Impaired movement timing in neurological disorders: rehabilitation and treatment strategies

A review of psychological and neuroscientific research on musical groove

When listening to music, we naturally move our bodies rhythmically to the beat, which can be pleasurable and difficult to resist. This pleasurable sensation of wanting to move the body to music has been called "groove." Following pioneering humanities research, psychological and neuroscientific studies have provided insights on associated musical features, behavioral responses, phenomenological aspects, and brain structural and functional correlates of the groove experience. Groove research has advanced the field of music science and more generally informed our understanding of bidirectional links between perception and action, and the role of the motor system in prediction. Activity in motor and reward-related brain networks during music listening is associated with the groove experience, and this neural activity is linked to temporal prediction and learning. This article reviews research on groove as a psychological phenomenon with neurophysiological correlates that link musical rhythm perception, sensorimotor prediction, and reward processing. Promising future research directions range from elucidating specific neural mechanisms to exploring clinical applications and socio-cultural implications of groove.

You, me, and us: Maintaining self-other distinction enhances coordination, agency, and affect

Coordinating our actions with others changes how we behave and feel. Here, we provide evidence that interacting with others rests on a balance between self-other integration and segregation. Using a group walking paradigm, participants were instructed to synchronize with a metronome while listening to the sounds of 8 virtual partners. By manipulating the similarity and synchronicity of the partners' steps to the participant's own, our novel auditory task disentangles the effects of synchrony and self-other similarity and examines their contribution to both collective and individual awareness. We measured temporal coordination (step timing regularity and synchrony with the metronome), gait patterns, and subjective reports about sense of self and group cohesion. The main findings show that coordination is best when participants hear distinct but synchronous virtual others, leading to greater subjective feelings of agency, strength, dominance, and happiness.

Can rhythm-mediated reward boost learning, memory, and social connection? Perspectives for future research

Studies of rhythm processing and of reward have progressed separately, with little connection between the two. However, consistent links between rhythm and reward are beginning to surface, with research suggesting that synchronization to rhythm is rewarding, and that this rewarding element may in turn also boost this synchronization. The current mini review shows that the combined study of rhythm and reward can be beneficial to better understand their independent and combined roles across two central aspects of cognition: 1) learning and memory, and 2) social connection and interpersonal synchronization; which have so far been studied largely independently. From this basis, it is discussed how connections between rhythm and reward can be applied to learning and memory and social connection across different populations, taking into account individual differences, clinical populations, human development, and animal research. Future research will need to consider the rewarding nature of rhythm, and that rhythm can in turn boost reward, potentially enhancing other cognitive and social processes.

Aberrant inter-network functional connectivity in drug-naive Parkinson's disease patients with tremor dominant and postural instability and gait difficulty

Background: Insight into neural mechanisms of tremor dominant (TD) and postural instability and gait disorder (PIGD) subtypes in Parkinson's disease (PD) is vital for understanding pathophysiological hypotheses underlying this phenotype. However, network disturbances and their correlation with motor subtypes of PD remain unclear. We aimed to investigate the alterations of intra- and inter-network functional connectivity (FC) in drug-naive PD patients with different motor subtypes. Methods: Resting-state functional magnetic resonance imaging was performed on 25 drug-naive PD patients with TD (PD-TD) and 40 drug-naive PD patients with PIGD (PD-PIGD), and 37 healthy controls (HCs) underwent. The following networks were extracted using independent component analysis: sensorimotor network (SMN), left executive control network (LECN), right executive control network, anterior salience network (aSN), posterior salience network (pSN), ventral attention network (VAN), dorsal attention network (DAN), default mode network (DMN), visual network, and auditory network (AN). We measured FC values within and between these networks. Results: There were no detectable variations in intra-network FC. PD-PIGD group demonstrated lower FC between aSN and pSN, as well as between VAN and DMN, in contrast to PD-TD group. Particularly, the FC strength between VAN and DMN was positively correlated with TD and tremor scores, and the best fitting classification models of TD and PIGD subtypes were based on the FC between aSN and pSN. Compared with HCs, both PD-TD and PD-PIGD patients displayed decreased FC between two SMN subnetworks, while PD-TD patients exhibited increased FC between the SMN subnetwork and pSN, and between LECN and VAN. Furthermore, PD-PIGD patients demonstrated decreased FC between the SMN subnetwork and AN. Conclusions: The altered FC between aSN and pSN can be an imaging marker to distinguish PD-TD from PD-PIGD. We for the first time disclosed that the PD-TD patients compensated by increasing attention resources and the PD-PIGD patients displayed reduced FC between SMN and AN. Our findings provide a basis for identification and precision treatment of PD motor subtypes.

Rhythmic serious games as an inclusive tool for music-based interventions

Technologies, such as mobile devices or sets of connected sensors, provide new and engaging opportunities to devise music-based interventions. Among the different technological options, serious games offer a valuable alternative. Serious games can engage multisensory processes, creating a rich, rewarding, and motivating rehabilitation setting. Moreover, they can be targeted to specific musical features, such as pitch production or synchronization to a beat. Because serious games are typically low cost and enjoy wide access, they are inclusive tools perfectly suited for remote at-home interventions using music in various patient populations and environments. The focus of this article is in particular on the use of rhythmic serious games for training auditory-motor synchronization. After reviewing the existing rhythmic games, initial evidence from a recent proof-of-concept study in Parkinson's disease is provided. It is shown that rhythmic video games using finger tapping can be used with success as an at-home protocol, and bring about beneficial effects on motor performance in patients. The use and benefits of rhythmic serious games can extend beyond the rehabilitation of patients with movement disorders, such as to neurodevelopmental disorders, including dyslexia and autism spectrum disorder.

Motor Influence in Developing Auditory Spatial Cognition in Hemiplegic Children with and without Visual Field Disorder

Spatial representation is a crucial skill for everyday interaction with the environment. Different factors seem to influence spatial perception, such as body movements and vision. However, it is still unknown if motor impairment affects the building of simple spatial perception. To investigate this point, we tested hemiplegic children with (HV) and without visual field (H) disorders in an auditory and visual-spatial localization and pitch discrimination task. Fifteen hemiplegic children (nine H and six HV) and twenty with typical development took part in the experiment. The tasks consisted in listening to a sound coming from a series of speakers positioned at the front or back of the subject. In one condition, subjects were asked to discriminate the pitch, while in the other, subjects had to localize the position of the sound. We also replicated the spatial task in a visual modality. Both groups of hemiplegic children performed worse in the auditory spatial localization task compared with the control, while no difference was found in the pitch discrimination task. For the visual-spatial localization task, only HV children differed from the two other groups. These results suggest that movement is important for the development of auditory spatial representation.

Neural Correlates of Listening to Varying Synchrony Between Beats in Samba Percussion and Relations to Feeling the Groove

Listening to samba percussion often elicits feelings of pleasure and the desire to move with the beat-an experience sometimes referred to as "feeling the groove"- as well as social connectedness. Here we investigated the effects of performance timing in a Brazilian samba percussion ensemble on listeners' experienced pleasantness and the desire to move/dance in a behavioral experiment, as well as on neural processing as assessed via functional magnetic resonance imaging (fMRI). Participants listened to different excerpts of samba percussion produced by multiple instruments that either were "in sync", with no additional asynchrony between instrumental parts other than what is usual in naturalistic recordings, or were presented "out of sync" by delaying the snare drums (by 28, 55, or 83 ms). Results of the behavioral experiment showed increasing pleasantness and desire to move/dance with increasing synchrony between instruments. Analysis of hemodynamic responses revealed stronger bilateral brain activity in the supplementary motor area, the left premotor area, and the left middle frontal gyrus with increasing synchrony between instruments. Listening to "in sync" percussion thus strengthens audio-motor interactions by recruiting motor-related brain areas involved in rhythm processing and beat perception to a higher degree. Such motor related activity may form the basis for "feeling the groove" and the associated desire to move to music. Furthermore, in an exploratory analysis we found that participants who reported stronger emotional responses to samba percussion in everyday life showed higher activity in the subgenual cingulate cortex, an area involved in prosocial emotions, social group identification and social bonding.

Adapting Footfall Rhythmicity to Auditory Perturbations Affects Resilience of Locomotor Behavior: A Proof-of-Concept Study

For humans, the ability to effectively adapt footfall rhythm to perturbations is critical for stable locomotion. However, only limited information exists regarding how dynamic stability changes when individuals modify their footfall rhythm. In this study, we recorded 3D kinematic activity from 20 participants (13 males, 18–30 years old) during walking on a treadmill while synchronizing with an auditory metronome sequence individualized to their baseline walking characteristics. The sequence then included unexpected temporal perturbations in the beat intervals with the subjects required to adapt their footfall rhythm accordingly. Building on a novel approach to quantify resilience of locomotor behavior, this study found that, in response to auditory perturbation, the mean center of mass (COM) recovery time across all participants who showed deviation from steady state (N = 15) was 7.4 (8.9) s. Importantly, recovery of footfall synchronization with the metronome beats after perturbation was achieved prior (+3.4 [95.0% CI +0.1, +9.5] s) to the recovery of COM kinematics. These results highlight the scale of temporal adaptation to perturbations and provide implications for understanding regulation of rhythm and balance. Thus, our study extends the sensorimotor synchronization paradigm to include analysis of COM recovery time toward improving our understanding of an individual’s resilience to perturbations and potentially also their fall risk.

Dynamic Modulation of Beta Band Cortico-Muscular Coupling Induced by Audio-Visual Rhythms

Human movements often spontaneously fall into synchrony with auditory and visual environmental rhythms. Related behavioral studies have shown that motor responses are automatically and unintentionally coupled with external rhythmic stimuli. However, the neurophysiological processes underlying such motor entrainment remain largely unknown. Here, we investigated with electroencephalography (EEG) and electromyography (EMG) the modulation of neural and muscular activity induced by periodic audio and/or visual sequences. The sequences were presented at either 1 or 2 Hz, while participants maintained constant finger pressure on a force sensor. The results revealed that although there was no change of amplitude in participants' EMG in response to the sequences, the synchronization between EMG and EEG recorded over motor areas in the beta (12-40 Hz) frequency band was dynamically modulated, with maximal coherence occurring about 100 ms before each stimulus. These modulations in beta EEG-EMG motor coherence were found for the 2-Hz audio-visual sequences, confirming at a neurophysiological level the enhancement of motor entrainment with multimodal rhythms that fall within preferred perceptual and movement frequency ranges. Our findings identify beta band cortico-muscular coupling as a potential underlying mechanism of motor entrainment, further elucidating the nature of the link between sensory and motor systems in humans.

A Narrative Review Examining the Utility of Interpersonal Synchrony for the Caregiver-Care Recipient Relationship in Alzheimer's Disease and Related Dementias

The stressful nature of caring for an older adult with a chronic disease, such as Alzheimer’s disease (AD), can create barriers between the caregiver-care recipient, as they try to navigate their continuously changing social relationship. Interpersonal synchrony (i.e., matching or similarity of movement, emotions, hormones, or brain activity), is an innovative approach that could help to sustain caregiving relationship dynamics by promoting feelings of connection and empathy through shared behavior and experiences. This review investigates the current literature on interpersonal synchrony from an interdisciplinary perspective by examining interpersonal synchrony through psychological, neural, and hormonal measures across the adult lifespan. We then present a case for examining the degree to which interpersonal synchrony can be used to facilitate affiliation and well-being in the caregiver-care recipient relationship. We find that there is significant evidence in healthy adult populations that interpersonal synchrony can support affiliative feelings, prosocial behavior, and well-being. Characterizing the psychological, neural, and hormonal mechanisms of interpersonal synchrony is a first step towards laying the groundwork for the development of tools to support relational closeness and empathy in the caregiving context. Finally, we explore the strengths and limitations of using interpersonal synchrony to support relational well-being, and discuss possible avenues for future research.

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.

Program of Seven 45-min Dry Immersion Sessions Improves Choice Reaction Time in Parkinson's Disease

The study hypothesis held that in subjects with Parkinson's disease (PD), the reaction time (RT) tests of the higher cognition demand would have more readily improved under the program of analog microgravity (μG) modeled with "dry" immersion (DI). To test this hypothesis, 10 subjects with PD have passed through a program of seven DI sessions (each 45 min long) within 25-30 days, with overall μG dose 5 1/4 h. Five patients were enrolled as controls, without DI (noDI group). Simple RT (SRT), disjunctive RT (DRT), and choice RT (CRT) were assessed in four study points: before the DI program (preDI), 1 day after the DI program (postDI), 2 weeks after the DI program (DI2w), and 2 months after the DI program (DI2m). The motor time (MT) was assessed with the tapping test (TT). Additionally, signal detection time (SDT) and central processing time (CPT) were extracted from the data. Before the program of DI, the RT tests are in accordance with their cognition load: SRT (284 ± 37 ms), DRT (338 ± 38 ms), and CRT (540 ± 156 ms). In accordance with the hypothesis, CRT and DRT have improved under DI by, respectively, 20 and 8% at the study point "DI2w," whereas SRT, SDT, and MT did not change (<5% in the preDI point, p > 0.05). Thus, the program of DI provoked RT improvement specifically in the cognitively loaded tasks, in a "dose of cognition-reaction" manner. The accuracy of reaction has changed in none of the RT tests. The neurophysiologic, hormonal/neuroendocrine, behavioral, neural plasticity, and acclimation mechanisms may have contributed to such a result.

Synchronization to auditory and visual beats in Parkinson's disease

The ability to move in synchrony with a perceived regular beat in time is essential for humans to interact with environments in an anticipatory manner, and the basal ganglia have been shown to be preferentially involved in beat processing. Auditory beats are often adopted in assessing the sensorimotor deficiency of patients with Parkinson's disease (PD), which is characterized by basal ganglia dysfunction. Whereas beat synchronization has long been considered to be specific to the auditory modality, recent studies employing moving instead of static visual stimuli have shown comparable synchronization performances of auditory and visual beats. Here, we show that compared with control subjects, synchronization stability of PD patients significantly decreased for beats composed of visual contracting rings but not for beats consisting of auditory tones or static visual flashes. The results revealed specific impairment of visual beat synchronization in PD. Considering the common experience of visuomotor interactions in daily lives of PD patients, the present finding emphasizes the importance of evaluation of visuomotor timing deficiency in PD by employing moving visual stimuli that have ecological relevance.

Sensorimotor synchronization during gait is altered by the addition of variability to an external cue

Sensorimotor synchronization has been used in the rehabilitation of gait, yet much remains unknown regarding the optimal use of this technique. The purpose of this study was to test the hypothesis that adding small amounts of variability to the motion of a vertically oscillating treadmill would affect the behavior of healthy walkers. Sixteen young adults walked on a treadmill and pneumatically actuated platform for one control trial (no oscillation) and eight trials in which the walking surface oscillated in the vertical direction under different conditions of variability. During the oscillation trials, the mean frequency of oscillation was equal to the preferred step frequency of the participant, but each individual cycle period was allowed to vary within a pre-determined range from 0% (no variability) to ±25% (high variability) of the mean cycle period. The amount of variance of each cycle period within each condition was drawn randomly from a white noise generator. Synchronization was improved when a small amount of noise was added to the platform motion but synchronization significantly decreased at higher levels of noise. Coefficient of variation of stride duration was relatively unchanged at lower levels of variability, but increased significantly at higher levels of variability. Statistical persistence of stride duration was significantly reduced during all trials with vertical oscillation relative to normal walking, but was not significantly altered by variability in the treadmill oscillation. These results suggest that the addition of a small amount of random variability to the cycle period of an oscillator may enhance sensorimotor synchronization of gait to an external signal. These data may have implications for the use of synchronization in a therapeutic setting.

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

Efeito imediato da estimulação auditiva rítmica nos parâmetros espaços-temporais da marcha de idosos sedentários: um estudo piloto

Resumo Objetivos Avaliar o efeito imediato da estimulação auditiva rítmica (EAR) com música sobre os parâmetros espaços-temporais da marcha em idosos sedentários e analisar possíveis interações com os episódios de quedas. Métodos Estudo piloto de intervenção com idosos sedentários (n=15), idade ≥ 60 anos, ambos os sexos, independentes na marcha. Adicionalmente, os idosos foram divididos em dois grupos, caidores (n=5) e não caidores (n=10), baseado no histórico de quedas no último ano. A avaliação dos parâmetros espaços-temporais da marcha foi realizada através do teste de Caminhada de 10 metros executado em marcha livre (T0), repetido com suporte da EAR com música (T1) e executado em marcha livre novamente (T2). Para a análise dos dados, foram utilizados a ANOVA de medidas repetidas e a ANOVA (two-way) para comparação entre os grupos, com o post hoc de Tukey. O tamanho do efeito das intervenções também foi calculado. Resultados Houve redução significativa do tempo e do número de passos e um aumento da velocidade da marcha (p<0,0001; com efeito grande) entre os momentos T0-T1 e T0-T2. Ambos os grupos caidores e não caidores apresentaram redução significativa do tempo e do número de passos (p<0,0001) e aumento da velocidade (p<0,0001), mas apenas na variável cadência houve efeito do grupo e da interação tempo e grupo. Conclusão Verificou-se um efeito imediato positivo do uso da EAR nos parâmetros espaços-temporais da marcha de idosos sedentários com maior efeito na cadência de idosos não caidores.

Preliminary Neurophysiological Evidence of Altered Cortical Activity and Connectivity With Neurologic Music Therapy in Parkinson's Disease

Neurologic Music Therapy (NMT) is a novel impairment-focused behavioral intervention system whose techniques are based on the clinical neuroscience of music perception, cognition, and production. Auditory Stimulation (RAS) is one of the NMT techniques, which aims to develop and maintain a physiological rhythmic motor activity through rhythmic auditory cues. In a series of breakthrough studies beginning in the mid-nineties, we discovered that RAS durably improves gait velocity, stride length, and cadence in Parkinson's disease (PD). No study to date reports the neurophysiological evidence of auditory-motor frequency entrainment after a NMT intervention in the Parkinson's community. We hypothesized that NMT-related motor improvements in PD are due to entrainment-related coupling between auditory and motor activity resulting from an increased functional communication between the auditory and the motor cortices. Spectral analysis in the primary motor and auditory cortices during a cued finger tapping task showed a simultaneous increase in evoked power in the beta-range along with an increased functional connectivity after a course of NMT in a small sample of three older adults with PD. This case study provides preliminary evidence that NMT-based motor rehabilitation may enhance cortical activation in the auditory and motor areas in a synergic manner. With a lack of both control subjects and control conditions, this neuroimaging case-proof of concept series of visible changes suggests potential mechanisms and offers further education on the clinical applications of musical interventions for motor impairments.

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.

Internal cueing improves gait more than external cueing in healthy adults and people with Parkinson disease

Walking can be challenging for aging individuals and people with neurological disorders such as Parkinson disease (PD). Gait impairment characterized by reduced speed and higher variability destabilizes gait and increases the risk of falls. External auditory cueing provides an effective strategy to improve gait, as matching footfalls to rhythms typically increases gait speed and elicits larger steps, but the need to synchronize to an outside source often has a detrimental effect on gait variability. Internal cueing in the form of singing may provide an alternative to conventional gait therapy. In the present study, we compare the effects of internal and external cueing techniques on forward and backward walking for both people with PD and healthy controls. Results indicate that internal cueing was associated with improvements in gait velocity, cadence, and stride length in the backward direction, and reduced variability in both forward and backward walking. In comparison, external cueing was associated with minimal improvement in gait characteristics and a decline in gait stability. People with gait impairment due to aging or neurological decline may benefit more from internal cueing techniques such as singing as compared to external cueing techniques.

Single (1:1) vs. double (1:2) metronomes for the spontaneous entrainment and stabilisation of human rhythmic movements

Rhythmic movements produced by humans become spontaneously entrained to auditory rhythms in the environment. Evidence suggests that synchronisation to external auditory rhythms can contribute to the stabilisation of movements in time and space, opening new perspectives for motor training and rehabilitation. Here we compared the effects of single (1:1) and double (1:2) metronomes (i.e., one or two stimulations per preferred movement cycle) on spontaneous movement entrainment and stabilisation. We examined the spontaneous entrainment of self-paced hand-held pendulum swinging when single or double metronomes were presented either at the participant's preferred tempo or slightly slower or faster (± 10%). The results showed that participants' movements spontaneously entrained to auditory rhythms, and that the strength of this entrainment was the same for single and double metronomes. However, double metronomes decreased movement tempo stability, whereas single metronomes increased movement tempo stability compared to a control condition without a stimulus. These effects preferentially occurred for metronomes presented at participants' preferred movement tempi and especially for participants whose movements were intrinsically more variable. Participants' movement amplitude stability was also modulated in such a way that the stability of participants who were intrinsically less stable increased, whereas the stability of intrinsically more stable participants decreased with auditory rhythms, an effect that was stronger with double than single metronomes. Moreover, movement stabilisation in time and space were positively correlated, suggesting that tempo and amplitude stabilisation depend on similar processes and may be complementary. These findings provide new insight into the processes underlying auditory-motor entrainment and how auditory rhythms can be used to improve movement stability in time and space.

Effects of pitch and tempo of auditory rhythms on spontaneous movement entrainment and stabilisation

Human movements spontaneously entrain to auditory rhythms, which can help to stabilise movements in time and space. The properties of auditory rhythms supporting the occurrence of this phenomenon, however, remain largely unclear. Here, we investigate in two experiments the effects of pitch and tempo on spontaneous movement entrainment and stabilisation. We examined spontaneous entrainment of hand-held pendulum swinging in time with low-pitched (100 Hz) and high-pitched (1600 Hz) metronomes to test whether low pitch favours movement entrainment and stabilisation. To investigate whether stimulation and movement tempi moderate these effects of pitch, we manipulated (1) participants' preferred movement tempo by varying pendulum mechanical constraints (Experiment 1) and (2) stimulation tempo, which was either equal to, or slightly slower or faster (± 10%) than the participant's preferred movement tempo (Experiment 2). The results showed that participants' movements spontaneously entrained to auditory rhythms, and that this effect was stronger with low-pitched rhythms independently of stimulation and movement tempi. Results also indicated that auditory rhythms can lead to increased movement amplitude and stabilisation of movement tempo and amplitude, particularly when low-pitched. However, stabilisation effects were found to depend on intrinsic movement variability. Auditory rhythms decreased movement variability of individuals with higher intrinsic variability but increased movement variability of individuals with lower intrinsic variability. These findings provide new insights into factors that influence auditory-motor entrainment and how they may be optimised to enhance movement efficiency.

Neural tracking of the musical beat is enhanced by low-frequency sounds

Bass sounds play a special role in conveying the rhythm and stimulating motor entrainment to the beat of music. However, the biological roots of this culturally widespread musical practice remain mysterious, despite its fundamental relevance in the sciences and arts, and also for music-assisted clinical rehabilitation of motor disorders. Here, we show that this musical convention may exploit a neurophysiological mechanism whereby low-frequency sounds shape neural representations of rhythmic input at the cortical level by boosting selective neural locking to the beat, thus explaining the privileged role of bass sounds in driving people to move along with the musical beat.

Music makes us move, and using bass instruments to build the rhythmic foundations of music is especially effective at inducing people to dance to periodic pulse-like beats. Here, we show that this culturally widespread practice may exploit a neurophysiological mechanism whereby low-frequency sounds shape the neural representations of rhythmic input by boosting selective locking to the beat. Cortical activity was captured using electroencephalography (EEG) while participants listened to a regular rhythm or to a relatively complex syncopated rhythm conveyed either by low tones (130 Hz) or high tones (1236.8 Hz). We found that cortical activity at the frequency of the perceived beat is selectively enhanced compared with other frequencies in the EEG spectrum when rhythms are conveyed by bass sounds. This effect is unlikely to arise from early cochlear processes, as revealed by auditory physiological modeling, and was particularly pronounced for the complex rhythm requiring endogenous generation of the beat. The effect is likewise not attributable to differences in perceived loudness between low and high tones, as a control experiment manipulating sound intensity alone did not yield similar results. Finally, the privileged role of bass sounds is contingent on allocation of attentional resources to the temporal properties of the stimulus, as revealed by a further control experiment examining the role of a behavioral task. Together, our results provide a neurobiological basis for the convention of using bass instruments to carry the rhythmic foundations of music and to drive people to move to the beat.

Optimal Tempo for Groove: Its Relation to Directions of Body Movement and Japanese nori

The tendency for groove-based music to induce body movements has been linked to multiple acoustical factors. However, it is unclear how or whether tempo affects groove, although tempo significantly affects other aspects of music perception. To address this issue, the present study investigated effects of tempo, specific rhythmic organizations of patterns, and syncopation on groove and the induction of the sensation of wanting to move. We focused on the directions of body movement in particular by taking into account nori, which is an indigenous Japanese musical term used not only synonymously with groove, but also as a spatial metaphor indicating vertical or horizontal movement directions. Thus, the present study explored how groove was felt and defined, as well as how musical factors induced the sensation of wanting to move in cross-cultural context. A listening experiment was conducted using drum breaks as stimuli. Stimuli consisted of various rhythm patterns at six tempi from 60 to 200 BPM. The main findings are that: (1) an optimal tempo for groove existed for drum breaks at around 100–120 BPM, (2) an optimal tempo existed for the sensation of wanting to move the body in specific directions (i.e., back-and-forth and side-to-side), (3) groove and nori shared a similar concept of wanting to move but differed on several points (i.e., association with sense of pulse and fast tempo). Overall, the present study suggests that there is an optimal tempo for body movement related to groove. This finding has implications for the use of music or rhythmic stimuli to induce smooth motion in rehabilitation, therapy, or dance.

Finger tapping and pre-attentive sensorimotor timing in adults with ADHD

Sensorimotor timing deficits are considered central to attention-deficit/hyperactivity disorder (ADHD). However, the tasks establishing timing impairments often involve interconnected processes, including low-level sensorimotor timing and higher level executive processes such as attention. Thus, the source of timing deficits in ADHD remains unclear. Low-level sensorimotor timing can be isolated from higher level processes in a finger-tapping task that examines the motor response to unexpected shifts of metronome onsets. In this study, adults with ADHD and ADHD-like symptoms (n = 25) and controls (n = 26) performed two finger-tapping tasks. The first assessed tapping variability in a standard tapping task (metronome-paced and unpaced). In the other task, participants tapped along with a metronome that contained unexpected shifts (±15, 50 ms); the timing adjustment on the tap following the shift captures pre-attentive sensorimotor timing (i.e., phase correction) and thus should be free of potential higher order confounds (e.g., attention). In the standard tapping task, as expected, the ADHD group had higher timing variability in both paced and unpaced tappings. However, in the pre-attentive task, performance did not differ between the ADHD and control groups. Together, results suggest that low-level sensorimotor timing and phase correction are largely preserved in ADHD and that some timing impairments observed in ADHD may stem from higher level factors (such as sustained attention).

Can Tai Chi training impact fractal stride time dynamics, an index of gait health, in older adults? Cross-sectional and randomized trial studies

Purpose

To determine if Tai Chi (TC) has an impact on long-range correlations and fractal-like scaling in gait stride time dynamics, previously shown to be associated with aging, neurodegenerative disease, and fall risk.

Methods

Using Detrended Fluctuation Analysis (DFA), this study evaluated the impact of TC mind-body exercise training on stride time dynamics assessed during 10 minute bouts of overground walking. A hybrid study design investigated long-term effects of TC via a cross-sectional comparison of 27 TC experts (24.5 ± 11.8 yrs experience) and 60 age- and gender matched TC-naïve older adults (50–70 yrs). Shorter-term effects of TC were assessed by randomly allocating TC-naïve participants to either 6 months of TC training or to a waitlist control. The alpha (α) long-range scaling coefficient derived from DFA and gait speed were evaluated as outcomes.

Results

Cross-sectional comparisons using confounder adjusted linear models suggest that TC experts exhibited significantly greater long-range scaling of gait stride time dynamics compared with TC-naïve adults. Longitudinal random-slopes with shared baseline models accounting for multiple confounders suggest that the effects of shorter-term TC training on gait dynamics were not statistically significant, but trended in the same direction as longer-term effects although effect sizes were very small. In contrast, gait speed was unaffected in both cross-sectional and longitudinal comparisons.

Conclusion

These preliminary findings suggest that fractal-like measures of gait health may be sufficiently precise to capture the positive effects of exercise in the form of Tai Chi, thus warranting further investigation. These results motivate larger and longer-duration trials, in both healthy and health-challenged populations, to further evaluate the potential of Tai Chi to restore age-related declines in gait dynamics.

Trial registration

The randomized trial component of this study was registered at ClinicalTrials.gov (NCT01340365).

Usability of Three-dimensional Augmented Visual Cues Delivered by Smart Glasses on (Freezing of) Gait in Parkinson's Disease

External cueing is a potentially effective strategy to reduce freezing of gait (FOG) in persons with Parkinson's disease (PD). Case reports suggest that three-dimensional (3D) cues might be more effective in reducing FOG than two-dimensional cues. We investigate the usability of 3D augmented reality visual cues delivered by smart glasses in comparison to conventional 3D transverse bars on the floor and auditory cueing via a metronome in reducing FOG and improving gait parameters. In laboratory experiments, 25 persons with PD and FOG performed walking tasks while wearing custom-made smart glasses under five conditions, at the end-of-dose. For two conditions, augmented visual cues (bars/staircase) were displayed via the smart glasses. The control conditions involved conventional 3D transverse bars on the floor, auditory cueing via a metronome, and no cueing. The number of FOG episodes and percentage of time spent on FOG were rated from video recordings. The stride length and its variability, cycle time and its variability, cadence, and speed were calculated from motion data collected with a motion capture suit equipped with 17 inertial measurement units. A total of 300 FOG episodes occurred in 19 out of 25 participants. There were no statistically significant differences in number of FOG episodes and percentage of time spent on FOG across the five conditions. The conventional bars increased stride length, cycle time, and stride length variability, while decreasing cadence and speed. No effects for the other conditions were found. Participants preferred the metronome most, and the augmented staircase least. They suggested to improve the comfort, esthetics, usability, field of view, and stability of the smart glasses on the head and to reduce their weight and size. In their current form, augmented visual cues delivered by smart glasses are not beneficial for persons with PD and FOG. This could be attributable to distraction, blockage of visual feedback, insufficient familiarization with the smart glasses, or display of the visual cues in the central rather than peripheral visual field. Future smart glasses are required to be more lightweight, comfortable, and user friendly to avoid distraction and blockage of sensory feedback, thus increasing usability.

Investigation of the effects of transcranial alternating current stimulation (tACS) on self-paced rhythmic movements

Human rhythmic movements spontaneously entrain to external rhythmic stimuli. Such sensory-motor entrainment can attract movements to different tempi and enhance their efficiency, with potential clinical applications for motor rehabilitation. Here we investigate whether entrainment of self-paced rhythmic movements can be induced via transcranial alternating current stimulation (tACS), which uses alternating currents to entrain spontaneous brain oscillations at specific frequencies. Participants swung a handheld pendulum at their preferred tempo with the right hand while tACS was applied over their left or right primary motor cortex at frequencies equal to their preferred tempo (Experiment 1) or in the alpha (10Hz) and beta (20Hz) ranges (Experiment 2). Given that entrainment generally occurs only if the frequency difference between two rhythms is small, stimulations were delivered at frequencies equal to participants' preferred movement tempo (≈1Hz) and ±12.5% in Experiment 1, and at 10Hz and 20Hz, and ±12.5% in Experiment 2. The comparison of participants' movement frequency, amplitude, variability, and phase synchrony with and without tACS failed to reveal entrainment or movement modifications across the two experiments. However, significant differences in stimulation-related side effects reported by participants were found between the two experiments, with phosphenes and burning sensations principally occurring in Experiment 2, and metallic tastes reported marginally more often in Experiment 1. Although other stimulation protocols may be effective, our results suggest that rhythmic movements such as pendulum swinging or locomotion that are low in goal-directedness and/or strongly driven by peripheral and mechanical constraints may not be susceptible to modulation by tACS.

The feasibility of singing to improve gait in Parkinson disease

Brain regions important for controlling movement are also responsible for rhythmic processing. In Parkinson disease (PD), defective internal timing within the brain has been linked to impaired beat discrimination, and may contribute to a loss of ability to maintain a steady gait rhythm. Less rhythmic gait is inherently less efficient, and this may lead to gait impairment including reduced speed, cadence, and stride length, as well as increased variability. While external rhythmic auditory stimulation (e.g. a metronome beat) is well-established as an effective tool to stabilize gait in PD, little is known about whether self-generated cues such as singing have the same beneficial effect on gait in PD. Thus, we compared gait patterns of 23 people with mild to moderate PD under five cued conditions: uncued, music only, singing only, singing with music, and a verbal dual-task condition. In our single-session study, singing while walking did not significantly alter velocity, cadence, or stride length, indicating that it was not excessively demanding for people with PD. In addition, walking was less variable when singing than during other cued conditions. This was further supported by the comparison between singing trials and a verbal dual-task condition. In contrast to singing, the verbal dual-task negatively affected gait performance. These findings suggest that singing holds promise as an effective cueing technique that may be as good as or better than traditional cueing techniques for improving gait among people with PD.

Impaired auditory-to-motor entrainment in Parkinson's disease

Several electrophysiological studies suggest that Parkinson's disease (PD) patients have a reduced tendency to entrain to regular environmental patterns. Here we investigate whether this reduced entrainment concerns a generalized deficit or is confined to movement-related activity, leaving sensory entrainment intact. Magnetoencephalography was recorded during a rhythmic auditory target detection task in 14 PD patients and 14 control subjects. Participants were instructed to press a button when hearing a target tone amid an isochronous sequence of standard tones. The variable pitch of standard tones indicated the probability of the next tone to be a target. In addition, targets were occasionally omitted to evaluate entrainment uncontaminated by stimulus effects. Response times were not significantly different between groups and both groups benefited equally from the predictive value of standard tones. Analyses of oscillatory beta power over auditory cortices showed equal entrainment to the tones in both groups. By contrast, oscillatory beta power and event-related fields demonstrated a reduced engagement of motor cortical areas in PD patients, expressed in the modulation depth of beta power, in the response to omitted stimuli, and in an absent motor area P300 effect. Together, these results show equally strong entrainment of neural activity over sensory areas in controls and patients, but, in patients, a deficient translation of the adjustment to the task rhythm to motor circuits. We suggest that the reduced activation reflects not merely altered resonance to rhythmic external events, but a compromised recruitment of an endogenous response reflecting internal rhythm generation.NEW & NOTEWORTHY Previous studies suggest that motor cortical activity in PD patients has a reduced tendency to entrain to regular environmental patterns. This study demonstrates that the deficient entrainment in PD concerns the motor system only, by showing equally strong entrainment of neural activity over sensory areas in controls and patients but, in patients, a deficient translation of this adjustment to the task rhythm to motor circuits.

Time Processing and Motor Control in Movement Disorders

The subjective representation of “time” is critical for cognitive tasks but also for several motor activities. The neural network supporting motor timing comprises: lateral cerebellum, basal ganglia, sensorimotor and prefrontal cortical areas. Basal ganglia and associated cortical areas act as a hypothetical “internal clock” that beats the rhythm when the movement is internally generated. When timing information is processed to make predictions on the outcome of a subjective or externally perceived motor act, cerebellar processing and outflow pathways appear to be primarily involved. Clinical and experimental evidence on time processing and motor control points to a dysfunction of the neural networks involving basal ganglia and cerebellum in movement disorders. In some cases, temporal processing deficits could directly contribute to core motor features of the movement disorder, as in the case of bradykinesia in Parkinson's disease. For other movement disorders, the relationship between abnormal time processing and motor performance is less obvious and requires further investigation, as in the reduced accuracy in predicting the temporal outcome of a motor act in dystonia. We aim to review the literature on time processing and motor control in Parkinson's disease, dystonia, Huntington's disease, and Tourette syndrome, integrating the available findings with current pathophysiological models; we will highlight the areas in which future explorations are warranted, as well as the aspects of time processing in motor control that present translational aspects in future rehabilitation strategies. The subjective representation of “time” is critical for cognitive tasks but also for motor activities. Recently, greater attention has been devoted to improve our understanding of how temporal information becomes integrated within the mechanisms of motor control. Experimental evidence recognizes time processing in motor control as a complex neural function supported by diffuse cerebral networks including cortical areas, cerebellum, and other subcortical structures (Ivry and Spencer, 2004; Coull and Nobre, 2008). Timing is an essential component of motor control primarily within two types of motor tasks: (i) when producing sequential rhythmic movements or sustained movements of a definite duration (explicit timing); (ii) when the temporal information is used implicitly, such as when coordinating our movements to those of moving objects or individuals within the external environment (implicit timing). In this review, we will provide a brief description of the neural network supporting motor timing focusing only on instrumental information to explain the link between timing and motor control in movement disorders. Then we will review available data on motor timing in Parkinson's disease, dystonia, Huntington's disease, and Tourette syndrome, and discuss how this body of evidence integrates with the available information on the pathophysiology of these movement disorders. Finally, we will discuss the translational aspects of the explored neural mechanisms with respect to future rehabilitation strategies.

Speech dysprosody but no music 'dysprosody' in Parkinson's disease

Parkinson's disease is characterized not only by bradykinesia, rigidity, and tremor, but also by impairments of expressive and receptive linguistic prosody. The facilitating effect of music with a salient beat on patients' gait suggests that it might have a similar effect on vocal behavior, however it is currently unknown whether singing is affected by the disease. In the present study, fifteen Parkinson patients were compared with fifteen healthy controls during the singing of familiar melodies and improvised melodic continuations. While patients' speech could reliably be distinguished from that of healthy controls matched for age and gender, purely on the basis of aural perception, no significant differences in singing were observed, either in pitch, pitch range, pitch variability, and tempo, or in scale tone distribution, interval size or interval variability. The apparent dissociation of speech and singing in Parkinson's disease suggests that music could be used to facilitate expressive linguistic prosody.

Moving Stimuli Facilitate Synchronization But Not Temporal Perception

Recent studies have shown that a moving visual stimulus (e.g., a bouncing ball) facilitates synchronization compared to a static stimulus (e.g., a flashing light), and that it can even be as effective as an auditory beep. We asked a group of participants to perform different tasks with four stimulus types: beeps, siren-like sounds, visual flashes (static) and bouncing balls. First, participants performed synchronization with isochronous sequences (stimulus-guided synchronization), followed by a continuation phase in which the stimulus was internally generated (imagery-guided synchronization). Then they performed a perception task, in which they judged whether the final part of a temporal sequence was compatible with the previous beat structure (stimulus-guided perception). Similar to synchronization, an imagery-guided variant was added, in which sequences contained a gap in between (imagery-guided perception). Balls outperformed flashes and matched beeps (powerful ball effect) in stimulus-guided synchronization but not in perception (stimulus- or imagery-guided). In imagery-guided synchronization, performance accuracy decreased for beeps and balls, but not for flashes and sirens. Our findings suggest that the advantages of moving visual stimuli over static ones are grounded in action rather than perception, and they support the hypothesis that the sensorimotor coupling mechanisms for auditory (beeps) and moving visual stimuli (bouncing balls) overlap.

Regional Interplay for Temporal Processing in Parkinson's Disease: Possibilities and Challenges

Parkinson's disease (PD) is primarily associated with two dominant features: cardinal motor symptoms and the loss of cells in the substantia nigra pars compacta of the basal ganglia. Consequently, these aspects are major foci in PD-related research. However, PD is a neurodegenerative disease, which progressively affects multiple brain regions outside the basal ganglia and leads to symptoms outside the motor domain. Much less is known about the individual contribution of these secondary regions, their interplay and interaction with the basal ganglia, and the respective network dynamics in the overall manifestation of PD. These regions include classical motor structures such as the cerebellum and the supplementary motor area (SMA). However, just as the basal ganglia, these regions display a fine-grained microarchitecture, which supports sensory and sensorimotor functions. One such function is temporal processing, which has been ascribed to a network comprising all of these regions. On the one hand, pathological changes in this temporal processing network may be part and parcel of motor and non-motor symptoms in PD. On the other hand, a better understanding of the role of each network node may offer a novel perspective on compensatory mechanisms, therapeutic interventions, as well as the heterogeneity and individual differences associated with PD. We unfold this perspective by relating the neural foundations and functional implications of temporal processing to pathophysiological and neurofunctional changes characteristic of PD.

Effects of Auditory Rhythm and Music on Gait Disturbances in Parkinson's Disease

Gait abnormalities, such as shuffling steps, start hesitation, and freezing, are common and often incapacitating symptoms of Parkinson’s disease (PD) and other parkinsonian disorders. Pharmacological and surgical approaches have only limited efficacy in treating these gait disorders. Rhythmic auditory stimulation (RAS), such as playing marching music and dance therapy, has been shown to be a safe, inexpensive, and an effective method in improving gait in PD patients. However, RAS that adapts to patients’ movements may be more effective than rigid, fixed-tempo RAS used in most studies. In addition to auditory cueing, immersive virtual reality technologies that utilize interactive computer-generated systems through wearable devices are increasingly used for improving brain–body interaction and sensory–motor integration. Using multisensory cues, these therapies may be particularly suitable for the treatment of parkinsonian freezing and other gait disorders. In this review, we examine the affected neurological circuits underlying gait and temporal processing in PD patients and summarize the current studies demonstrating the effects of RAS on improving these gait deficits.

The E-music box: an empirical method for exploring the universal capacity for musical production and for social interaction through music

Humans are assumed to have a natural-universal-predisposition for making music and for musical interaction. Research in this domain is, however, typically conducted with musically trained individuals, and therefore confounded with expertise. Here, we present a rediscovered and updated invention-the E-music box-that we establish as an empirical method to investigate musical production and interaction in everyone. The E-music box transforms rotatory cyclical movements into pre-programmable digital musical output, with tempo varying according to rotation speed. The user's movements are coded as continuous oscillatory data, which can be analysed using linear or nonlinear analytical tools. We conducted a proof-of-principle experiment to demonstrate that, using this method, pairs of non-musically trained individuals can interact according to conventional musical practices (leader/follower roles and lower-pitch dominance). The results suggest that the E-music box brings 'active' and 'interactive' musical capacities within everyone's reach. We discuss the potential of this method for exploring the universal predisposition for music making and interaction in developmental and cross-cultural contexts, and for neurologic musical therapy and rehabilitation.

Exploring Music-Based Rehabilitation for Parkinsonism through Embodied Cognitive Science

Recent embodied approaches in cognitive sciences emphasize the constitutive roles of bodies and environment in driving cognitive processes. Cognition is thus seen as a distributed system based on the continuous interaction of bodies, brains, and environment. These categories, moreover, do not relate only causally, through a sequential input-output network of computations; rather, they are dynamically enfolded in each other, being mutually implemented by the concrete patterns of actions adopted by the cognitive system. However, while this claim has been widely discussed across various disciplines, its relevance and potential beneficial applications for music therapy remain largely unexplored. With this in mind, we provide here an overview of the embodied approaches to cognition, discussing their main tenets through the lenses of music therapy. In doing so, we question established methodological and theoretical paradigms and identify possible novel strategies for intervention. In particular, we refer to the music-based rehabilitative protocols adopted for Parkinson's disease patients. Indeed, in this context, it has recently been observed that music therapy not only affects movement-related skills but that it also contributes to stabilizing physiological functions and improving socio-affective behaviors. We argue that these phenomena involve previously unconsidered aspects of cognition and (motor) behavior, which are rooted in the action-perception cycle characterizing the whole living system.

Effect of mechanical tactile noise on amplitude of visual evoked potentials: multisensory stochastic resonance

The present investigation documents the electrophysiological occurrence of multisensory stochastic resonance in the human visual pathway elicited by tactile noise. We define multisensory stochastic resonance of brain evoked potentials as the phenomenon in which an intermediate level of input noise of one sensory modality enhances the brain evoked response of another sensory modality. Here we examined this phenomenon in visual evoked potentials (VEPs) modulated by the addition of tactile noise. Specifically, we examined whether a particular level of mechanical Gaussian noise applied to the index finger can improve the amplitude of the VEP. We compared the amplitude of the positive P100 VEP component between zero noise (ZN), optimal noise (ON), and high mechanical noise (HN). The data disclosed an inverted U-like graph for all the subjects, thus demonstrating the occurrence of a multisensory stochastic resonance in the P100 VEP.