Auditory Proprioceptive Integration: Effects of Real-Time Kinematic Auditory Feedback on Knee Proprioception

Online reach adjustments induced by real-time movement sonification

Movement sonification can improve motor control in both healthy subjects (e.g., learning or refining a sport skill) and those with sensorimotor deficits (e.g., stroke patients and deafferented individuals). It is not known whether improved motor control and learning from movement sonification are driven by feedback-based real-time ("online") trajectory adjustments, adjustments to internal models over multiple trials, or both. We searched for evidence of online trajectory adjustments (muscle twitches) in response to movement sonification feedback by comparing the kinematics and error of reaches made with online (i.e., real-time) and terminal sonification feedback. We found that reaches made with online feedback were significantly more jerky than reaches made with terminal feedback, indicating increased muscle twitching (i.e., online trajectory adjustment). Using a between-subject design, we found that online feedback was associated with improved motor learning of a reach path and target over terminal feedback; however, using a within-subjects design, we found that switching participants who had learned with online sonification feedback to terminal feedback was associated with a decrease in error. Thus, our results suggest that, with our task and sonification, movement sonification leads to online trajectory adjustments which improve internal models over multiple trials, but which themselves are not helpful online corrections.

Enhancing Perceptual-Motor Skills in Sports: The Role of Ecological Sounds

Starting approximately from the beginning of the new millennium, a series of studies highlighted that auditory information deriving from biological motion can significantly influence the behavioral, cognitive and neurophysiological processes involved in the perception and execution of complex movements. In particular, it was observed that an appropriate use of sounds deriving from one's own movement promotes improvements in the movement execution itself. Two main approaches can be used, namely the sonification one or the ecological sound one; the former is based on the conversion of physiological and/or physical movement data into sound, while the latter is based on the use of auditory recordings of movement sounds as models. In the present article, some of the main applications of both approaches-especially the latter-to the domains of sport and motor rehabilitation are reviewed, with the aim of addressing two questions: Is it possible to consider rhythm as a Gestalt of human movement? If so, is it possible to build up cognitive strategies to improve/standardize movement performance from this Gestalt? As with most topics in science, a definitive answer is not possible, yet the evidence leads us to lean toward a positive answer to both questions.

Movement Sonification Techniques to Improve Balance in Parkinson's Disease: A Pilot Randomized Controlled Trial

BACKGROUND

Movement sonification has been recently introduced into the field of neuromotor rehabilitation alongside Neurologic Music Therapy and music-based interventions. This study introduces the use of musical auditory cues encompassing the melodic-harmonic aspect of music.

METHODS

Nineteen patients with Parkinson's disease were randomly assigned to the experimental (n = 10) and control (n = 9) groups and underwent thrice-weekly sessions of the same gait training program, with or without sonification. Functional and motor parameters, as well as fatigue, quality of life, and the impact of intervention on patients' well-being, were assessed at baseline (PRE), the end of treatment (POST), and at follow-up (FU). Between-group differences were assessed for each outcome measure using linear mixed-effects models. The outcome measure was entered as the dependent variable, group and time as fixed effects, and time by group as the interaction effect.

RESULTS

Mini BESTest and Dynamic Gait Index scores significantly improved in the experimental group (p = 0.01 and p = 0.03, respectively) from PRE to FU, demonstrating a significant impact of the sonification treatment on balance. No other significant differences were observed in the outcome measures.

CONCLUSIONS

Larger sample sizes are needed to confirm the effectiveness of sonification approaches in Parkinson's disease, as well as in other neurological disorders.

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

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

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

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

Review of Real-Time Biomechanical Feedback Systems in Sport and Rehabilitation

Real-time biomechanical feedback (BMF) is a relatively new area of research. The potential of using advanced technology to improve motion skills in sport and accelerate physical rehabilitation has been demonstrated in a number of studies. This paper provides a literature review of BMF systems in sports and rehabilitation. Our motivation was to examine the history of the field to capture its evolution over time, particularly how technologies are used and implemented in BMF systems, and to identify the most recent studies showing novel solutions and remarkable implementations. We searched for papers in three research databases: Scopus, Web of Science, and PubMed. The initial search yielded 1167 unique papers. After a rigorous and challenging exclusion process, 144 papers were eventually included in this report. We focused on papers describing applications and systems that implement a complete real-time feedback loop, which must include the use of sensors, real-time processing, and concurrent feedback. A number of research questions were raised, and the papers were studied and evaluated accordingly. We identified different types of physical activities, sensors, modalities, actuators, communications, settings and end users. A subset of the included papers, showing the most perspectives, was reviewed in depth to highlight and present their innovative research approaches and techniques. Real-time BMF has great potential in many areas. In recent years, sensors have been the main focus of these studies, but new types of processing devices, methods, and algorithms, actuators, and communication technologies and protocols will be explored in more depth in the future. This paper presents a broad insight into the field of BMF.

Neurophysiological Changes Induced by Music-Supported Therapy for Recovering Upper Extremity Function after Stroke: A Case Series

Music-supported therapy (MST) follows the best practice principles of stroke rehabilitation and has been proven to instigate meaningful enhancements in motor recovery post-stroke. The existing literature has established that the efficacy and specificity of MST relies on the reinforcement of auditory-motor functional connectivity in related brain networks. However, to date, no study has attempted to evaluate the underlying cortical network nodes that are key to the efficacy of MST post-stroke. In this case series, we evaluated changes in connectivity within the auditory-motor network and changes in upper extremity function following a 3-week intensive piano training in two stroke survivors presenting different levels of motor impairment. Connectivity was assessed pre- and post-training in the α- and the β-bands within the auditory-motor network using magnetoencephalography while participants were passively listening to a standardized melody. Changes in manual dexterity, grip strength, movement coordination, and use of the upper extremity were also documented in both stroke survivors. After training, an increase in the clinical measures was accompanied by enhancements in connectivity between the auditory and motor network nodes for both the α- and the β-bands, especially in the affected hemisphere. These neurophysiological changes associated with the positive effects of post-stroke MST on motor outcomes delineate a path for a larger scale clinical trial.

Hand rehabilitation with sonification techniques in the subacute stage of stroke

After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2 weeks, at the end of treatment and at follow-up (1 month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction < 0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation.

Differential effects of visual versus auditory biofeedback training for voluntary postural sway

Augmented sensory biofeedback training is often used to improve postural control. Our previous study showed that continuous auditory biofeedback was more effective than continuous visual biofeedback to improve postural sway while standing. However, it has also been reported that both discrete visual and auditory biofeedback training, presented intermittently, improves bimanual task performance more than continuous visual biofeedback training. Therefore, this study aimed to investigate the relative effectiveness of discrete visual biofeedback versus discrete auditory biofeedback to improve postural control. Twenty-two healthy young adults were randomly assigned to either a visual or auditory biofeedback group. Participants were asked to shift their center of pressure (COP) by voluntary postural sway forward and backward in line with a hidden target, which moved in a sinusoidal manner and was displayed intermittently. Participants were asked to decrease the diameter of a visual circle (visual biofeedback) or the volume of a sound (auditory biofeedback) based on the distance between the COP and the target in the training session. The feedback and the target were given only when the target reached the inflection points of the sine curves. In addition, the perceptual magnitudes of visual and auditory biofeedback were equalized using Stevens’ power law. Results showed that the mean and standard deviation of the distance between COP and the target were reduced int the test session, removing the augmented sensory biofeedback, in both biofeedback training groups. However, the temporal domain of the performance improved in the test session in the auditory biofeedback training group, but not in the visual biofeedback training group. In conclusion, discrete auditory biofeedback training was more effective for the motor learning of voluntarily postural swaying compared to discrete visual biofeedback training, especially in the temporal domain.

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.

Audio Feedback for Device-Supported Balance Training: Parameter Mapping and Influencing Factors

Recent studies suggest that real-time auditory feedback is an effective method to facilitate motor learning. The evaluation of the parameter mapping (sound-to-movement mapping) is a crucial, yet frequently neglected step in the development of audio feedback. We therefore conducted two experiments to evaluate audio parameters with target finding exercises designed for balance training. In the first experiment with ten participants, five different audio parameters were evaluated on the X-axis (mediolateral movement). Following that, in a larger experiment with twenty participants in a two-dimensional plane (mediolateral and anterior-posterior movement), a basic and synthetic audio model was compared to a more complex audio model with musical characteristics. Participants were able to orient themselves and find the targets with the audio models. In the one-dimensional condition of experiment one, percussion sounds and synthetic sound wavering were the overall most effective audio parameters. In experiment two, the synthetic model was more effective and better evaluated by the participants. In general, basic sounds were more helpful than complex (musical) sound models. Musical abilities and age were correlated with certain exercise scores. Audio feedback is a promising approach for balance training and should be evaluated with patients. Preliminary evaluation of the respective parameter mapping is highly advisable.

Virtual reality training enhances gait poststroke: a systematic review and meta-analysis

Virtual reality (VR)-based interventions are gaining widespread attention for managing neurological disorders such as stroke. A metastatistical consensus regarding the intervention is strongly warranted. In this study, we attempt to address this gap in the literature and provide the current state of evidence for the effects of VR on gait performance. We conducted both between- and within-group meta-analyses to provide a state of evidence for VR. Moreover, we conducted a search adhering to PRISMA guidelines on nine databases. Out of 1866 records, 32 studies involving a total of 809 individuals were included in this review. Considering all included studies, significant enhancements in gait parameters were observed with VR-based interventions compared with conventional therapy. A between-group meta-analysis reported beneficial significant medium effects of VR training on cadence (Hedge's g = 0.55), stride length ((STrL; Hedge's g = 0.46), and gait speed (Hedge's g = 0.30). Similarly, a within-group meta-analysis further revealed positive medium effects of VR on cadence (Hedge's g = 0.76), STrL (Hedge's g = 0.61), and gait speed (Hedge's g = 0.69). Additional subgroup analyses revealed beneficial effects of joint application of VR and robot-assisted gait training on gait speed (Hedge's g = 0.50). Collectively, findings from this review provide evidence for the effectiveness of VR-based gait training for stroke survivors.

Joint position reproduction and joint position discrimination at the ankle are not related

Purpose: Limited data in current literature can be found on the relation between the two commonly-used active proprioception assessment methods -active joint position reproduction (JPR) and active movement extent discrimination assessment (AMEDA). The current study compared the two active methods, JPR and AMEDA, to investigate their interrelationship over two studies that differed in task difficulty, using active ankle inversion movements made in weight-bearing to maximise ecological validity.Methods: 50 participants volunteered in this research, 20 of whom on a harder protocol and the other 30 on an easier protocol, were tested by both methods, JPR and AMEDA. Proprioceptive acuity was represented by absolute error (AE) and variable error (VE) for JPR and by AE and the area under the curve (AUC) for AMEDA.Results: Proprioceptive acuity scores are found to be significantly correlated within test methods but not between methods for either hard or easy tasks, where JPR AE and VE scores were not correlated with either AMEDA AE or AUC. Further, proprioceptive acuity scores were significantly higher on the easy task when tested with the AMEDA method, but not with JPR method.Conclusion: Scores obtained from the two active movement proprioception tests, movement extent discrimination and joint position reproduction, were not significantly correlated. Taken together with previous findings, these results show that for proprioception, scores from the three classical psychophysical methods for measuring sensitivity (adjustment, limits and constant stimuli) are not correlated with each other. This suggests that each proprioception measurement system assesses a different aspect of proprioception.

Virtual Reality Enhances Gait in Cerebral Palsy: A Training Dose-Response Meta-Analysis

Virtual-reality-based training can influence gait recovery in children with cerebral palsy. A consensus concerning its influence on spatiotemporal gait parameters and effective training dosage is still warranted. This study analyzes the influence of virtual-reality training (relevant training dosage) on gait recovery in children with cerebral palsy. A search was performed by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on nine databases: PEDro, EBSCO, PubMed, Cochrane, Web of Science, EMBASE, ICI, Scopus, and PROQUEST. Of 989 records, 16 studies involving a total of 274 children with cerebral palsy met our inclusion criteria. Eighty-eight percent of the studies reported significant enhancements in gait performance after training with virtual reality. Meta-analyses revealed positive effects of virtual-reality training on gait velocity (Hedge's g = 0.68), stride length (0.30), cadence (0.66), and gross motor function measure (0.44). Subgroup analysis reported a training duration of 20–30 min per session, ≤4 times per week across ≥8 weeks to allow maximum enhancements in gait velocity. This study provides preliminary evidence for the beneficial influence of virtual-reality training in gait rehabilitation for children with cerebral palsy.

Dual Mode Gait Sonification for Rehabilitation After Unilateral Hip Arthroplasty

The pattern of gait after hip arthroplasty strongly affects regeneration and quality of life. Acoustic feedback could be a supportive method for patients to improve their walking ability and to regain a symmetric and steady gait. In this study, a new gait sonification method with two different modes—real-time feedback (RTF) and instructive model sequences (IMS)—is presented. The impact of the method on gait symmetry and steadiness of 20 hip arthroplasty patients was investigated. Patients were either assigned to a sonification group (SG) (n = 10) or a control group (CG) (n = 10). All of them performed 10 gait training sessions (TS) lasting 20 min, in which kinematic data were measured using an inertial sensor system. Results demonstrate converging step lengths of the affected and unaffected leg over time in SG compared with a nearly parallel development of both legs in CG. Within the SG, a higher variability of stride length and stride time was found during the RTF training mode in comparison to the IMS mode. Therefore, the presented dual mode method provides the potential to support gait rehabilitation as well as home-based gait training of orthopedic patients with various restrictions.

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

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

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

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

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

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

Dynamic Analysis of Vibration, Muscle Firing, and Force as a Novel Model for Non-Invasive Assessment of Joint Disruption in the knee: A Multiple Case Report

We present a new method for understanding knee pathology through non-invasive techniques. The combination of electromyography (EMG), vibroarthrographic (VAG), and force analysis in proposed to examine the force transfer between unhealthy and healthy knees. A multiple case report is presented to demonstrate the technique and its potential application for future study. The comparison of four individuals’ knee characteristics will be explained using this innovative methodology.

Training proprioception with sound: effects of real-time auditory feedback on intermodal learning

Our study analyzed the effects of real-time auditory feedback on intermodal learning during a bilateral knee repositioning task. Thirty healthy participants were randomly allocated to control and experimental groups. Participants performed an active knee joint repositioning task for the four target angles (20°, 40°, 60°, and 80°) bilaterally, with or without additional real-time auditory feedback. Here, the frequency of auditory feedback was mapped to the knee's angle range (0-90°). Retention measurements were performed on the same four angles, without auditory feedback, after 15 min and 24 hours. A generalized knee proprioception test was performed after the 24-h retention measurement on three untrained knee angles (15°, 35°, and 55°). Statistical analysis revealed a significant enhancement of knee proprioception, shown as a lower knee repositioning error with auditory feedback. This enhancement of proprioception also persisted in tests performed between the 5th and 6th auditory-motor training blocks (without auditory feedback). Enhancement in proprioception also remained stable during retention measurements (after 15 min and 24 h). Similarly, enhancement in the generalized proprioception on untrained knee angles was evident in the experimental group. This study extends our previous findings and demonstrates the beneficial effects of real-time auditory feedback to facilitate intermodal learning by enhancing knee proprioception in a persisting and generalized manner.

Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function Post Stroke: A Systematic Review and Meta-Analysis

Background: External auditory stimuli have been widely used for recovering arm function post-stroke. Rhythmic and real-time auditory stimuli have been reported to enhance motor recovery by facilitating perceptuomotor representation, cross-modal processing, and neural plasticity. However, a consensus as to their influence for recovering arm function post-stroke is still warranted because of high variability noted in research methods. Objective: A systematic review and meta-analysis was carried out to analyze the effects of rhythmic and real-time auditory stimuli on arm recovery post stroke. Method: Systematic identification of published literature was performed according to PRISMA guidelines, from inception until December 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Results: Of 1,889 records, 23 studies which involved 585 (226 females/359 males) patients met our inclusion criteria. The meta-analysis revealed beneficial effects of training with both types of auditory inputs for Fugl-Meyer assessment (Hedge's g: 0.79), Stroke impact scale (0.95), elbow range of motion (0.37), and reduction in wolf motor function time test (-0.55). Upon further comparison, a beneficial effect of real-time auditory feedback was found over rhythmic auditory cueing for Fugl-meyer assessment (1.3 as compared to 0.6). Moreover, the findings suggest a training dosage of 30 min to 1 h for at least 3-5 sessions per week with either of the auditory stimuli. Conclusion: This review suggests the application of external auditory stimuli for recovering arm functioning post-stroke.

Effects of Rhythmic Auditory Cueing in Gait Rehabilitation for Multiple Sclerosis: A Mini Systematic Review and Meta-Analysis

Rhythmic auditory cueing has been shown to enhance gait performance in several movement disorders. The "entrainment effect" generated by the stimulations can enhance auditory motor coupling and instigate plasticity. However, a consensus as to its influence over gait training among patients with multiple sclerosis is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing in studies gait performance in patients with multiple sclerosis. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until Dec 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 602 records, five studies (PEDro score: 5.7 ± 1.3) involving 188 participants (144 females/40 males) met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e., velocity (Hedge's g: 0.67), stride length (0.70), and cadence (1.0), and reduction in timed 25 feet walking test (-0.17). Underlying neurophysiological mechanisms, and clinical implications are discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance gait performance in the multiple sclerosis community.