Randomized controlled trial of neurologic music therapy in Parkinson's disease: research rehabilitation protocols for mechanistic and clinical investigations

Background

Presently available medications and surgical treatments for Parkinson’s disease have limited effects on fine motor problems and often leave patients with significant fine motor disability. Standard of care occupational therapy (OT) yields low efficacy, potentially due to a lack of standard protocols. Neurologic music therapy (NMT) techniques, especially rhythmic auditory stimulation which relies on interaction between rhythm and movement, have shown to be effective in PD gait rehabilitation possibly through their reliance on neural pathways that are not affected by PD. Therapeutic instrumental music performance (TIMP) is one other NMT technique that holds promise but which mode of action and efficacy has not been investigated in PD yet.

Methods

One hundred PD participants will be randomly assigned to receive 15 sessions of either TIMP with rhythm or TIMP without rhythm, standard of care OT, or to be waitlisted (control) over 5 consecutive weeks. Brain oscillatory responses will be collected using magnetoencephalography during an auditory-motor task to understand the underlying mechanisms. The Grooved Pegboard, the UPDRS III finger tap, and the finger-thumb opposition will be assessed to investigate clinical changes related to fine motor function. This project will also serve to confirm or refute our pilot data findings suggesting NMT relies on compensatory brain networks utilized by the PD brain to bypass the dysfunctional basal ganglia.

Discussion

This study aims to use standardized TIMP and OT research protocols for investigating the neuronal pathways utilized by each intervention and possibly study their efficacy with respect to fine motor rehabilitation via a randomized control trial in the PD population.

Trial registration

ClinicalTrials.gov NCT03049033. Registered on September 29, 2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05560-7.

Familiarity with music influences stride amplitude and variability during rhythmically-cued walking in individuals with Parkinson's disease

BACKGROUND

Entrainment of walking with rhythmic auditory cues (e.g., metronome or music) induces gait improvements in people with Parkinson's disease (PD). However, evidence regarding acute impacts of music cues on parkinsonian gait is lacking. Findings in healthy adults imply that familiarity with music cues modulates stride amplitude and stride-to-stride variability; yet the role of familiarity with music on parkinsonian gait remains unknown.

RESEARCH QUESTION

To investigate 1) whether familiar and unfamiliar music cueing differentially influences stride and arm swing amplitude and stride-to-stride variability, 2) how stride and arm swing amplitude and stride-to-stride variability are altered by enhanced familiarity with music by repeated listening and walking during rhythmically-cued walking in persons with PD.

METHODS

Twenty individuals with idiopathic PD (mean age = 68.9 years, 7 females, H&Y stage 1-3) walked in time with familiar and unfamiliar music cues (Session 1). Participants then repeatedly listened and walked to the same familiar and unfamiliar music cues (Session 2). Spatiotemporal gait parameters in each 2-min trial were recorded with motion capture wearable sensors.

RESULTS

In Session 1, gait velocity, stride length, arm swing peak velocity and range of motion, and stride-to-stride variability increased with both music cues compared with baseline; stride length, enjoyment and beat salience were greater in familiar than unfamiliar music cues. In Session 2, repeatedly listening and walking to unfamiliar music, but not familiar music, increased gait velocity, stride length, familiarity, enjoyment, and beat salience, and reduced stride-to-stride time variability.

SIGNIFICANCE

Music cues in general induced acute improvements of stride and arm swing amplitude but not stride-to-stride variability, and enhanced familiarity with music improved stride amplitude and variability along with increased enjoyment and reduced cognitive demand in people with PD. Our findings aid in understanding the role of familiarity with music in alleviating gait disturbance and optimizing music-based interventions for PD.

Supporting coordination of children with ASD using neurological music therapy: A pilot randomized control trial comparing an elastic touch-display with tambourines

AIM

To evaluate the efficacy of Neurologic Music Therapy (NMT) using a traditional and a technological intervention (elastic touch-display) in improving the coordination of children with Autism Spectrum Disorder (ASD), as a primary outcome, and the timing and strength control of their movements as secondary outcomes.

METHODS

Twenty-two children with ASD completed 8 NMT sessions, as a part of a 2-month intervention. Participants were randomly assigned to either use an elastic touch-display (experimental group) or tambourines (control group). We conducted pre- and post- assessment evaluations, including the Developmental Coordination Disorder Questionnaire (DCDQ) and motor assessments related to the control of strength and timing of movements.

OUTCOMES AND RESULTS

All participants improved their coordination, according to the DCDQ scores, and exhibited better control of their movements according to the strength and timing assessments after the intervention. Participants who used the elastic touch-display scored higher on the DCDQ.

CONCLUSIONS AND IMPLICATIONS

NMT is an efficacious treatment to improve the coordination skills of children with ASD. Elastic touch-displays provide more benefits than the use of tambourines.