Continuous 12 min walking to music, metronomes and in silence: Auditory-motor coupling and its effects on perceived fatigue, motivation and gait in persons with multiple sclerosis

Moumdjian, Lousin; Moens, Bart; Maes, Pieter-Jan; Geel, Fanny Van; Ilsbroukx, Stephan; Borgers, Sophie; Leman, Marc; Feys, Peter

doi:10.1016/j.msard.2019.07.014

Cited by 25 publications

(37 citation statements)

References 24 publications

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“…The explanations above are supported by existing evidence of different control mechanisms of timing 40 , event based and emergent based control of timing 44 given the discrete and continuous stimulus structures 35,37,45 . These explanations could also explain our previous behavioral findings showing that walking to music was perceived less cognitively fatiguing than walking to a metronome, even when the coupling was sustained longer with music 30 . This manner of step-to-beat alignment can also explain the significant lower synchronization constancy reported when coupling to music as compared to metronomes, the lower gait speed and higher variability of step durations.…”

Section: Discussionmentioning

confidence: 70%

“…In terms of clinical application, the use of music is advantageous to implement in a rehabilitation setting compared to metronomes, as seen in studies with persons with multiple sclerosis (PwMS) [29][30][31] , a disease where walking impairments are prevalent 32,33 . Additionally, in PwMS, changes in spatiotemporal gait parameters were shown to be dependent on walking impairment and speed instructions 34 .…”

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confidence: 99%

“…Additionally, in PwMS, changes in spatiotemporal gait parameters were shown to be dependent on walking impairment and speed instructions 34 . In previous studies, we have shown that PwMS and healthy controls (HC) can sustain auditory-motor coupling 30 and synchronize their walking to music and metronomes across different tempi 29 . In addition, lower fatigue perception when walking to music compared to metronomes in PwMS compared to HC were reported in these studies.…”

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confidence: 99%

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Detrended fluctuation analysis of gait dynamics when entraining to music and metronomes at different tempi in persons with multiple sclerosis

Moumdjian

Maes

Bella

et al. 2020

Sci Rep

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In persons with multiple sclerosis (PwMS), synchronizing walking to auditory stimuli such as to music and metronomes have been shown to be feasible, and positive clinical effects have been reported on step frequency and perception of fatigue. Yet, the dynamic interaction during the process of synchronization, such as the coupling of the steps to the beat intervals in music and metronomes, and at different tempi remain unknown. Understanding these interactions are clinically relevant, as it reflects the pattern of step intervals over time, known as gait dynamics. 28 PwMS and 29 healthy controls were instructed to walk to music and metronomes at 6 tempi (0-10% in increments of 2%). Detrended fluctuation analysis was applied to calculate the fractal statistical properties of the gait time-series to quantify gait dynamics by the outcome measure alpha. The results showed no group differences, but significantly higher alpha when walking to music compared to metronomes, and when walking to both stimuli at tempi + 8, + 10% compared to lower tempi. These observations suggest that the precision and adaptation gain differ during the coupling of the steps to beats in music compared to metronomes (continuous compared to discrete auditory structures) and at different tempi (different inter-beat-intervals). The study of temporal correlations in step or stride intervals over time-also known as gait dynamics 1-provides useful insights on the neural control of locomotion in young adults 2,3 , healthy older adults 4 , and patients with movement disorders such as Parkinson's disease 5 , Huntington's disease 5,6 or multiple sclerosis (MS) 7. Gait gives rise to non-stationary inter-step/stride-interval signals, with temporal fluctuations which can be analyzed via non-linear methods 1. An example of these methods, capable of capturing the complexity of time-evolving behavior in the domain of gait analysis, is detrended fluctuation analysis (DFA). This analysis method can be applied to a time series obtained from gait measurements such as inter-step/stride-intervals 2,3,8. DFA is robust to non-stationaries in the data, often observed in gait interval time series. This method scales the long-term auto-correlations of non-stationary signals and quantifies the fluctuations in the time series using its self-similar property 8,9 with a value of fractal scaling index 'alpha' 8,9. Alpha provides an estimation of statistical 'persistence' or 'anti-persistence' in a time series 1. A healthy value of alpha in gait is between 0.5 and 1.0 (1 being highly persistent), and indicates the presence of statistical persistence within the inter-step-intervals 1,10. This means that the inter-step-intervals between consecutive steps are non-random and constant at a long range, with small deviations still being present across multiple consecutive strides. On the other hand, a value of alpha < 0.5 signifies

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Section: Discussionmentioning

confidence: 70%

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confidence: 99%

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confidence: 99%

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Detrended fluctuation analysis of gait dynamics when entraining to music and metronomes at different tempi in persons with multiple sclerosis

Moumdjian

Maes

Bella

et al. 2020

Sci Rep

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“…PwMS require compensatory strategies to overcome their movement dysfunction, and the use of cues has been shown to be useful for optimizing the cognitive processing required for MI ( 58 ), which acts as an internal stimulus that is enhanced and made more vivid by outside cues. Moumdjian et al ( 59 , 60 ) compared the abilities of PwMS with those of healthy controls (HC) for sustaining synchronization of a 12-min period of walking accompanied by music and a metronome. They analyzed physical and cognitive fatigue, motivation, and gait compared with walking in silence.…”

Section: Discussionmentioning

confidence: 99%

Motor Imagery: A Resource in the Fatigue Rehabilitation for Return-to-Work in Multiple Sclerosis Patients—A Mini Systematic Review

et al. 2021

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Fatigue is a multidimensional symptom with both physical and cognitive aspects, which can affect the quality of daily and working life activities. Motor Imagery (MI) represents an important resource for use during the rehabilitation processes, useful, among others, for job integration/reintegration, of neurological pathologies, such as Multiple Sclerosis (MS). To define the effective rehabilitation protocols that integrate MI for the reduction of fatigue in patients with MS (PwMS), a literary review was performed through August 2020. Five articles were included in the qualitative synthesis, including two feasibility pilot randomized control trials (RCTs) and 3 RCTs with good quality according to the PEDro score and a low risk of bias according to the Cochrane Collaboration tool. The literature suggested that MI, in association with rhythmic-auditory cues, may be an effective rehabilitation resource for reducing fatigue. Positive effects were observed on perceived cognitive and psychological fatigue. PwMS require greater compensatory strategies than healthy individuals, and the use of rhythmic-auditory cues may be useful for optimizing the cognitive processing of MI, which acts as an internal stimulus that is enhanced and made more vivid by outside cues. These findings provide evidence that MI is a promising rehabilitation tool for reducing fatigue in PwMS and return to work strategies.

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“…The outcome of an entrainment process is typically a more stable state of synchronization (Phillips-Silver et al, 2010 ; Moens et al, 2014 ; Leman, 2016 ). So far, the entrainment effect has been quantified by means of behavioral outcome measures, in particular temporal outcomes of the rhythmic auditory-motor coupling (Moumdjian et al, 2018 ), which contributed to a better understanding of underlying mechanisms as a result of the interaction (Moumdjian et al, 2019c , 2020 ), and to the development of task-oriented training tools for walking in persons with the neurological disease of multiple sclerosis (Moumdjian et al, 2019a , b ).…”

Section: Introductionmentioning

confidence: 99%

Neural Entrainment Meets Behavior: The Stability Index as a Neural Outcome Measure of Auditory-Motor Coupling

Rosso

Leman

Moumdjian

2021

Front. Hum. Neurosci.

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Understanding rhythmic behavior in the context of coupled auditory and motor systems has been of interest to neurological rehabilitation, in particular, to facilitate walking. Recent work based on behavioral measures revealed an entrainment effect of auditory rhythms on motor rhythms. In this study, we propose a method to compute the neural component of such a process from an electroencephalographic (EEG) signal. A simple auditory-motor synchronization paradigm was used, where 28 healthy participants were instructed to synchronize their finger-tapping with a metronome. The computation of the neural outcome measure was carried out in two blocks. In the first block, we used Generalized Eigendecomposition (GED) to reduce the data dimensionality to the component which maximally entrained to the metronome frequency. The scalp topography pointed at brain activity over contralateral sensorimotor regions. In the second block, we computed instantaneous frequency from the analytic signal of the extracted component. This returned a time-varying measure of frequency fluctuations, whose standard deviation provided our “stability index” as a neural outcome measure of auditory-motor coupling. Finally, the proposed neural measure was validated by conducting a correlation analysis with a set of behavioral outcomes from the synchronization task: resultant vector length, relative phase angle, mean asynchrony, and tempo matching. Significant moderate negative correlations were found with the first three measures, suggesting that the stability index provided a quantifiable neural outcome measure of entrainment, with selectivity towards phase-correction mechanisms. We address further adoption of the proposed approach, especially with populations where sensorimotor abilities are compromised by an underlying pathological condition. The impact of using stability index can potentially be used as an outcome measure to assess rehabilitation protocols, and possibly provide further insight into neuropathological models of auditory-motor coupling.

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Continuous 12 min walking to music, metronomes and in silence: Auditory-motor coupling and its effects on perceived fatigue, motivation and gait in persons with multiple sclerosis

Cited by 25 publications

References 24 publications

Detrended fluctuation analysis of gait dynamics when entraining to music and metronomes at different tempi in persons with multiple sclerosis

Detrended fluctuation analysis of gait dynamics when entraining to music and metronomes at different tempi in persons with multiple sclerosis

Motor Imagery: A Resource in the Fatigue Rehabilitation for Return-to-Work in Multiple Sclerosis Patients—A Mini Systematic Review

Neural Entrainment Meets Behavior: The Stability Index as a Neural Outcome Measure of Auditory-Motor Coupling

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