Walking to the beat of different drums: Practical implications for the use of acoustic rhythms in gait rehabilitation

Abstract

Acoustic rhythms are frequently used in gait rehabilitation, with positive instantaneous and prolonged transfer effects on various gait characteristics. The gait modifying ability of acoustic rhythms depends on how well gait is tied to the beat, which can be assessed with measures of relative timing of auditory-motor coordination. We examined auditory-motor coordination in 20 healthy elderly individuals walking to metronome beats with pacing frequencies slower than, equal to, and faster than their preferred cadence. We found that more steps were required to adjust gait to the beat, the more the metronome rate deviated from the preferred cadence. Furthermore, participants anticipated the beat with their footfalls to various degrees, depending on the metronome rate; the faster the tempo, the smaller the phase advance or phase lead. Finally, the variability in the relative timing between footfalls and the beat was smaller for metronome rates closer to the preferred cadence, reflecting superior auditory-motor coordination. These observations have three practical implications. First, instantaneous effects of acoustic stimuli on gait characteristics may typically be underestimated given the considerable number of steps required to attune gait to the beat in combination with the usual short walkways. Second, a systematic phase lead of footfalls to the beat does not necessarily reflect a reduced ability to couple gait to the metronome. Third, the efficacy of acoustic rhythms to modify gait depends on metronome rate. Gait is coupled best to the beat for metronome rates near the preferred cadence.

The discovery of human auditory–motor entrainment and its role in the development of neurologic music therapy

“…Patients entered the studies in the subacute stage, approximately 2 weeks post stroke. These clinical findings have been replicated by a number of other research groups substantiating the existence of rhythmic auditory-motor circuitry for entrainment (Ford et al, 2007;Roerdink et al, 2007Roerdink et al, , 2011. RAS is now recognized among the evidence-based, state of the art motor therapies for cardiovascular accidents (Hoemberg, 2013).…”

Agency, gait and self-consciousness

“…Concerning gait, auditory cues have been shown to alter gait (in Parkinson's Disease, Enzensberger and Fischer, 1996; healthy elderly, Roerdink et al, 2011;stroke rehabilitation, Thaut et al, 1997), but their influence on gait agency is not well understood. This was only recently studied by Menzer et al (2010) who investigated gait agency by introducing temporal conflicts between footsteps and footstep-related auditory cues.…”

Questioning Classic Patient Classification Techniques in Gait Rehabilitation: Insights from Wearable Haptic Technology

“…This allowed them to familiarise themselves with the procedure and the environment, and allowed for recording of base-line kinematic and kinetic data. Participants' preferred own pace was used for metronomic cueing, as this is considered to be the most beneficial cueing rate when used within the context of gait rehabilitation to improve symmetry [5].…”