Velocity modulation and rhythmic synchronization of gait in Huntington's disease

Abstract

This study analyzed the ability of patients with Huntington's disease (HD) to modulate gait velocity without external sensory cues and in response to an auditory rhythmic cue within a frequency entrainment design. Uncued gait patterns of 27 patients were first assessed during normal, slower, and faster self‐paced walking. During rhythmic trials, metronome and musical beat patterns were delivered at rates 10% slower and 10–20% faster than baseline cadence to cue gait patterns. After the rhythmic trials, patients were retested at normal gait speed without rhythm. Gait velocities in the patients with HD were below normal reference values in all ranges. Patients were able to significantly (p <0.05) modulate their gait velocity during self‐paced and rhythmic metronome cueing but not during music. The ability to modulate gait velocity was retained regardless of the severity of the disease. Gait velocity declined with an increase in disability and chorea score. The disability score differentiated better between gait velocity of moderately and severe patients than chorea score. Slowness of gait was significantly correlated only with disability score and not with chorea. Patients had more difficulty producing adequate step rates than stride lengths during normal and fast walking speeds. After the rhythmic trials, unpaced gait velocity remained significantly (p <0.05) higher than baseline. This carry‐over effect was not seen after the uncued trials. Synchronization ability was deficient in all patients, deteriorated with severity of disease, and was already compromised in patients with soft disease signs. Rhythmic tracking of music declined more with severity of disease than metronome tracking. In summary, patients were able to modulate velocity with and without external cues. Velocity adaptations to the external rhythm in music and metronome were achieved without exact synchronization between step cadence and rhythmic stimulus.

Video game play (Dance Dance Revolution) as a potential exercise therapy in Huntington’s disease: a controlled clinical trial

“…8 However, apathy, depression, motor problems, and inadequate transportation present exercise barriers. 13 Programs that are enjoyable, motivating, and home-based may overcome these barriers. 8 Research has shown that video game-based exercise increases practice volume, attention span and compliance compared with traditional exercise programs.…”

“…The game incorporates balance training methods (multidirectional stepping), attentional strategies (performance biofeedback), and external cueing (step synchronization to music), which are recommended for individuals with basal ganglia disorders. 13,14 Thus, Dance Dance Revolution may help overcome exercise barriers while targeting motor deficits in people with basal ganglia disorders. To date no studies have examined the use of video games as an exercise intervention in Huntington's disease.…”

Effect of silybin in 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine (MPTP) induced parkinsonism in mice

“…Several studies in mouse models of PD have described "gait" by estimating stride length and stance width. 31 Fernagut et al, reported that stride length is a reliable index of motor disorders due to basal ganglia dysfunction in mice. 32 In the present study silybin at both doses (300 and 600mg/kg) reversed the reduction in stride length by MPTP.…”

The Effect of Music Therapy for Patients With Huntington’s Disease: A Systematic Literature Review

“…Source: Aldridge, 2005. (Hoskyns, 1982) Encourage group participation (Hoskyns, 1982) Counteract anxiety and frustration (Hoskyns, 1982) Increase/maintain movement, increase relaxation, (Rainey Perry, 1983) Providing opportunities for self-expression, encouraging participation (Rainey Perry, 1983) Stimulating communication (Rainey Perry, 1983) Preservation of vocal abilities, demonstrate and maintaining physical strength (Magee, 1995a(Magee, , 1995b Improvement of memory function, organizing information, musical interaction, initiation (Magee, 1995a(Magee, , 1995b Stimulating active participation, avoiding isolation (Magee, 1995a(Magee, , 1995b Gait improvement (Thaut et al, 1999) ecall of information espite memory function terioration (Magee, 1995a(Magee, , 1995b Developing relationship, increasing communicative contact (Davis & Magee, 2001) Modulating velocity (Thaut et al, 1999) Choice making (Magee, 1995a(Magee, , 1995b Stimulating expressive speech (Grocke-Erdonmez, 1976) Reducing involuntary movements/stimulating voluntary movements (Brandt, 2000) Increasing/organizing responses (Magee, 1995a(Magee, , 1995b Preserving expressive and communication skills (Daveson, 2007) Improvement of physical presentation (Daveson, 2007) Improving cognitive skills (Davis & Magee, 2007) Enabling emotional expression (Daveson, 2007) Improving behavior problems (Daveson, 2007) Practice Based Studies Hoskyns (1982) focused on the effects of music therapy on counteracting anxiety and frustration by encouraging relaxation and group participation, and on reducing choreic movement by use of singing, playing, and listening. The most significant findings were that group singing seemed to be very beneficial and that playing musical instruments increased the choreic movement.…”

“…She did find that several patients were able to sing out words that they had previously had trouble articulation through speech. Thaut, Miltner, Lange, Hurt, and Hoemberg (1999) investigated the rhythmic synchronization ability of 27 HD patients under different conditions and circumstances using the Rhythmic Auditory Stimulation (RAS) techniques. The gait speed of most of the patients could be changed in the direction of the RAS cue.…”