Changes in gait patterns induced by rhythmic auditory stimulation for adolescents with acquired brain injury

Integrative Review of Music and Music Therapy Interventions on Functional Outcomes in Children with Acquired Brain Injury

Acquired brain injury (ABI) can result in a multitude of impairments to physical, cognitive, communicative, psychological, and psychosocial functioning. Music interventions are emerging as a valuable form of intervention in the rehabilitation of children with ABI, stimulating brain functions involved in movement, cognition, speech, emotions, and sensory perceptions. To date, the literature detailing the impact of music and music therapy interventions on functional outcomes in children with ABI has not been reviewed systematically. To address this, Whittemore and Knafl's five-stage integrative review framework was employed, which includes (a) problem identification, (b) literature search, (c) data evaluation, (d) data analysis and synthesis, and (e) presentation of the findings. A total of 388 articles were retrieved, and 8 studies met the inclusion criteria. Analysis and synthesis resulted in 3 overarching themes: outcomes of using music therapy in pediatric ABI, music therapy as a motivator in pediatric ABI rehabilitation, and collaboration. The review highlights the pivotal role of music as a motivational catalyst that promotes adherence to rehabilitative intervention. Nevertheless, it underscores a significant gap in empirical research within the field, emphasizing the necessity for larger, more rigorous studies.

Evidence of Implicit and Explicit Motor Learning during Gait Training with Distorted Rhythmic Auditory Cues

Gait training with rhythmic auditory cues contains motor learning mechanisms that are weighted more explicitly than implicitly. However, various clinical populations may benefit from a shift to gait training with greater implicit motor learning mechanisms. To investigate the ability to incorporate more implicit-weighted motor learning processes during rhythmic auditory cueing, we attempted to induce error-based recalibration using a subtly varying metronome cue for naïve unimpaired young adults. We assessed the extent of implicit and explicit retention after both an isochronous metronome and subtly varying metronome frequency during treadmill and overground walking. Despite 90% of participants remaining unaware of the changing metronome frequency, participants adjusted their cadence and step length to the subtly changing metronome, both on a treadmill and overground (p < 0.05). However, despite evidence of both implicit and explicit processes involved with each metronome (i.e., isochronous and varying), there were no between-condition differences in implicit or explicit retention for cadence, step length, or gait speed, and thus no increased implicit learning advantage with the addition of error-based recalibration for young, unimpaired adults.

Neurologic Music Therapy in Geriatric Rehabilitation: A Systematic Review

(1) Introduction: Neurologic music therapy (NMT) is a non-pharmacological approach of interaction through the therapeutic use of music in motor, sensory and cognitive dysfunctions caused by damage or diseases of the nervous system. (2) Objective: This study aimed to critically appraise the available literature on the application of particular NMT techniques in the rehabilitation of geriatric disorders. (3) Methods: PubMed, ScienceDirect and EBSCOhost databases were searched. We considered randomized controlled trials (RCTs) from the last 12 years using at least one of the NMT techniques from the sensorimotor, speech/language and cognitive domains in the therapy of patients over 60 years old and with psychogeriatric disorders. (4) Results: Of the 255 articles, 8 met the inclusion criteria. All papers in the final phase concerned the use of rhythmic auditory stimulation (RAS) (sensorimotor technique) in the rehabilitation of both Parkinson's disease (PD) patients (six studies) and stroke patients (SPs) (two studies). (5) Conclusion: All reports suggest that the RAS technique has a significant effect on the improvement of gait parameters and the balance of PD patients and SPs, as well as the risk of falls in PD patients.

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.

[Physical factors in the rehabilitation of patients after brain injury: a scientometric analysis of evidence-based studies]

OBJECTIVE

Scientometric analysis of evidence-based studies of the physical and rehabilitation medicine (PRM) technologies' effectiveness in the rehabilitation of patients with traumatic brain injury (TBI).

MATERIAL AND METHODS

The search for the material was carried out in electronic databases (PEDro, eLIBRARY, PubMed), as well as databases of systematic reviews (SR) (Cochrane Library) using the keywords: «brain injury», «brain», «physical therapy». RCTs were assessed on the PEDro scale from 1 to 10 points. For the final analysis the results of foreign SRs and RCTs published in the period from January 2014 to December 2019 were selected.

RESULTS

The analysis of studies devoted to the use of therapeutic physical factors in the rehabilitation of patients with TBI from the standpoint of evidence-based medicine is carried out. The basic trends in evidence-based studies on the use of various forms of physical exercise, neuromuscular stimulation, and robot-assisted training in the rehabilitation of patients with TBI are highlighted. PRM technologies have been identified which usage led to positive results in patients with TBI for a number of physiological indicators but the number of evidence-based studies on this topic was insufficient. Based on the scientometric analysis of benign studies the promising directions in the study of the influence of therapeutic physical factors in the rehabilitation of patients with TBI have been identified.

CONCLUSION

The presented data demonstrate the studies' results conducted over the past 5 years on the use of PRM technologies in patients with previous TBI. A significant part of the methods considered in the article is actively used in domestic rehabilitation that reflects the ubiquitous process of integrating information obtained in the course of evidence-based research. In order to improve the quality of rehabilitation care for patients with TBI the practice of analyzing and conducting evidence-based studies on this nosology should be continued.

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

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

Feasibility of a rhythmic auditory stimulation gait training program in community-dwelling adults after TBI: A case report

BACKGROUND

Traumatic brain injury has multiple impacts on gait including decreased speed and increased gait variability. Rhythmic auditory stimulation (RAS) gait training uses the rhythm and timing structure of music to train and ultimately improve slow and variable walking patterns.

OBJECTIVE

To describe the feasibility of RAS gait training in community-dwelling adults with traumatic brain injury (TBI). A secondary objective is to report changes in spatiotemporal gait parameters and clinical measures of balance and walking endurance.

METHODS

Two individuals with a TBI participated in nine sessions of gait training with RAS over a 3-week period. At baseline, post-training and 3-week follow-up, spatiotemporal parameters of walking were analyzed at preferred pace, maximum pace and dual-task walking conditions. Secondary outcomes included the Community Balance and Mobility Scale and the 6-Minute Walk Test. Feasibility was assessed using reports of physical fatigue, adverse event reporting, and perceived satisfaction.

RESULTS

Both participants completed all 9 planned intervention sessions. The sessions were well tolerated with no adverse events. Participant 1 and 2 exhibited different responses to the intervention in line with the therapeutic goals set with the therapist. Participant 1 exhibited improved speed and decreased gait variability. Participant 2 exhibited reduced gait speed but less fatigue during the 6MWT.

CONCLUSIONS

RAS was found to be a safe and feasible gait intervention with the potential to improve some aspects of gait impairments related to gait speed, gait variability, dynamic balance and walking endurance. Further investigation including a pilot randomized controlled trial is warranted.

EFFECT OF PHASE-SHIFTED AUDITORY CUE ON GAIT SYMMETRY AND TRUNK DISPLACEMENT DURING TREADMILL WALKING

This study investigated changes in gait symmetry with trunk displacement during phase-shifted auditory paced treadmill walking for effective training with auditory cueing provided in conventional gait training. Eighteen able-bodied participants walked at a comfortable speed on a treadmill and the measured cadence was set at 100% (baseline). The phase-shifted auditory cue was set to both phase advance and delay of 20% at 5% intervals based on the baseline with respect to matching foot contact to the auditory cue. Trunk displacement increased with the phase-shifted auditory cue, and the largest value was found in the 120% condition compared to baseline ([Formula: see text]). Step length, step time, and swing phase time symmetry ratio gradually increased with increasing phase delay and gradually decreased with increasing phase advance on the linear model. However, single support time and stance phase time symmetry ratio showed contrasting characteristics compared to above parameters. The results indicate that the phase-shifted auditory cue significantly changes gait symmetry and trunk displacement. Particularly, the 20% phase advance and delay cues yielded about a 5% change in the step length symmetry ratio. These results could be used to induce a symmetric gait pattern when an asymmetric gait appears in hemiplegia.

Effects of acupuncture treatment on motor function in patients with subacute hemorrhagic stroke: A randomized controlled study

OBJECTIVE

The aim of this study was to evaluate the additional effects of acupuncture treatment on motor function in patients with subacute hemorrhagic stroke.

DESIGN

One hundred and thirty-four patients with subacute hemorrhagic stroke were randomized to receive acupuncture treatment plus conventional treatment (treatment group) or conventional treatment only (control group). Acupuncture treatments were given in 24 sessions over 4 weeks, with 3-month follow-up period. Blinded evaluation was based on Fugl-Meyer Assessment, Barthel Index with an intention-to-treat analysis. For those patients who were able to walk, a three-dimensional gait analysis system was employed to objectively record spatiotemporal and kinematic parameters.

RESULTS

Compared with control group, the treatment group showed a significantly greater over-time improvement in total Fugl-Meyer, lower-limb Fugl-Meyer, but not in upper-limb Fugl-Meyer and Barthel Index. The spatiotemporal parameters of velocity, step length, cadence, step width all showed significant difference between the 2 groups. The velocity in treatment group decreased unexpectedly at day 14, then increased sharply and overcame control group at day 28. The treatment group also showed a significantly greater increase in peak circumduction, peak hip hiking, hip range of motion, knee range of motion and a tendency for the ankle range of motion.

CONCLUSIONS

Acupuncture may promote the motor function recovery of hemorrhagic stroke patients in subacute phase mainly by enhancing the lower limb ability. It probably diminishes the compensation strategies earlier to correct the abnormal gait pattern. Although this adjustment may result in a compromise in the improvement of gait velocity temporarily, patients would benefit from it in a long run.

Effects of supraspinal feedback on human gait: rhythmic auditory distortion

BACKGROUND

Different types of sound cues have been used to adapt the human gait rhythm. We investigated whether young healthy volunteers followed subliminal metronome rhythm changes during gait.

METHODS

Twenty-two healthy adults walked at constant speed on a treadmill following a metronome sound cue (period 566 msec). The metronome rhythm was then either increased or decreased, without informing the subjects, at 1 msec increments or decrements to reach, respectively, a low (596 msec) or a high frequency (536 msec) plateaus. After 30 steps at one of these isochronous conditions, the rhythm returned to the original period with decrements or increments of 1 msec. Motion data were recorded with an optical measurement system to determine footfall. The relative phase between sound cue (stimulus) and foot contact (response) were compared.

RESULTS

Gait was entrained to the rhythmic auditory stimulus and subjects subconsciously adapted the step time and length to maintain treadmill speed, while following the rhythm changes. In most cases there was a lead error: the foot contact occurred before the sound cue. The mean error or the absolute mean relative phase increased during the isochronous high (536 msec) or low frequencies (596 msec).

CONCLUSION

These results showed that the gait period is strongly "entrained" with the first metronome rhythm while subjects still followed metronome changes with larger error. This suggests two processes: one slow-adapting, supraspinal oscillator with persistence that predicts the foot contact to occur ahead of the stimulus, and a second fast process linked to sensory inputs that adapts to the mismatch between peripheral sensory input (foot contact) and supraspinal sensory input (auditory rhythm).

The impact of auditory rhythmic cueing on gross motor skills in children with autism

[Purpose] This study aimed to investigate the effect of auditory rhythmic cueing on gross motor skills in children with autism. [Participants and Methods] A total of 30 autistic children aged 8–10 years with mild to moderate autistic features participated in this study. They were randomly allocated to either the control group (n=15), which underwent a specially designed physical therapy program, or the study group (n=15), which underwent the same program in addition to gait training with rhythmic auditory stimulation. To provide rhythmic auditory stimulation, combination of a metronome beat set to the child’s cadence and rhythmic cueing from the MIDI Cuebase musical program was used. Both groups received 3 sessions per week for 3 months. The Bruininks-Oseretsky Test of Motor Proficiency 2nd Edition was used to assess gross motor skills at baseline and after 3 months of intervention. [Results] The study found statistically significant improvements in bilateral coordination, balance, running speed and agility, and strength in both groups after treatment. Moreover, there were statistically significant differences between the 2 groups, with the study group showing better improvement in all outcome measures. [Conclusion] Gait training with auditory rhythmic cueing elicited a positive effect on the gross motor skills of children with autism.

Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis

Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge's g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy.