Auditory rhythmical cueing to improve gait in community-dwelling stroke survivors (ACTIVATE): a pilot randomised controlled trial

Abstract

Background Gait impairment limiting mobility and restricting activities is common after stroke. Auditory rhythmical cueing (ARC) uses a metronome beat delivered during exercise to train stepping and early work reports gait improvements. This study aimed to establish the feasibility of a full scale multicentre randomised controlled trial to evaluate an ARC gait and balance training programme for use by stroke survivors in the home and outdoors. Methods A parallel-group observer-blind pilot randomised controlled trial was conducted. Adults within 2 years of stroke with a gait-related mobility impairment were recruited from four NHS stroke services and randomised to an ARC gait and balance training programme (intervention) or the training programme without ARC (control). Both programmes consisted of 3x30 min sessions per week for 6 weeks undertaken at home/nearby outdoor community. One session per week was supervised and the remainder self-managed. Gait and balance performance assessments were undertaken at baseline, 6 and 10 weeks. Key trial outcomes included recruitment and retention rates, programme adherence, assessment data completeness and safety. Results Between November 2018 and February 2020, 59 participants were randomised (intervention n=30, control n=29), mean recruitment rate 4/month. At baseline, 6 weeks and 10 weeks, research assessments were conducted for 59/59 (100%), 47/59 (80%) and 42/59 (71%) participants, respectively. Missing assessments were largely due to discontinuation of data collection from mid-March 2020 because of the UK COVID-19 pandemic lockdown. The proportion of participants with complete data for each individual performance assessment ranged from 100% at baseline to 68% at 10 weeks. In the intervention group, 433/540 (80%) total programme exercise sessions were undertaken, in the control group, 390/522 (75%). Falls were reported by five participants in the intervention group, six in the control group. Three serious adverse events occurred, all unrelated to the study. Conclusion We believe that a definitive multicentre RCT to evaluate the ARC gait and balance training programme is feasible. Recruitment, programme adherence and safety were all acceptable. Although we consider that the retention rate and assessment data completeness were not sufficient for a future trial, this was largely due to the UK COVID-19 pandemic lockdown. Trial registration ISRCTN, ISRCTN10874601, Registered on 05/03/2018,

Effects of “accurate measurement” comprehensive sports activities on balance ability, body composition and bone density of female college students

“…The results of the study female college students after exercise intervention, the balance area of the test group increased substantially, and the control group decreased slightly, proving that exercise is important for enhancing the balance ability of female college students. Studies have demonstrated that exercise is beneficial in improving functional capacity and dynamic balance in children with hemiplegia (Soliman et al, 2022), a randomized controlled trial showed that a gait training program used by stroke patients was beneficial in improving balance (Shaw et al, 2022), and another study female university students through 8 weeks of fitness qigong exercises. The result was a significant increase in balance test scores post-intervention compared to pre-intervention scores (Su et al, 2018).…”

Gait Variability and its Relationship to Functional Mobility in Hemiparetic Stroke

“…Additionally, participants were required to have a Mini-Mental State Examination (MMSE) score greater than 24 and a Modified Ashworth Scale grade of 1 or 1+ to qualify for the study (17,21). Conversely, individuals presenting with dementia, depression, productive psychosis, visual and auditory impairments, foot drop, or a history of recurrent transient ischemic attacks (TIA) were systematically excluded from participation (18). Data collection commenced with the acquisition of demographic information from each participant.…”

“…Techniques such as acoustic cueing through metronomes have shown promise in improving walking cadence, speed, symmetry, and stride length, with both immediate and lasting effects (17). Auditory rhythmic cueing (ARC) and cadence retraining with audio or visual feedback are among the strategies employed to facilitate gait rehabilitation (18,19). The imperative to enhance the quality of life for individuals with hemiplegia through effective intervention strategies is clear.…”