BeatWalk: Personalized Music-Based Gait Rehabilitation in Parkinson’s Disease

Abstract

Taking regular walks when living with Parkinson’s disease (PD) has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors (BeatWalk) and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application (30 min/day, 5 days/week). The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% (±28.2) of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242.

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives

“…Recent evidence also suggests that RAS-assisted gait training significantly reduces patients’ overall fear of falling ( Thaut et al, 2019 ; Capato et al, 2020b ; Naro et al, 2020 ; Cochen De Cock et al, 2021 ) and the number of falls ( Thaut et al, 2019 ). Using a randomized withdrawal/discontinuation design, a recent study investigated the effect of RAS on incidences of falls in 47 participants with moderate to severe stages of PD (H&Y 3 and 4) with a history of falls ( Thaut et al, 2019 ).…”

“…Recent advances in mobile technologies whereby motor behaviors can be monitored via dedicated sensors may be instrumental to implementing assistive rehabilitation strategies via apps, serious games, or touchscreen musical instruments on tablets ( Dalla Bella, 2018 ). For instance, a recent open-label clinical trial demonstrated the beneficial effects of a 1-month (30 min/day, 5 days) gait training with auditory rhythm in a home setting with 45 patients with moderate PD via the use of a smartphone application combined with ankle-worn sensors ( Cochen De Cock et al, 2021 ). Street et al (2020) discussed the potential use of touchscreen devices (iPad) in acute stroke rehabilitation as tools to enhance treatment dosage and engagement.…”

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

“…Technologies, such as dedicated apps on smartphone and tablet devices, coupled with external sensors, 88,89 are recent additions to the methods for music-based interventions. 9 Implementing music-based interventions as serious games has several advantages, such as making them particularly motivating and rewarding, allowing performance monitoring and individualization, which all should add to the potential of music as a tool for rehabilitation.…”

Neuropsychiatric Treatments for Parkinson's Disease: Nonpharmacological Approaches

“…52 One study looked at the effects of Tango and Ballroom dancing classes on balance control and locomotion in PD patients, showing significant improvements in both. 53 Music-based gait rehabilitation 54 has also been studied as a means to incorporate the effect of rhythm into movement.…”