Effects of Emotionally Charged Auditory Stimulation on Gait Performance in the Elderly: A Preliminary Study

Abstract

Objectives To evaluate the effect of a novel divided attention task—walking under auditory constraints—on gait performance in older adults and to determine whether this effect was moderated by cognitive status. Design Validation cohort. Setting General community. Participants Ambulatory older adults without dementia (N=104). Interventions Not applicable. Main Outcome Measures In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds. Results The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5–10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences. Conclusions Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment. A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals, but lead to decompensation in those with minimal cognitive impairment. Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints.

Effect of Rhythmic Auditory Cueing on Aging Gait: A Systematic Review and Meta-Analysis

“…Several mechanisms have been suggested to ascertain the beneficial effects of rhythmic auditory cueing. Rizzo, Raghavan, McCrery, Oh-Park and Verghese [ 113 ] for instance, speculated that auditory entrainment while performing gait might act as an efficient distractor. In addition, the auditory entrainment might also have aided in reducing the errors while executing the gait [ 114 , 115 ].…”

“…This was also demonstrated by Dotov, et al [ 100 ], here the authors demonstrated beneficial effects in parkinsonian and healthy gait parameters with biologically variable rhythmic auditory cueing as compared to isosynchronous cueing. Moreover, recent research has also revealed the possibilities of including emotional [ 113 ], motivational [ 68 ], and expressiveness [ 142 ], component in auditory entrainment to portray differential effects on gait parameters. Unfortunately, lack of pertinent, repeatable literature concerning the specific type of modified auditory feedback makes it difficult to interpret, as to which type of feedback might be most optimal, and for which age groups.…”

Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis

“… 106 Ecologically valid action-related sounds have been suggested to enhance salience of sensory information concerning spatiotemporal information, thereby aiding movement execution. 105 – 107 Moreover, recent research has revealed the possibilities of including emotional, 108 motivational, 109 and expressiveness 110 components in auditory entrainment to portray differential effects on gait parameters. Unfortunately, a lack of pertinent literature concerning the specific type of modified auditory cueing in cerebral palsy limits our interpretation of the type of auditory cueing that might be beneficial in rehabilitation.…”

Enriching footsteps sounds in gait rehabilitation in chronic stroke patients: a pilot study

“…Further studies examining this relationship might reinforce previous findings linking changes in body perception, emotion, and gait. 24,36,37,60,61 Future studies could be performed addressing these issues by performing multicenter collaborations and randomized controlled trials for testing the feasibility of this new technology. like to thank our patients for their help, support, and willingness to collaborate in all cases during this project.…”

“…19 For example, musical sonification therapy has been used effectively to enhance gross movements of the upper extremity after stroke, [20][21][22][23] and emotionally charged auditory stimulation with happy or sad sounds has been shown to enhance gait velocity and cadence. 24 In the specific case of gait rehabilitation, real-time auditory feedback on walking and step cueing has been used to compensate for limited proprioceptive feedback and to promote correct movement in gait rehabilitation in clinical populations, such as Parkinson's disease, 25,26 children with cerebral palsy, 27 patients with multiple sclerosis, 28 as well as in modifying gait patterns in healthy older adults. 29,30 On the other hand, much less work has been done using sound as a source of sensory alteration or distortion of one's own body, augmenting or distorting the actual natural feedback recalibrating the feed-forward motor commands of the action performed, impacting motor behavior and body representation.…”