Effect of musical cues on gait in individuals with Parkinson disease with comorbid dementia.

BACKGROUND: Individuals with Parkinson disease and comorbid dementia (PDD) demonstrate gait impairments, but little is known about how these individuals respond to interventions for gait dysfunction. Rhythmic auditory stimulation (RAS), which utilizes music or other auditory cues to alter gait, has been shown to be effective for improving gait in individuals with PD without dementia, but has not been explored in individuals with PDD. RESEARCH QUESTION: Can individuals with PDD modulate their gait in response to music and mental singing cues? METHODS: This single center, cross-sectional, interventional study included 17 individuals with PDD. Participants received Music and Mental singing cues at tempos of 90 %, 100 %, 110 %, and 120 % of their uncued walking cadence. Participants were instructed to walk to the beat of the song. Gait variables were collected using APDM Opal sensors. Data were analyzed using mixed effect models to explore the impact of tempo and cue type (Music vs Mental) on selected gait parameters of velocity, cadence, and stride length. RESULTS: Mixed effects models showed a significant effect of tempo but not for cue type for velocity (F=11.51, p < .001), cadence (F=11.13, p < .001), and stride length (F=5.68, p = .002). When looking at the marginal means, velocity at a cue rate of 90 % was significantly different from 100 %, indicating participants walked slower with a cue rate of 90 %. Participants did not significantly increase their velocity, cadence, or stride length with faster cue rates of 110 % and 120 % SIGNIFICANCE: Individuals with PDD appear to be able to slow their velocity in response to slower cues, but do not appear to be able to increase their velocity, cadence, or stride length in response to faster cue tempos. This is different from what has been reported in individuals with PD without dementia. Further research is necessary to understand the underlying mechanism for these differences.

The effect of auditory cues on gait variability in people with Parkinson's disease and older adults: a systematic review.

Aim: The goal of this study was to analyze the effects of external rhythmic auditory stimulation (RAS) on gait variability in older adults and people with Parkinson's disease (PD). Methods: Academic databases searched included PubMed, Web of Science, PEDro and Cochrane, from inception to September 2021. Eligible articles scored a minimum of 4 on the PEDro scale. Results: Twenty-three papers were included. People with PD show varied responses in gait variability to RAS during cued walking trials. Healthy older adults tended to increase variability during cued trials. Cue rates below preferred walking cadence tend to increase gait variability. Conclusion: Gait variability is closely associated with fall risk and an important consideration in development of gait rehabilitation techniques.

People with Parkinson's disease (PD) tend to walk slower and with higher gait variability. Walking to metronome tones or musical cues are common rehabilitation techniques to improve gait speed and stride length for people with PD. However, recent reports suggest that cues may augment differences between each stride, making walking less even and less rhythmic, in other words, more variable. Gait variability is closely associated with fall risk. In this review, we investigated the effects of external rhythmic auditory cues ­ both metronome and music ­ to see how they affected gait variability for people with PD and older adults. The results of our analysis suggest that cues may increase gait variability for both groups. Several factors that may foster positive responses to cues are considered.

Finger tapping as a proxy for gait: Similar effects on movement variability during external and self-generated cueing in people with Parkinson's disease and healthy older adults.

BACKGROUND: Rhythmic auditory cueing has been widely studied for gait rehabilitation in Parkinson's disease (PD). Our research group previously showed that externally generated cues (i.e., music) increased gait variability measures from uncued gait, whereas self-generated cues (i.e., mental singing) did not. These different effects may be due to differences in underlying neural mechanisms that could be discerned via neuroimaging; however, movement types that can be studied with neuroimaging are limited. OBJECTIVE: The primary aim of the present study was to investigate the effects of different cue types on gait, finger tapping, and foot tapping, to determine whether tapping can be used as a surrogate for gait in future neuroimaging studies. The secondary aim of this study was to investigate whether rhythm skills or auditory imagery abilities are associated with responses to these different cue types. METHODS: In this cross-sectional study, controls (n=24) and individuals with PD (n=33) performed gait, finger tapping, and foot tapping at their preferred pace (UNCUED) and to externally generated (MUSIC) and self-generated (MENTAL) cues. Spatiotemporal parameters of gait and temporal parameters of finger tapping and foot tapping were collected. The Beat Alignment Task (BAT) and Bucknell Auditory Imagery Scale (BAIS) were also administered. RESULTS: The MUSIC cues elicited higher movement variability than did MENTAL cues across all movements. The MUSIC cues also elicited higher movement variability than the UNCUED condition for gait and finger tapping. CONCLUSIONS: This study shows that different cue types affect gait and finger tapping similarly. Finger tapping may be an adequate proxy for gait in studying the underlying neural mechanisms of these cue types.

A walking dance to improve gait speed for people with Parkinson disease: a pilot study.

Aim: To determine the effectiveness of a targeted dance intervention to improve walking speed for people with Parkinson disease (PD) by increasing motor motivation. Materials & methods: 11 participants with PD participated in a 6-week pilot study in which they learned a contemporary dance composed of walking steps and designed to mimic everyday walking. 1 h classes occurred twice-weekly. Results: Pre- and post-intervention assessments revealed a significant increase in gait speed (t9 = 3.30; p = 0.009), cadence (t9 = 2.345; p = 0.044), and stride length (t9 = 3.757; p = 0.005), and a significant decrease (improvement) in single support time variability (t9 = -2.744; p = 0.022). There were no significant changes in other measures of gait variability nor in motor symptoms, mood and anxiety, extent of life-space mobility, or quality of life. No adverse events were reported. Conclusion: Joywalk provides preliminary evidence that a targeted physical intervention for people with PD may specifically counter bradykinesia.

Yoga Improves Balance and Low-Back Pain, but Not Anxiety, in People with Parkinson's Disease.

Individuals with Parkinson's disease (PD) experience postural instability, low-back pain (LBP), and anxiety. These symptoms increase the risk of falls and decrease quality of life. Research shows yoga improves balance and decreases LBP and anxiety in healthy adults, but its effects in PD are poorly understood. All participants were part of a larger intervention study. Participants received pretest and posttest evaluations, including the Balance Evaluation Systems Test (BESTest), Beck Anxiety Inventory (BAI), and Revised Oswestry Disability Index (ROSW). Total scores for each measure, as well as individual balance system section scores from the BESTest (biomechanical constraints, stability limits/verticality, transitions/anticipatory, reactive, sensory orientation, and stability in gait) were compared within groups pre- to posttest. Participants in the yoga group (n = 13) completed a twice-weekly 12-week yoga interve n t i o n , whereas controls (n = 13) continued their usual routines for 12 weeks. Both the yoga (Z = -3.20, p = 0.001) and control (Z = -2.10, p = 0.040) groups improved on the BESTest total score. The control group showed no changes in individual balance systems, whereas the yoga group improved in stability limits/verticality (Z = -2.3, p = 0.020), transitions/ anticipatory (Z = -2.50, p = 0.010), reactive (Z = -2.70, p = 0.008), and sensory orientation (Z = -2.30, p = 0.020). ROSW decreased in the yoga group only (Z = -2.10, p = 0.030). BAI did not change in either group. Yoga is a nonpharmacological intervention that can improve balance and LBP in people with PD. This study demonstrated that yoga is feasible for people with PD, and participants reported high levels of enjoyment and intent to practice yoga after the study.

Internal cueing improves gait more than external cueing in healthy adults and people with Parkinson disease.

Walking can be challenging for aging individuals and people with neurological disorders such as Parkinson disease (PD). Gait impairment characterized by reduced speed and higher variability destabilizes gait and increases the risk of falls. External auditory cueing provides an effective strategy to improve gait, as matching footfalls to rhythms typically increases gait speed and elicits larger steps, but the need to synchronize to an outside source often has a detrimental effect on gait variability. Internal cueing in the form of singing may provide an alternative to conventional gait therapy. In the present study, we compare the effects of internal and external cueing techniques on forward and backward walking for both people with PD and healthy controls. Results indicate that internal cueing was associated with improvements in gait velocity, cadence, and stride length in the backward direction, and reduced variability in both forward and backward walking. In comparison, external cueing was associated with minimal improvement in gait characteristics and a decline in gait stability. People with gait impairment due to aging or neurological decline may benefit more from internal cueing techniques such as singing as compared to external cueing techniques.

The feasibility of singing to improve gait in Parkinson disease.

Brain regions important for controlling movement are also responsible for rhythmic processing. In Parkinson disease (PD), defective internal timing within the brain has been linked to impaired beat discrimination, and may contribute to a loss of ability to maintain a steady gait rhythm. Less rhythmic gait is inherently less efficient, and this may lead to gait impairment including reduced speed, cadence, and stride length, as well as increased variability. While external rhythmic auditory stimulation (e.g. a metronome beat) is well-established as an effective tool to stabilize gait in PD, little is known about whether self-generated cues such as singing have the same beneficial effect on gait in PD. Thus, we compared gait patterns of 23 people with mild to moderate PD under five cued conditions: uncued, music only, singing only, singing with music, and a verbal dual-task condition. In our single-session study, singing while walking did not significantly alter velocity, cadence, or stride length, indicating that it was not excessively demanding for people with PD. In addition, walking was less variable when singing than during other cued conditions. This was further supported by the comparison between singing trials and a verbal dual-task condition. In contrast to singing, the verbal dual-task negatively affected gait performance. These findings suggest that singing holds promise as an effective cueing technique that may be as good as or better than traditional cueing techniques for improving gait among people with PD.