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Gait rehabilitation in Parkinson’s disease via musical rhythm: How to improve it

Simone Dalla Bella1*
  • 1 University of Montpellier, EuroMov Laboratory, France

Gait dysfunctions in Parkinson's disease (PD) can be partly alleviated by rhythmic auditory cueing (Lim et al., 2005; Nombela et al., 2013; Spaulding et al., 2013). In this rehabilitation technique, patients are asked to walk with a rhythmic auditory stimulus such as a simple metronome, music, or music with an embedded metronome stressing the beat. The beneficial effect on gait of this stimulation is visible immediately in terms of increased speed and stride length. Moreover, when the stimulation is part of a training program, these positive effects can carry over to non-cued gait after the training, and extend to improved rhythm processing beyond gait (e.g., Benoit et al., 2014). These beneficial effects of rhythmic cueing are probably supported by the activation of a cerebello-thalamo-cortical compensatory network, or by the reactivation of residual activity of the impaired basal-ganglia-thalamo-cortical circuitry (Dalla Bella et al., 2015; Schwartze & Kotz, 2013). In spite of these positive effects, rhythmic cueing has some drawbacks, though. In standard rhythmic auditory cueing, the interval between sounds or musical beats is fixed. However, this may not be an optimal stimulation condition, as it fails to take into account that motor activity is intrinsically variable and tends to be correlated in time. In addition, patients show typical variability (accelerations and decelerations) during walking which may lead them to progressively desynchronize with the beat. Stimulation with embedded biological variability and capable to adapt in real time to patients’ variable step times could be a valuable alternative to optimize rhythmic auditory cueing. These possibilities have been examined by asking a group of PD patients (n = 40) and matched controls (n = 40) to walk with various rhythmic auditory stimuli (a metronome, music, and amplitude-modulated noise) under different conditions. In some conditions, inter-beat variability has been manipulated, by embedding biological vs. random variability in the stimulation. Another manipulation was to adapt in real time the stimulus beats to participants’ step times using dedicated algorithms. Performance was quantified by way of the typical spatio-temporal gait parameters and additional measures akin to complex systems (e.g., long-range correlations). The results indicated that biologically-variable stimulation which is adapted to patients’ steps is the most efficient for improving gait performance. These findings provide useful guidelines for optimizing music-driven rehabilitation of gait in PD.

References

Benoit, C.E. et al. (2014). Musically cued gait-training improves both perceptual and motor timing in Parkinson's disease. Front Hum Neurosci, 8, 494.

Dalla Bella, S., Benoit, C. E., Farrugia, N., Schwartze, M. & Kotz, S. A. (2015). Effects of musically cued gait training in Parkinson's disease: beyond a motor benefit. Ann N Y Acad Sci, 1337, 77-85.

Lim, I. et al. (2005). Effects of external rhythmical cueing on gait in patients with Parkinson's disease: a systematic review. Clin Rehabil, 19, 695-713.

Nombela, C., Hughes, L. E., Owen, A.M. & Grahn, J. A. (2013). Into the groove: can rhythm influence Parkinson's disease? Neurosci Biobehav Rev, 37, 2564-2570.

Spaulding, S.J. et al. (2013). Cueing and gait improvement among people with Parkinson's disease: a meta-analysis. Arch Phys Med Rehabil, 94, 562-570.

Schwartze, M. & Kotz, S.A. (2013). A dual-pathway neural architecture for specific temporal prediction. Neurosci Biobehav Rev, 37, 2587-2596.

Keywords: Parkinson Disease, Rhythm, Rehabilitation, Music, Gait and posture

Conference: SAN2016 Meeting, Corfu, Greece, 6 Oct - 9 Oct, 2016.

Presentation Type: Oral presentation in the Symposium in Neurosciences and Music

Topic: Symposium in Neurosciences and Music

Citation: Dalla Bella S (2016). Gait rehabilitation in Parkinson’s disease via musical rhythm: How to improve it. Conference Abstract: SAN2016 Meeting. doi: 10.3389/conf.fnhum.2016.220.00042

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Received: 29 Jul 2016; Published Online: 01 Aug 2016.

* Correspondence: Prof. Simone Dalla Bella, University of Montpellier, EuroMov Laboratory, Montpellier, France, simone.dalla.bella@gmail.com