Walking to your right music: a randomized controlled trial on the novel use of treadmill plus music in Parkinson’s disease

Abstract

Background Rhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic Parkinson’s disease (PD). However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training. Methods We enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical, kinematic, and electrophysiological effects of both the gait trainings. Results We found a greater improvement in Functional Gait Assessment ( p < 0.001), Tinetti Falls Efficacy Scale ( p < 0.001), Unified Parkinson Disease Rating Scale ( p = 0.001), and overall gait quality index ( p < 0.001) following RAS than non_RAS training. In addition, the RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle, and a greater improvement of fronto-centroparietal/temporal electrode connectivity than the non_RAS gait training. Conclusions The findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity. Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum. Finally, identifying these mechanisms is crucial to create patient-tailored, RAS-based rehabilitative approaches in PD. Trial registration NCT03434496 . Registered 15 February 2018, retrospectively registered.

A Case-Controlled Pilot Study on Rhythmic Auditory Stimulation-Assisted Gait Training and Conventional Physiotherapy in Patients With Parkinson's Disease Submitted to Deep Brain Stimulation

“…The clinical aftereffects our patients reported are consistent with previous data on the efficacy of RAS-assisted gait training plus conventional physiotherapy in improving gait performance in patients with PD (15,16,18,49). Actually, our rehab paradigm improved gait velocity, stability and overall mobility, and reduced the risk for falls and, thus, disability, in PD patients, in whom changes in gait often affect disability, morbidity, and mortality (50,51).…”

“…GT3 is a validated electronic walkway equipped with an instrumented deck that monitors and records step length, step speed and step symmetry to train neurologic patients (including PD and stroke) in achieving better gait performance. By combining audio-visual feedback and music-assisted therapy, GT3 helps promoting neuroplasticity-based recovery processes (18,29). The device provides clinicians with data on load distribution during the stance phase, the actual location of feet, and the matching of the length of the step performed with a pre-determined step length at a certain speed (audiomotor synchronization).…”

“…The temporally predictable cues can support gait initiation and continuation both immediately and long after an extensive period of RAS by resetting the PD-related variability of sensorimotor timing skills (19,55,62,63). In particular, RAS training improves patent's capacity to coordinate steps to the timing and rate of RAS, and to the time goal-directed movements to the beat onsets, with overall positive effects on gait performance (18). The exact neurophysiological underpinnings of RAS have to be elucidated clearly.…”

“…However, a few studies have assessed gait in PD patients who underwent DBS, reporting some promising results (4,5,9,10). Integrating treadmill-assisted gait training equipped with rhythmic auditory stimulation (RAS) with physiotherapy has been shown to increase further speed, cadence, stride length, gait symmetry and stability in PD patients, because RAS works as a peripheral timekeeper (17)(18)(19). However, patients with DBS have not been assessed specifically for physiotherapy plus RAS-treadmill gait training aftereffects yet (14,20,21).…”

Feasibility of Music-Assisted Treadmill Training in Parkinson's Disease Patients With and Without Deep Brain Stimulation: Insights From an Ongoing Pilot Randomized Controlled Trial

“…In this feasibility analysis, patients' acceptance of the protocol was measured as the rate of participating patients out of eligible patients (=inclusion rate), which was 84%. In a comparable study by Calabrò et al (67), also examined the effects of MATT, an inclusion rate of 94% was obtained. It has to be noted that in the present study, six eligible patients declined to participate.…”