Rhythmic auditory cues shape neural network recruitment in Parkinson's disease during repetitive motor behavior

Integration of music-based game approaches with wearable devices for hand neurorehabilitation: a narrative review

BACKGROUND

Restoring hand functionality is critical for fostering independence in individuals with neurological disorders. Various therapeutic approaches have emerged to address motor function restoration, with music-based therapies demonstrating notable advantages in enhancing neuroplasticity, an integral component of neurorehabilitation. Despite the positive effects observed, there remains a gap in the literature regarding implementing music treatments in neurorehabilitation, such as Neurologic Music Therapy (NMT), especially in conjunction with emerging fields like wearable devices and game-based therapies.

METHODS

A literature search was conducted in various databases, including PubMed, Scopus, IEEE Xplore, and ACM Digital Library. The search was performed using a literature search methodology based on keywords. Information collected from the studies pertained to the approach used in music therapy, the design of the video games, and the types of wearable devices utilized.

RESULTS

A total of 158 articles were found, including 39 from PubMed, 34 from IEEE Xplore, 48 from Scopus, 37 from ACM Digital Library, and 35 from other sources. Duplicate entries, of which there were 41, were eliminated. In the first screening phase, 152 papers were screened for title and abstract. Subsequently, 89 articles were removed if they contained at least one exclusion criterion. Sixteen studies were considered after 63 papers had their full texts verified.

CONCLUSIONS

The convergence of NMT with emerging fields, such as gamification and wearable devices designed for hand functionality, not only expands therapeutic horizons but also lays the groundwork for innovative, personalized approaches to neurorehabilitation. However, challenges persist in effectively incorporating NMT into rehabilitation programs, potentially hindering its effectiveness.

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.

The Efficacy of Wearable Cueing Devices on Gait and Motor Function in Parkinson Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To summarize the efficacy of wearable cueing devices for improving gait and motor function of patients with Parkinson disease (PWP).

DATA SOURCES

PubMed, Embase, and Cochrane CENTRAL databases were searched for papers published in English, from inception to October 23, 2022.

STUDY SELECTION

Randomized controlled trials focusing on the effects of wearable cueing devices on gait and motor function in PWP were included.

DATA EXTRACTION

Two reviewers independently selected articles and extracted the data. The Cochrane Bias Risk Assessment Tool was used to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of evidence.

DATA SYNTHESIS

Seven randomized controlled trials with 167 PWP were included in the meta-analysis. Significant effect of wearable cueing devices on walking speed (mean difference [MD]=0.07 m/s, 95% confidence interval [CI]: [0.05, 0.09], P<.00001) was detected; however, after sensitivity analysis, no significant overall effect on walking speed was noted (MD=0.04 m/s, 95% CI: [-0.03, 0.12], P=.25). No significant improvements were found in stride length (MD=0.06 m, 95% CI: [0.00, 0.13], P=.05), the Unified Parkinson's Disease Rating Scale-III score (MD=-0.61, 95% CI: [-4.10, 2.88], P=.73), Freezing of Gait Questionnaire score (MD=-0.83, 95% CI: [-2.98, 1.33], P=.45), or double support time (MD=-0.91, 95% CI: [-3.09, 1.26], P=.41). Evidence was evaluated as low quality.

CONCLUSIONS

Wearable cueing devices may result in an immediate improvement on walking speed; however, there is no evidence that their use results in a significant improvement in other gait or motor functions.

Rhythmic musical activities may strengthen connectivity between brain networks associated with aging-related deficits in timing and executive functions

Brain aging and common conditions of aging (e.g., hypertension) affect networks important in organizing information, processing speed and action programming (i.e., executive functions). Declines in these networks may affect timing and could have an impact on the ability to perceive and perform musical rhythms. There is evidence that participation in rhythmic musical activities may help to maintain and even improve executive functioning (near transfer), perhaps due to similarities in brain regions underlying timing, musical rhythm perception and production, and executive functioning. Rhythmic musical activities may present as a novel and fun activity for older adults to stimulate interacting brain regions that deteriorate with aging. However, relatively little is known about neurobehavioral interactions between aging, timing, rhythm perception and production, and executive functioning. In this review, we account for these brain-behavior interactions to suggest that deeper knowledge of overlapping brain regions associated with timing, rhythm, and cognition may assist in designing more targeted preventive and rehabilitative interventions to reduce age-related cognitive decline and improve quality of life in populations with neurodegenerative disease. Further research is needed to elucidate the functional relationships between brain regions associated with aging, timing, rhythm perception and production, and executive functioning to direct design of targeted interventions.

Effects of training involving patterned sensory enhancement on improving upper-limb movements in patients with Parkinson's disease: protocol of a randomised controlled trial

INTRODUCTION

Bradykinesia (ie, slow movements) is one of the most prominent symptoms of Parkinson's disease (PD) and has a negative impact on quality of life. Rhythmic auditory stimulation (RAS), a widely used and promising treatment technique, has been shown to effectively improve gait speed in patients with PD. The upper-limb movements, which also suffer from bradykinesia, are essential for daily life and directly impact quality of life. The term, patterned sensory enhancement (PSE) instead of RAS, is used when movement training targets the human body except lower limbs. Up until now, scarce studies have explored effects of training involving PSE on upper-limb movements. The purpose of this study is to investigate effects of movement training involving PSE on upper-limb movement speed and function in patients with PD.

METHODS AND ANALYSIS

A total of 138 patients with PD will be randomly assigned into two groups: the PSE group and the no-PSE group. A 21-day upper-limb training involving PSE (for the PSE group) or without PSE (for the no-PSE group) will be provided to the patients. An assessor will administer the box and block test and the Jebsen hand function test before and after training to assess upper-limb movement speed and function. The one-way analysis of covariance will be performed. This randomised controlled trial will provide evidence supporting effectiveness of upper-limb movement training involving PSE on reducing severity of bradykinesia in patients with PD.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Institutional Review Board of the Hong Kong Polytechnic University with the reference number HSEARS20221027005. Informed consent forms will be gathered from all patients before their participation. Study results will be disseminated through conferences and peer-reviewed academic journals.

TRIAL REGISTRATION NUMBER

NCT05637593.

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.

Music Therapy for Gait and Speech Deficits in Parkinson's Disease: A Mini-Review

Parkinson's disease (PD) is a progressive central nervous system disease with a common motor symptom of gait disturbance in PD, which is more pronounced in the later stages. Although FDA-approved treatments, including dopaminergic pharmacotherapy, deep brain stimulation, and rehabilitation, have some benefits in improving gait dysfunction, a fair amount of advanced PD patients can develop a disability, social isolation, and high mortality and morbidity. Recently, clinicians and scientists have applied music to clinical therapy, namely music therapy. It has been used as a unique rehabilitation tool to improve PD-induced gait and speech disorders. Based on relevant studies in recent years, this paper reviews the published literature about music in treating gait disorders and speech problems in PD patients. Additionally, we discuss current studies' limitations and emphasize the future potential research fields.

Learning a novel rhythmic stepping task in children with probable developmental coordination disorder

BACKGROUND

Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing.

METHODS

Movement Assessment Battery for Children-2nd edition was used to identify 48 children with probable developmental coordination disorder (13.9 ± 0.05 yrs., 27% male) and 37 typically developed (13.9 ± 0.10 yrs., 54% male). While instrumented with an inertial measurement unit, both groups performed a novel rhythmic stepping task and with a concurrent auditory stroop test (dual-task), underwent seven weeks of intervention with step training with rhythmic cuing and were tested for retention five weeks post-intervention.

FINDINGS

Initially, the group with probable developmental coordination disorder had a higher variability of step timing (coefficient of variation: 0.08 ± 0.003-typically developed - 0.09 ± 0.004-probable developmental coordination disorder, p < 0.05) and a frequency of peak power spectral density further from the target 0.5 Hz (0.50 ± 0.002 Hz-typically developed - 0.51 ± 0.003 Hz-probable developmental coordination disorder, p < 0.05), and were more affected by the dual-task: power spectral density at 0.5 Hz (-7.2 ± 3.3%-typically developed - -13.4 ± 4.6%- prob_DCD, p < 0.05) and stroop test errors (6.4 ± 1.1%-typically developed - -11.1 ± 2.4%- probable developmental coordination disorder, p < 0.05). The intervention led to similar improvements in both groups in coefficient of variation of step timing (0.12 ± 0.01-Pre - 0.07 ± 0.002-Post, p < 0.05), frequency of the peak power spectral density (0.51 ± 0.005 Hz-Pre - 0.50 ± 0.001 Hz-Post, p < 0.05) and relative power spectral density bandpower (3.2 ± 0.2%-Pre - 5.9 ± 0.3%-Post, p < 0.05). All improvements were retained after five weeks post-training.

INTERPRETATION

Rhythmic cueing shows strong promise for enhancing motor learning in children with probable developmental coordination disorder.

TRIAL REGISTRATION

Retrospectively registered on ClinicalTrials.gov with reference: NCT03150784.

A corticostriatal projection for sound-evoked and anticipatory motor behavior following temporal expectation

The ability to form predictions based on recent sensory experience is essential for behavioral adaptation to our ever-changing environment. Predictive encoding represented by neuronal activity has been observed in sensory cortex, but how this neuronal activity is transformed into anticipatory motor behavior remains unclear. Fiber photometry to investigate a corticostriatal projection from the auditory cortex to the posterior striatum during an auditory paradigm in mice, and pharmacological experiments in a task that induces a temporal expectation of upcoming sensory stimuli. We find that the auditory corticostriatal projection relays both sound-evoked stimulus information as well as predictive signals in relation to stimulus timing following rhythmic auditory stimulation. Pharmacological experiments suggest that this projection is required for the initiation of both sound-evoked and anticipatory licking behavior in an auditory associative-learning behavioral task, but not for the general recognition of presented auditory stimuli. This auditory corticostriatal projection carries predictive signals, and the posterior striatum is critical to the anticipatory stimulus-driven motor behavior.

Mapping Research Trends from 20 Years of Publications in Rhythmic Auditory Stimulation

This study aims to create an all-around insight into the evolutions, status, and global trends of rhythmic auditory stimulation (RAS) research via enhanced bibliometric methods for the 2001-2020 time period. Articles concerning RAS were extracted from the Web of Science database. CiteSpace, Bibliometrix, VOSviewer, and Graphpad Prism were employed to analyze publication patterns and research trends. A total of 586 publications related to RAS between 2001 and 2020 were retrieved from the Web of Science database. The researcher Goswami U. made the greatest contribution to this field. The University of Toronto was the institution that published the most articles. Motor dysfunction, sensory perception, and cognition are the three major domains of RAS research. Neural tracking, working memory, and neural basis may be the latest research frontiers. This study reveals the publication patterns and topic trends of RAS based on the records published between 2001 and 2020. The insights obtained provided useful references for the future research and applications of RAS.

Auditory Cueing of Pre-Learned Skills and Role of Subcortical Information Processing to Maximize Rehabilitative Outcomes Bridging Science and Music-Based Interventions

Auditory entrainment of motor function is a fundamental tool in neurologic music therapy with many studies demonstrating improved clinical outcomes in people with movement disorders such as Parkinson's Disease, acquired brain injuries, and stroke. However, the specific mechanisms of action within neural networks and cortical regions that are aroused and influenced by auditory entrainment still need to be identified. This paper draws from some contemporary neuroscience studies that indicate the role of the cerebellum and other subcortical systems in modulating pre-learned motor schema and proposes a possible rationale for the success of auditory entrainment within neurologic music therapy.

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.

Rhythmic auditory stimulation promotes gait recovery in Parkinson's patients: A systematic review and meta-analysis

Objective

Using rhythmic auditory stimulation (RAS) to improve gait disturbance in Parkinson's disease (PD) is an available treatment option, yet a consensus on its effectiveness remains controversial. We summarized the effects of RAS on gait, functional activity and quality of life in PD patients through a systematic review and meta-analysis.

Methods

PubMed, Embase, Web of Science, Medline, and Cochrane Library databases were initially searched to identify relevant literature up to August 2021. Next, the methodological quality of eligible comparative studies was assessed by the Physiotherapy Evidence Database Scale. The treatment effects to clinical outcome in relation to gait, motor activities, and quality of life were analyzed.

Results

A total of 18 studies consisted of 774 subjects were included in this meta-analysis. Comparing with the control group, RAS had significantly increased stride length (p &lt; 0.001), accelerated gait speed (p &lt; 0.001), reduced the occurrence of freezing events during walking (P = 0.009), achieved an improvement in Unified Parkinson's Disease Rating Scale (UPDRS) II (P = 0.030), UPDRS-III (P &lt; 0.001) and Parkinson's Disease Quality of Life Questionnaire (PDQL) (p = 0.009) scores over an interval of 1–26 months.

Conclusion

In this meta-analysis of 18 randomized controlled trials, we have demonstrated that RAS improves the general motor functions (UPDRS-III), particularly in gait, mobility and quality of life, in patients with Parkinson's disease.

Effects of rhythmic auditory stimulation on upper-limb movements in patients with Parkinson's disease

INTRODUCTION

Rhythmic auditory stimulation (RAS) is an effective technique extensively used to alleviate lower-limb bradykinesia in patients with Parkinson's disease (PD). However, RAS effects on upper-limb bradykinesia have not been well studied. This study investigated immediate effects of RAS on upper-limb movements in PD patients and healthy people.

METHODS

PD patients (n = 23) and age- and gender-matched healthy controls (n = 23) executed left-hand, right-hand, and both-hand movement tasks of the Purdue Pegboard Test when listening to the beats of RAS, including 100%, 110%, and 120% of the baseline tempo, which was fastest movement performance of each participant without the aid of RAS. Sequence of RAS and tasks was randomized for each participant.

RESULTS

PD patients had slower upper-limb movements than did health controls. An interaction was found between RAS and tasks. In both patients and controls and for all task conditions, 120%RAS induced higher scores than did 110% RAS, and the latter induced higher scores than did 100%RAS. In both patients and controls and for all RAS conditions, the right-hand condition induced higher scores than did the left-hand condition, and the latter induced higher scores than did the both-hand condition.

CONCLUSIONS

RAS was effective in regulating upper-limb movements in PD patients, which may be explained by rich neural connections between auditory and motor cortical areas in humans. Clinical practitioners should consider using RAS in clinical therapy. Future neuroimaging studies are needed to explore neural mechanisms of RAS in PD patients.

Events Detection of Anticipatory Postural Adjustments through a Wearable Accelerometer Sensor Is Comparable to That Measured by the Force Platform in Subjects with Parkinson's Disease

Out-of-the-lab instrumented gait testing focuses on steady-state gait and usually does not include gait initiation (GI) measures. GI involves Anticipatory Postural Adjustments (APAs), which propel the center of mass (COM) forward and laterally before the first step. These movements are impaired in persons with Parkinson’s disease (PD), contributing to their pathological gait. The use of a simple GI testing system, outside the lab, would allow improving gait rehabilitation of PD patients. Here, we evaluated the metrological quality of using a single inertial measurement unit for APA detection as compared with the use of a gold-standard system, i.e., the force platforms. Twenty-five PD and eight elderly subjects (ELD) were asked to initiate gait in response to auditory stimuli while wearing an IMU on the trunk. Temporal parameters (APA-Onset, Time-to-Toe-Off, Time-to-Heel-Strike, APA-Duration, Swing-Duration) extracted from the accelerometric data and force platforms were significantly correlated (mean(SD), r: 0.99(0.01), slope: 0.97(0.02)) showing a good level of agreement (LOA [s]: 0.04(0.01), CV [%]: 2.9(1.7)). PD showed longer APA-Duration compared to ELD ([s] 0.81(0.17) vs. 0.59(0.09) p < 0.01). APA parameters showed moderate correlation with the MDS-UPDRS Rigidity, Characterizing-FOG questionnaire and FAB-2 planning. The single IMU-based reconstruction algorithm was effective in measuring APAs timings in PD. The current work sets the stage for future developments of tele-rehabilitation and home-based exercises.

What about the role of the cerebellum in music-associated functional recovery? A secondary EEG analysis of a randomized clinical trial in patients with Parkinson disease

Rhythmic Auditory Stimulation (RAS) has been shown to be of help in an effective gait training of people with idiopathic Parkinson's disease (PD). The cerebellum may play an important role in RAS aftereffects by compensating the detrimental internal clock for automatic and rhythmic motricity. However, the neurophysiological mechanisms underlying RAS aftereffects are still poorly understood. In the present study, we tested the contribution of the cerebellum to RAS-based gait training aftereffects in people with PD by examining cerebellum-cerebral connectivity indices using standard EEG recording. We enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical and kinematic gait indices and electrophysiological data (standard EEG recording during walking on GaitTrainer3) of both the gait trainings. We found that the greater improvement in gait performance following RAS than non_RAS training, as per clinical and kinematic assessment, was paralleled by a more evident reshape of cerebellum-brain functional connectivity with regard to specific brain areas (pre-motor, sensorimotor and temporal cortices) and gait-cycle phases (mainly 25-75% of the gait cycle duration). These findings suggest that the cerebellum mediates the reshape of sensorimotor rhythms and fronto-centroparietal connectivity in relation to specific gait-cycle phases. This may be consistent with a recovery of the internal timing mechanisms generating and controlling motor rhythmicity, eventually improving gait performance. The precise definition of the cerebellar role to gait functional recovery in people with PD may be crucial to create patient-tailored rehabilitative approaches.

Perspectives of Circadian-Based Music Therapy for the Pathogenesis and Symptomatic Treatment of Neurodegenerative Disorders

Music therapy (MT) and other rhythmic-based interventions for the treatment of neurodegeneration (ND) have been successful in improving the quality of life of affected individuals. Music therapy and rhythm-based stimuli affect patients with Alzheimer’s disease (AD) and Parkinson’s disease (PD) respectively not only through cognitive channels and subjective qualifications but also through altered brain structures and neural systems. Often implicated in the pathogenesis and resulting symptoms of these diseases is the role of aberrant circadian rhythmicity (CR), namely disrupted sleep. Recent literature suggests that proper maintenance of this timekeeping framework may be beneficial for patients with neurodegenerative disorders and serve a neuroprotective role. While music therapy can improve the quality of life for neurodegenerative patients, longitudinal studies analyzing sleep patterns of affected individuals and possible mechanisms of intervention remain sparse. Furthermore, the role of music therapy in the context of circadian rhythmicity has not been adequately explored. By analyzing the links between circadian rhythmicity, neurodegeneration, and music therapy, a more comprehensive picture emerges, suggesting that possible uses of non-pharmacological circadian-based music therapy to target mechanisms involved in the pathogenesis of Alzheimer’s disease and Parkinson’s disease may enhance clinical treatment and potentially indicate neuroprotection as a preventative measure.

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.

E-Commerce Credit Risk Assessment Based on Fuzzy Neural Network

In this paper, we propose a cooperative strategy-based self-organization mechanism to reconstruct the network. The mechanism includes a comprehensive evaluation algorithm and structure adjustment mechanism. The self-organization mechanism can be carried out simultaneously with the parameter optimization process. By calculating the similarity and independent contribution of normative neurons, the effectiveness of fuzzy rules can be jointly evaluated, and effective structural changes can be realized. Moreover, this mechanism should not set the threshold in advance in practical application. In order to optimize the parameters of SC-IR2FNN, we developed a parameter optimization mechanism based on an interaction strategy. The parameter optimization mechanism based on a joint strategy, namely multilayer optimization engine, can split SC-IR2FNN parameters into nonlinear and linear parameters for joint optimization. The nonlinear parameters are optimized by an advanced two-level algorithm, and the linear parameters are updated with the minimum biological multiplication. Two parameter optimization algorithms optimize nonlinear and linear parameters, reduce the computational complexity of SC-IR2FNN, and improve the learning rate. Using the principal component factor analysis method, seven representative common factors are selected to replace the original variables, which include the profitability factor of the financing enterprise, the solvency factor of the financing enterprise, the profitability factor of the core enterprise, the operation guarantee factor, and the growth ability of the financing enterprise. Factors, supply chain online degree factors, financing enterprise quality, and cooperation factors, can well measure the credit risk of online supply chains. The logistic model shows that the profitability factor of the financing company, the debt repayment factor of the financing company, and the profitability of the core company are three factors that have a significant impact on the credit risk of online supply chain finance. Based on the improved credit calculation model, we developed an online clue risk calculation. This method is based on site conditions and can evaluate credit risk. From the test results, the improved credit scoring system is the result of facing speculative and circular credit fraud and implies that the traders of risk commentators are in a leading position in each electronic device. The results show that risk analysis is effective in any case.

Future Therapeutic Strategies for Freezing of Gait in Parkinson's Disease

Freezing of gait (FOG) is a common and challenging clinical symptom in Parkinson’s disease. In this review, we summarise the recent insights into freezing of gait and highlight the strategies that should be considered to improve future treatment. There is a need to develop individualised and on-demand therapies, through improved detection and wearable technologies. Whilst there already exist a number of pharmacological (e.g., dopaminergic and beyond dopamine), non-pharmacological (physiotherapy and cueing, cognitive training, and non-invasive brain stimulation) and surgical approaches to freezing (i.e., dual-site deep brain stimulation, closed-loop programming), an integrated collaborative approach to future research in this complex area will be necessary to systematically investigate new therapeutic avenues. A review of the literature suggests standardising how gait freezing is measured, enriching patient cohorts for preventative studies, and harnessing the power of existing data, could help lead to more effective treatments for freezing of gait and offer relief to many patients.

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.

Dual-Task-Based Drum Playing with Rhythmic Cueing on Motor and Attention Control in Patients with Parkinson's Disease: A Preliminary Randomized Study

Although there have been increasing reports regarding the effectiveness of dual-task interventions in rehabilitation, the scope of this research is limited to gross motor movement, such as gait among patients with Parkinson's disease (PD). To expand the dual-task paradigm to upper extremity motor and attention control in PD, drum playing with modulation of musical elements was attempted. The objective of this study was to evaluate the effects of a drum playing intervention with rhythmic cueing on upper extremity motor control and attention control in patients with PD. Twelve participants were randomly assigned to the drum playing intervention with rhythmic cueing group or the control group. The results showed that the drum playing with rhythmic cueing (DPRC) group significantly increased their sustained time of entrainment (45 BPM) and their latency time until entrainment from pretest to posttest. For the DPRC group, the latency time until entrainment was significantly improved, and improvements in cognitive measures were also found. This study shows that DPRC has great potential to improve upper extremity motor control and attention control and supports the development of new interventions that include this technique for rehabilitation in patients with PD.

Hierarchical control as a shared neurocognitive mechanism for language and music

Although comparative research has made substantial progress in clarifying the relationship between language and music as neurocognitive systems from both a theoretical and empirical perspective, there is still no consensus about which mechanisms, if any, are shared and how they bring about different neurocognitive systems. In this paper, we tackle these two questions by focusing on hierarchical control as a neurocognitive mechanism underlying syntax in language and music. We put forward the Coordinated Hierarchical Control (CHC) hypothesis: linguistic and musical syntax rely on hierarchical control, but engage this shared mechanism differently depending on the current control demand. While linguistic syntax preferably engages the abstract rule-based control circuit, musical syntax rather employs the coordination of the abstract rule-based and the more concrete motor-based control circuits. We provide evidence for our hypothesis by reviewing neuroimaging as well as neuropsychological studies on linguistic and musical syntax. The CHC hypothesis makes a set of novel testable predictions to guide future work on the relationship between language and music.

The Impact of Exercise Intervention with Rhythmic Auditory Stimulation to Improve Gait and Mobility in Parkinson Disease: An Umbrella Review

Difficulties in walking, controlling balance, and performing activities of daily living are common problems encountered by individuals affected by Parkinson disease. Scientific evidence suggests that exercise performed with music or auditory or rhythmical cues facilitates movement and improves balance, gait, mobility, and activities of daily living (ADL) performance in patients with PD. The aim of this umbrella review was to summarize available high-quality evidence from systematic reviews and meta-analyses on the effectiveness of rhythmically cued exercise to improve gait, mobility, and ADL performance in individuals with PD. PubMed, Cochrane, and Embase databases were searched from January 2010 to October 2020 for systematic reviews and meta-analyses which had to be (1) written in English, (2) include studies on populations of males and females with PD of any age, (3) analyze outcomes related to gait, mobility, and ADL, and (4) apply exercise interventions with music or auditory or rhythmical cues. Two independent authors screened potentially eligible studies and assessed the methodological quality of the studies using the AMSTAR 2 tool. Four studies, two systematic reviews and meta-analyses, one a systematic review, and one a meta-analysis, were selected. Overall results indicated positive effects for gait and mobility of the use of rhythmic auditory cueing with exercise and suggested that it should be incorporated into a regular rehabilitation program for patients affected by PD. Nonetheless, more primary level research is needed to address the identified gaps regarding the application of this method to physical exercise interventions.

Development and evaluation of a novel music-based therapeutic device for upper extremity movement training: A pre-clinical, single-arm trial

Restoration of upper limb motor function and patient functional independence are crucial treatment targets in neurological rehabilitation. Growing evidence indicates that music-based intervention is a promising therapeutic approach for the restoration of upper extremity functional abilities in neurologic conditions such as cerebral palsy, stroke, and Parkinson's Disease. In this context, music technology may be particularly useful to increase the availability and accessibility of music-based therapy and assist therapists in the implementation and assessment of targeted therapeutic goals. In the present study, we conducted a pre-clinical, single-arm trial to evaluate a novel music-based therapeutic device (SONATA) for upper limb extremity movement training. The device consists of a graphical user interface generated by a single-board computer displayed on a 32" touchscreen with built-in speakers controlled wirelessly by a computer tablet. The system includes two operational modes that allow users to play musical melodies on a virtual keyboard or draw figures/shapes whereby every action input results in controllable sensory feedback. Four motor tasks involving hand/finger movement were performed with 21 healthy individuals (13 males, aged 26.4 ± 3.5 years) to evaluate the device's operational modes and main features. The results of the functional tests suggest that the device is a reliable system to present pre-defined sequences of audiovisual stimuli and shapes and to record response and movement data. This preliminary study also suggests that the device is feasible and adequate for use with healthy individuals. These findings open new avenues for future clinical research to further investigate the feasibility and usability of the SONATA as a tool for upper extremity motor function training in neurological rehabilitation. Directions for future clinical research are discussed.

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.

Individuals With Parkinson's Disease Retain Spatiotemporal Gait Control With Music and Metronome Cues

The purpose of this study was to determine the difference in spatiotemporal gait measures induced by stepping to the beat of a metronome and to music cues of various frequencies in individuals with Parkinson's disease. Twenty-one participants with Parkinson's disease were instructed to time their steps to a metronome and music cues (at 85%, 100%, and 115% of overground cadence). The authors calculated cadence, cadence accuracy, and step length during each cue condition and an uncued control condition. The music and metronome cues produced comparable results in cadence manipulation, with reduced cadence accuracy noted at slower intended frequencies. Nevertheless, the induced cadence elicited a concomitant alteration in step length. The music and metronome cues produced comparable changes to gait, but suggest that temporal control is more limited at slower frequencies, presumably by the challenge of increasing the step length.

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.

Effects of rhythmic auditory cueing on stepping in place in patients with Parkinson's disease

BACKGROUND

Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease(PD).

METHODS

Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition).

RESULTS

In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023).

CONCLUSIONS

Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.

Walking to your right music: a randomized controlled trial on the novel use of treadmill plus music in Parkinson's disease

BACKGROUND

Rhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic Parkinson's disease (PD). However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training.

METHODS

We enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical, kinematic, and electrophysiological effects of both the gait trainings.

RESULTS

We found a greater improvement in Functional Gait Assessment (p < 0.001), Tinetti Falls Efficacy Scale (p < 0.001), Unified Parkinson Disease Rating Scale (p = 0.001), and overall gait quality index (p < 0.001) following RAS than non_RAS training. In addition, the RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle, and a greater improvement of fronto-centroparietal/temporal electrode connectivity than the non_RAS gait training.

CONCLUSIONS

The findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity. Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum. Finally, identifying these mechanisms is crucial to create patient-tailored, RAS-based rehabilitative approaches in PD.

TRIAL REGISTRATION

NCT03434496 . Registered 15 February 2018, retrospectively registered.

Motor Synchronization to Rhythmic Auditory Stimulation (RAS) Attenuates Dopaminergic Responses in Ventral Striatum in Young Healthy Adults: [11C]-(+)-PHNO PET Study

Auditory-motor entrainment using rhythmic auditory stimulation (RAS) has been shown to improve motor control in healthy persons and persons with neurologic motor disorders such as Parkinson's disease and stroke. Neuroimaging studies have shown the modulation of corticostriatal activity in response to RAS. However, the underlying neurochemical mechanisms for auditory-motor entrainment are unknown. The current study aimed to investigate RAS-induced dopamine (DA) responses in basal ganglia (BG) during finger tapping tasks combined with [11C]-(+)-PHNO-PET in eight right-handed young healthy participants. Each participant underwent two PET scans with and without RAS. Binding potential relative to the non-displaceable compartment (BPND) values were derived using the simplified reference tissue method. The task performance was measured using absolute tapping period error and its standard deviation. We found that the presence of RAS significantly improved the task performance compared to the absence of RAS, demonstrated by reductions in the absolute tapping period error (p = 0.007) and its variability (p = 0.006). We also found that (1) the presence of RAS reduced the BG BPND variability (p = 0.013) and (2) the absence of RAS resulted in a greater DA response in the left ventral striatum (VS) compared to the presence of RAS (p = 0.003), These suggest that the absence of external cueing may require more DA response in the left VS associated with more motivational and sustained attentional efforts to perform the task. Additionally, we demonstrated significant age effects on D2/3 R availability in BG: increasing age was associated with reduced D2/3 R availability in the left putamen without RAS (p = 0.026) as well as in the right VS with RAS (p = 0.02). This is the first study to demonstrate the relationships among RAS, DA response/D2/3 R availability, motor responses and age, providing the groundwork for future studies to explore mechanisms for auditory-motor entrainment in healthy elderly and patients with dopamine-based movement disorders.

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.