variability or endpoint error. Therefore, rhythmic and non-rhythmic auditory stimuli impacted movement performance differently. Based on the pattern of results we propose multiple mechanisms impact movement planning processes when rhythmic auditory stimuli are present.

Dynamic modulation of cortico-muscular coupling during real and imagined sensorimotor synchronisation

People have a natural and intrinsic ability to coordinate body movements with rhythms surrounding them, known as sensorimotor synchronisation. This can be observed in daily environments, when dancing or singing along with music, or spontaneously walking, talking or applauding in synchrony with one another. However, the neurophysiological mechanisms underlying accurately synchronised movement with selected rhythms in the environment remain unclear. Here we studied real and imagined sensorimotor synchronisation with interleaved auditory and visual rhythms using cortico-muscular coherence (CMC) to better understand the processes underlying the preparation and execution of synchronised movement. Electroencephalography (EEG), electromyography (EMG) from the finger flexors, and continuous force signals were recorded in 20 participants during tapping and imagined tapping with discrete stimulus sequences consisting of alternating auditory beeps and visual flashes. The results show that the synchronisation between cortical and muscular activity in the beta (14-38 Hz) frequency band becomes time-locked to the taps executed in synchrony with the visual and auditory stimuli. Dynamic modulation in CMC also occurred when participants imagined tapping with the visual stimuli, but with lower amplitude and a different temporal profile compared to real tapping. These results suggest that CMC does not only reflect changes related to the production of the synchronised movement, but also to its preparation, which appears heightened under higher attentional demands imposed when synchronising with the visual stimuli. These findings highlight a critical role of beta band neural oscillations in the cortical-muscular coupling underlying sensorimotor synchronisation.

Temporal features of goal-directed movements change with source, but not frequency, of rhythmic auditory stimuli

Music and metronomes differentially impact movement performance. The current experiment presented metronome and drum beats in simple and complex rhythms before goal-directed reaching movements, while also quantifying enjoyment. Auditory conditions were completed with and without visual feedback and were blocked and counterbalanced. There were no differences between simple and complex rhythms, indicating that rhythmic information alone is sufficient to benefit performance. The drum elicited shorter movement times and higher peak velocities, without an increase in spatial variability. Reaction times were moderately correlated with ratings of enjoyment. These data provide evidence that the source of an auditory stimulus impacts movement performance of a goal-directed reaching task. Results are contextualized within models of goal-directed reaching to elucidate mechanisms contributing to performance improvements.

The neural correlates of gait improvement by rhythmic sound stimulation in adults with Parkinson's disease - A functional magnetic resonance imaging study

INTRODUCTION

Adults with Parkinson's disease (PD) experience gait disturbances that can sometimes be improved with rhythmic auditory stimulation (RAS); however, the underlying physiological mechanism for this improvement is not well understood. We investigated brain activation patterns in adults with PD and healthy controls (HC) using functional magnetic resonance imaging (fMRI) while participants imagined gait with or without RAS.

METHODS

Twenty-seven adults with PD who could walk independently and walked more smoothly with rhythmic auditory cueing than without it, and 25 age-matched HC participated in this study. Participants imagined gait in the presence of RAS or white noise (WN) during fMRI.

RESULTS

In the PD group, gait imagery with RAS activated cortical motor areas, including supplementary motor areas and the cerebellum, while gait imagery with WN additionally recruited the left parietal operculum. In HC, the induced activation was limited to cortical motor areas and the cerebellum for both the RAS and WN conditions. Within- and between-group analyses demonstrated that RAS reduced the activity of the left parietal operculum in the PD group but not in the HC group (condition-by-group interaction by repeated measures analysis of variance, p < 0.05).

CONCLUSION

During gait imagery in adults with PD, the left parietal operculum was less activated by RAS than by WN, while no change was observed in HC, suggesting that rhythmic auditory stimulation may support the sensory-motor networks involved in gait, thus alleviating the overload of the parietal operculum and compensating for its dysfunction in these patients.

A general procedure to measure the pacing of body movements timed to music and metronome in younger and older adults

Finger-tapping tasks are classically used to investigate sensorimotor synchronization in relation to neutral auditory cues, such as metronomes. However, music is more commonly associated with an entrained bodily response, such as toe tapping, or dancing. Here we report an experimental procedure that was designed to bridge the gap between timing and intervention studies by directly comparing the effects of metronome and musical cue types on motor timing abilities across the three naturalistic voluntary actions of finger tapping, toe tapping, and stepping on the spot as a simplified case of whole body movement. Both pacing cues were presented at slow, medium, and fast tempi. The findings suggested that the task of stepping on the spot enabled better timing performances than tapping both in younger and older adults (75+). Timing performances followed an inverse U shape with best performances observed in the medium tempi that were set close to the spontaneous motor tempo in each movement type. Finally, music provided an entrainment effect in addition to pace setting that enabled better motor timing and greater stability than classically reported using a metronome. By applying time-stamp analyses to kinetic data, we demonstrate that tapping and stepping engage different timing modes. This work details the importance of translational research for a better understanding of motor timing. It offers a simple procedure that strengthens the validity of applying academic work and contributes in knowledge towards a wide range of therapeutic interventions.

Patterns of enhancement in paretic shoulder kinematics after stroke with musical cueing

Musical cueing has been widely utilised in post-stroke motor rehabilitation; however, the kinematic evidence on the effects of musical cueing is sparse. Further, the element-specific effects of musical cueing on upper-limb movements have rarely been investigated. This study aimed to kinematically quantify the effects of no auditory, rhythmic auditory, and melodic auditory cueing on shoulder abduction, holding, and adduction in patients who had experienced hemiparetic stroke. Kinematic data were obtained using inertial measurement units embedded in wearable bands. During the holding phase, melodic auditory cueing significantly increased the minimum Euler angle and decreased the range of motion compared with the other types of cueing. Further, the root mean square error in the angle measurements was significantly smaller and the duration of movement execution was significantly shorter during the holding phase when melodic auditory cueing was provided than when the other types of cueing were used. These findings indicated the important role of melodic auditory cueing for enhancing movement positioning, variability, and endurance. This study provides the first kinematic evidence on the effects of melodic auditory cueing on kinematic enhancement, thus suggesting the potential use of pitch-related elements in psychomotor rehabilitation.

Music-based physical therapy in Parkinson's disease: An approach based on international Classification of Functioning, Disability and Health

INTRODUCTION

Several studies suggests that the provision of auditory cues with music could be beneficial for people with Parkinson's Disease (PD). The aim of the study was to evaluate the effects of music-based physical therapy on the international Classification of Functioning, Disability and Health (ICF) components: disability, cognition, muscle strength, balance, and functional mobility.

METHODS

This was a controlled, non-randomized clinical trial involving 13 individuals with PD assessed at three times: baseline, period 1 (treatment), and period 2 (no treatment). The variables analyzed were: disability by Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn & Yahr (H&Y), cognitive function by Trail Making Test, muscle strength by Medical Research Council (MRC) and sitting-rising (SR) test, balance and functional mobility by Berg Balance Scale (BBS) and Timed up and Go (TUG). ANOVA with post-hoc multiple comparison was used to determine statistical differences between the baseline, period 1 and 2.

RESULTS

there was statistically significant difference among the period 1 and 2 for the cognitive function; there was a statistically significant difference between the period 1 and 2 in SR test; in the balance evaluation by BBS, an increase was observed between the baseline and the period 1, followed by a decrease in period 2; in the TUG, there was an increase between the period 1 and 2.

CONCLUSION

the music-based physical therapy, according to the ICF construct, was able to improve balance and functional mobility in individuals with PD. The functional gains were not maintained when the therapy was discontinued.

Rhythm in the blood: The influence of rhythm skills on literacy development in third graders

Several studies have shown the influence of rhythm skills on the processing of written language, especially at the beginning of literacy development. The first objective of this study was to determine the persistence of this link at an advanced grade level. The second objective was to better understand the factors underlying this relationship and, more specifically, to examine the hypothesis of mediation by phonological and/or motor skills. In total, 278 third graders performed literacy tasks (word/pseudoword decoding and spelling), a rhythm production task, two phonological tasks (phonological awareness and rapid automatized naming), and motor tasks. Significant correlations were observed between literacy and each of rhythm skills, phonological skills, and motor skills. However, structural equation models showed that the influence of rhythm skills on literacy was mediated neither by phonological skills nor by motor abilities. These results suggest that rhythm skills continue to play a role in the acquisition of written language in third graders and that this contribution seems to be independent of phonological and motor skills.

Spontaneous and stimulus-driven rhythmic behaviors in ADHD adults and controls

Many aspects of human behavior are inherently rhythmic, requiring production of rhythmic motor actions as well as synchronizing to rhythms in the environment. It is well-established that individuals with ADHD exhibit deficits in temporal estimation and timing functions, which may impact their ability to accurately produce and interact with rhythmic stimuli. In the current study we seek to understand the specific aspects of rhythmic behavior that are implicated in ADHD. We specifically ask whether they are attributed to imprecision in the internal generation of rhythms or to reduced acuity in rhythm perception. We also test key predictions of the Preferred Period Hypothesis, which suggests that both perceptual and motor rhythmic behaviors are biased towards a specific personal 'default' tempo. To this end, we tested several aspects of rhythmic behavior and the correspondence between them, including spontaneous motor tempo (SMT), preferred auditory perceptual tempo (PPT) and synchronization-continuations tapping in a broad range of rhythms, from sub-second to supra-second intervals. Moreover, we evaluate the intra-subject consistency of rhythmic preferences, as a means for testing the reality and reliability of personal 'default-rhythms'. We used a modified operational definition for assessing SMT and PPT, instructing participants to tap or calibrate the rhythms most comfortable for them to count along with, to avoid subjective interpretations of the task. Our results shed new light on the specific aspect of rhythmic deficits implicated in ADHD adults. We find that individuals with ADHD are primarily challenged in producing and maintaining isochronous self-generated motor rhythms, during both spontaneous and memory-paced tapping. However, they nonetheless exhibit good flexibility for synchronizing to a broad range of external rhythms, suggesting that auditory-motor entrainment for simple rhythms is preserved in ADHD, and that the presence of an external pacer allows overcoming their inherent difficulty in self-generating isochronous motor rhythms. In addition, both groups showed optimal memory-paced tapping for rhythms near their 'counting-based' SMT and PPT, which were slightly faster in the ADHD group. This is in line with the predictions of the Preferred Period Hypothesis, indicating that at least for this well-defined rhythmic behavior (i.e., counting), individuals tend to prefer similar time-scales in both motor production and perceptual evaluation.

Rhythmic auditory stimuli heard before and during a reaching movement elicit performance improvements in both temporal and spatial movement parameters

Rhythmic auditory stimuli (RAS) have been proposed to improve motor performance in populations with and without sensorimotor impairments. However, the reasons for the reported benefits are poorly understood. One idea is that RAS may supplement intrinsic feedback when other sensory input is diminished. The current experiment tested this idea by removing vision during a goal-directed reaching task. We hypothesized that any improvements in movement performance due to the RAS would be greater when vision was removed. Twenty-two typically developing adults performed reaching movements to one of two targets with RAS presented before movement initiation, after movement initiation, both before and after movement initiation, and no sound, all with and without vision. Dependent variables were analyzed using a 2 vision by 2 sound-before by 2 sound-during repeated measures ANOVA. Conditions where the metronome was heard before movement initiation yielded shorter and less variable reaction times compared when there was no sound before the movement. The RAS heard before and during the movement independently impacted spatial aspects of the movement. Sound before movement initiation resulted in smaller endpoint error, primarily in the anterior-posterior axis. Sound during the movement resulted in smaller endpoint error, primarily in the mediolateral axis. In no-vision blocks, inclusion of RAS resulted in improved endpoint performance, indicating that RAS supplemented the motor system. The present results strengthen our understanding of sensory integration underlying reaching performance by demonstrating that sound heard before and during a reaching movement can improve motor performance by supplementing the motor system when vision is unavailable.

Auditory rhythmical cueing to improve gait and physical activity in community-dwelling stroke survivors (ACTIVATE): study protocol for a pilot randomised controlled trial

Background

Mobility problems are present in 70–80% of stroke survivors and can result in impaired gait and reduced physical activity limiting independent living. Auditory rhythmic cueing (ARC) has been used to provide auditory feedback and shows promise in improving a variety of walking parameters following stroke. The aim of this pilot study is to assess the feasibility of conducting a multi-centre, observer blind, randomised controlled trial of auditory rhythmical cueing (ARC) intervention in home and community settings in North East England.

Methods

This pilot observer blind randomised controlled feasibility trial aims to recruit 60 participants over 15 months from community stroke services in the North East of England. Participants will be within 24 months of stroke onset causing new problems with mobility. Each participant will be randomised to the study intervention or control group. Intervention treatment participants will undertake 18 auditory rhythmical cueing (ARC) treatment sessions over 6 weeks (3 × 30 min per week, 6 supervised (physiotherapist/research associate)/12 self-managed) in a home/community setting. A metronome will be used to provide ARC during a series of balance and gait exercises, which will be gradually progressed. The control treatment participants will undertake the same duration balance and gait exercise training programme as the intervention group but without the ARC. Feasibility will be determined in terms of recruitment, retention, adverse events, adherence, collection of descriptive clinical and accelerometer motor performance data at baseline, 6 weeks and 10 weeks and description of participant, provider and clinical therapists’ experiences. As well as using questionnaires to collate participant views, qualitative interviews will be undertaken to further understand how the intervention is delivered in practice in a community setting and to identify aspects perceived important by participants.

Discussion

The ACTIVATE study will address an important gap in the evidence base by reporting whether it is feasible to deliver auditory rhythmical cueing in the home and community to improve gait and balance parameters following stroke. The feasibility of the study protocol will be established and results will inform the design of a future multi-centre randomised controlled trial.

Trial registration

Trial register: ISRCTN, Trial identifier: ISRCTN10874601: Date of registration: 12/03/2018.

Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms

What are the principles underlying effective neurorehabilitation? The aim of neurorehabilitation is to exploit interventions based on human and animal studies about learning and adaptation, as well as to show that the activation of experience-dependent neuronal plasticity augments functional recovery after stroke. Instead of teaching compensatory strategies that do not reduce impairment but allow the patient to return home as soon as possible, functional recovery might be more sustainable as it ensures a long-term reduction in impairment and an improvement in quality of life. At the same time, neurorehabilitation permits the scientific community to collect valuable data, which allows inferring about the principles of brain organization. Hence neuroscience sheds light on the mechanisms of learning new functions or relearning lost ones. However, current rehabilitation methods lack the exact operationalization of evidence gained from skill learning literature, leading to an urgent need to bridge motor learning theory and present clinical work in order to identify a set of ingredients and practical applications that could guide future interventions. This work aims to unify the neuroscientific literature relevant to the recovery process and rehabilitation practice in order to provide a synthesis of the principles that constitute an effective neurorehabilitation approach. Previous attempts to achieve this goal either focused on a subset of principles or did not link clinical application to the principles of motor learning and recovery. We identified 15 principles of motor learning based on existing literature: massed practice, spaced practice, dosage, task-specific practice, goal-oriented practice, variable practice, increasing difficulty, multisensory stimulation, rhythmic cueing, explicit feedback/knowledge of results, implicit feedback/knowledge of performance, modulate effector selection, action observation/embodied practice, motor imagery, and social interaction. We comment on trials that successfully implemented these principles and report evidence from experiments with healthy individuals as well as clinical work.

Music Therapy and Music-Based Interventions for Movement Disorders

PURPOSE OF REVIEW

There is emerging evidence that music therapy and other methods using music and rhythm may meaningfully improve a broad range of symptoms in neurological and non-neurological disorders. This review highlights the findings of recent studies utilizing music and rhythm-based interventions for gait impairment, other motor symptoms, and non-motor symptoms in Parkinson disease (PD) and other movement disorders. Limitations of current studies as well as future research directions are discussed.

RECENT FINDINGS

Multiple studies have demonstrated short-term benefits of rhythmic auditory stimulation on gait parameters including gait freezing in PD, with recent studies indicating that it may reduce falls. Demonstration of benefits for gait in both dopaminergic "on" and "off" states suggests that this intervention can be a valuable addition to the current armamentarium of PD therapies. There is also emerging evidence of motor and non-motor benefits from group dancing, singing, and instrumental music performance in PD. Preliminary evidence for music therapy and music-based interventions in movement disorders other than PD (such as Huntington disease, Tourette syndrome, and progressive supranuclear palsy) is limited but promising. Music therapy and other music and rhythm-based interventions may offer a range of symptomatic benefits to patients with PD and other movement disorders. Studies investigating the potential mechanisms of music's effects and well-controlled multicenter trials of these interventions are urgently needed.

Promoting independence in Lewy body dementia through exercise (PRIDE) study: Protocol for a pilot study

Background

Lewy Body dementia (LBD) is the second most prevalent neurodegenerative dementia. This form of dementia is notable for an aggressive disease course consisting of a combination of cognitive, Parkinsonian, affective, and physiological symptoms that significantly increase morbidity and mortality, and decrease life expectancy in this population compared to more common dementias. Additionally, those diagnosed with LBD are often excluded from trials evaluating exercise in similar diseases such as Alzheimer's disease or Parkinson's disease due to the complexity and concurrency of motor and cognitive symptoms. Consequently, there is scarce research evaluating the effect of exercise on individuals with LBD.

Methods

The PRomoting Independence in Lewy Body Dementia through Exercise (PRIDE) trial is a novel non-randomised, crossover pilot study consisting of an 8-week wait-list usual care period, followed by an 8-week exercise intervention targeting progressive resistance and balance training. The trial aim is to evaluate the effect of exercise on the primary outcome of functional independence and secondary outcomes including cognitive, physical, psychosocial and quality of life measures in people living with LBD and their caregivers. The intervention involves 3 supervised 1-h sessions per week (24 sessions in total) administered by an Accredited Exercise Physiologist in a clinical facility at the University of Sydney in Lidcombe, Australia.

Discussion

The PRIDE study is the first controlled trial to evaluate a robust exercise intervention within a LBD cohort and will provide crucial information required to inform robust future clinical trials.

Trial registration

Australia and New Zealand Trial Register (ANZCTR): ACTRN12616000466448; Key words: Lewy body; dementia; exercise; anabolic; functional independence.

Musical sonification improves motor control in Parkinson's disease: a proof of concept with handwriting

A growing number of studies postulate the use of music to improve motor control in patients with Parkinson's disease (PD). The effects of music are greatly variable from one individual to the other and do not always reach the expected benefits. This study aimed to optimize the use of music in the management of movement disorders inherent to PD in a handwriting task. We developed and tested musical sonification (MS), a method that transforms in real-time kinematic variables into music. Twelve patients with PD, on medication, and 12 healthy controls were recruited in a pretest/training/posttest design experiment. Three training sessions were compared, for which participants were asked to produce graphomotor exercises: one session with music (unrelated to handwriting), one with MS (controlled by handwriting), and one in silence. Results showed that the performance in training was better under MS than under silence or background music, for both groups. After training, the benefits of MS were still present for both groups, with a higher effect for PD patients than for control group. Our results provide a proof of concept to consider MS as a relevant auditory guidance strategy for movement rehabilitation in patients with PD.

Pavement patterns can be designed to improve gait in Parkinson's disease patients

BACKGROUND

Public spaces are usually designed with respect to various patient populations, but not Parkinson's disease. The objective of this study was to explore what type of easily applicable visual cueing might be used in public spaces and some interiors to improve gait in people with Parkinson's disease.

METHODS

Thirty-two patients with freezing of gait walked an 8-meter track on 6 different floor patterns in single- and dual-task conditions in random sequence. The reference pattern was a virtual large transverse chessboard, and the other patterns differed either in size (small floor stones), orientation (diagonal), nature (real paving), regularity (irregular), or no pattern. Time, number of steps, velocity, step length, cadence, and dual-task effect were calculated. The number and total duration of freezing episodes were analyzed.

RESULTS

Virtual, large, transverse floor stones improve time (P = 0.0101), velocity (P = 0.0029), number of steps (P = 0.0291), and step length (P = 0.0254) in Parkinson's disease patients compared with walking on no pattern. Virtual floor stones were superior in time and velocity to the real ones. Transverse floor stones were better than diagonal, whereas regular pattern stones were superior to irregular in some gait parameters. Subjectively, the reference pattern was preferred to the irregular one and to no pattern. No direct effect on freezing of gait was observed.

CONCLUSIONS

Parkinson's disease patients may benefit from floor patterns incorporating transverse oriented large rectangular visual cues. Because public space can be regulated with respect to people with medical conditions, the relevant legislative documents should be extended to allow for parkinsonian gait disorder. © 2019 International Parkinson and Movement Disorder Society.

Music and Metronomes Differentially Impact Motor Timing in People with and without Parkinson's Disease: Effects of Slow, Medium, and Fast Tempi on Entrainment and Synchronization Performances in Finger Tapping, Toe Tapping, and Stepping on the Spot Tasks

Introduction

Rhythmic auditory stimulation (RAS) has successfully helped regulate gait for people with Parkinson's disease. However, the way in which different auditory cues and types of movements affect entrainment, synchronization, and pacing stability has not been directly compared in different aged people with and without Parkinson's. Therefore, this study compared music and metronomes (cue types) in finger tapping, toe tapping, and stepping on the spot tasks to explore the potential of RAS training for general use.

Methods

Participants (aged 18–78 years) included people with Parkinson's (n = 30, Hoehn and Yahr mean = 1.78), older (n = 26), and younger adult controls (n = 36), as age may effect motor timing. Timed motor production was assessed using an extended synchronization-continuation task in cue type and movement conditions for slow, medium, and fast tempi (81, 116, and 140 mean beats per minute, respectively).

Results

Analyses revealed main effects of cue and movement type but no between-group interactions, suggesting no differences in motor timing between people with Parkinson's and controls. Music supported entrainment better than metronomes in medium and fast tempi, and stepping on the spot enabled better entrainment and less asynchrony, as well as more stable pacing compared to tapping in medium and fast tempi. Age was not confirmed as a factor, and no differences were observed in slow tempo.

Conclusion

This is the first study to directly compare how different external auditory cues and movement types affect motor timing. The music and the stepping enabled participants to maintain entrainment once the external pacing cue ceased, suggesting endogenous mechanisms continued to regulate the movements. The superior performance of stepping on the spot suggests embodied entrainment can occur during continuous movement, and this may be related to emergent timing in tempi above 600 ms. These findings can be applied therapeutically to manage and improve adaptive behaviours for people with Parkinson's.

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

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

Effects of (music-based) rhythmic auditory cueing training on gait and posture post-stroke: A systematic review & dose-response meta-analysis

Gait dysfunctions are common post-stroke. Rhythmic auditory cueing has been widely used in gait rehabilitation for movement disorders. However, a consensus regarding its influence on gait and postural recovery post-stroke is still warranted. A systematic review and meta-analysis was performed to analyze the effects of auditory cueing on gait and postural stability post-stroke. Nine academic databases were searched according to PRISMA guidelines. The eligibility criteria for the studies were a) studies were randomized controlled trials or controlled clinical trials published in English, German, Hindi, Punjabi or Korean languages b) studies evaluated the effects of auditory cueing on spatiotemporal gait and/or postural stability parameters post-stroke c) studies scored ≥4 points on the PEDro scale. Out of 1,471 records, 38 studies involving 968 patients were included in this present review. The review and meta-analyses revealed beneficial effects of training with auditory cueing on gait and postural stability. A training dosage of 20–45 minutes session, for 3–5 times a week enhanced gait performance, dynamic postural stability i.e. velocity (Hedge’s g: 0.73), stride length (0.58), cadence (0.75) and timed-up and go test (−0.76). This review strongly recommends the incorporation of rhythmic auditory cueing based training in gait and postural rehabilitation, post-stroke.

A Review on the Relationship Between Sound and Movement in Sports and Rehabilitation

The role of auditory information on perceptual-motor processes has gained increased interest in sports and psychology research in recent years. Numerous neurobiological and behavioral studies have demonstrated the close interaction between auditory and motor areas of the brain, and the importance of auditory information for movement execution, control, and learning. In applied research, artificially produced acoustic information and real-time auditory information have been implemented in sports and rehabilitation to improve motor performance in athletes, healthy individuals, and patients affected by neurological or movement disorders. However, this research is scattered both across time and scientific disciplines. The aim of this paper is to provide an overview about the interaction between movement and sound and review the current literature regarding the effect of natural movement sounds, movement sonification, and rhythmic auditory information in sports and motor rehabilitation. The focus here is threefold: firstly, we provide an overview of empirical studies using natural movement sounds and movement sonification in sports. Secondly, we review recent clinical and applied studies using rhythmic auditory information and sonification in rehabilitation, addressing in particular studies on Parkinson's disease and stroke. Thirdly, we summarize current evidence regarding the cognitive mechanisms and neural correlates underlying the processing of auditory information during movement execution and its mental representation. The current state of knowledge here reviewed provides evidence of the feasibility and effectiveness of the application of auditory information to improve movement execution, control, and (re)learning in sports and motor rehabilitation. Findings also corroborate the critical role of auditory information in auditory-motor coupling during motor (re)learning and performance, suggesting that this area of clinical and applied research has a large potential that is yet to be fully explored.

Role of Sonification and Rhythmic Auditory Cueing for Enhancing Gait Associated Deficits Induced by Neurotoxic Cancer Therapies: A Perspective on Auditory Neuroprosthetics

Patients undergoing chemotherapy, radiotherapy, and immunotherapy experience neurotoxic changes in the central and peripheral nervous system. These neurotoxic changes adversely affect functioning in the sensory, motor, and cognitive domains. Thereby, considerably affecting autonomic activities like gait and posture. Recent evidence from a range of systematic reviews and meta-analyses have suggested the beneficial influence of music-based external auditory stimulations i.e., rhythmic auditory cueing and real-time auditory feedback (sonification) on gait and postural stability in population groups will balance disorders. This perspective explores the conjunct implications of auditory stimulations during cancer treatment to simultaneously reduce gait and posture related deficits. Underlying neurophysiological mechanisms by which auditory stimulations might influence motor performance have been discussed. Prompt recognition of this sensorimotor training strategy in future studies can have a widespread impact on patient care in all areas of oncology.