BeatWalk: Personalized Music-Based Gait Rehabilitation in Parkinson's Disease.

Taking regular walks when living with Parkinson's disease (PD) has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients' gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors (BeatWalk) and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application (30 min/day, 5 days/week). The music tempo was being aligned in real-time to patients' gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% (±28.2) of the prescribed duration and enjoyed it throughout the program. The application was considered "easy to use" by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases "walk for exercise" duration thanks to high observance. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242.

The role of interaction and predictability in the spontaneous entrainment of movement.

People walking side by side spontaneously synchronize their steps on some occasions but not on others, which poses a challenge to theories of perception-action based on interactive dynamic systems. How can action be spontaneously entrained by some sources of perceptual information while others are selectively ignored? The predictive processing framework suggests that saliency factors such as stimulus predictability, consistent deviation, and interactivity of the stimulus control the coupling between the motor system and perceptual information. To test this, we compared entrainment of gait cadence by two interactive auditory stimuli and two noninteractive but predictable, faster than preferred stimuli that were isochronous or statistically matched to gait. One interactive stimulus had properties that are optimal for mutual entrainment as per a mathematical model of interactive periodic processes, the Kuramoto system. In particular, the stimulus was faster than the participant but also adapted its rate to a limited degree as function of phase mismatch with the participant's steps. The second interactive stimulus fully mirrored the gait cycle hence it did not induce mutual synchronization. Furthermore, healthy participants were compared to ones with impaired gait due to Parkinson's disease, a model disorder that makes movement more dependent on external cueing. The mutually interactive condition produced the strongest entrainment, in patients and healthy participants, without differences between groups. The stimulus adapted to each participant's gait while maintaining a consistent lead in phase. Auditory-motor coupling may be enhanced by stimuli that are not only predictable but also interactive in that they align to self-generated movements. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Design and development of a gait training system for Parkinson's disease.

BACKGROUND: Rhythmic Auditory Stimulation (RAS) is an effective technique to improve gait and reduce freezing episodes for Persons with Parkinson's Disease (PwPD). The BeatHealth system, which comprises a mobile application, gait sensors, and a website, exploits the potential of the RAS technique. This paper describes the tools used for co-designing and evaluating the system and discusses the results and conclusions. METHODS: Personas, interviews, use cases, and ethnographic observations were used to define the functional requirements of the system. Low fidelity prototypes were created for iterative and incremental evaluation with end-users. Field trials were also performed with the final system. The process followed a user centered design methodology defined for this project with the aim of building a useful, usable, and easy-to-use system. RESULTS: Functional requirements of the system were produced as a result of the initial exploration phase. Building upon these, mock-ups for the BeatHealth system were created. The mobile application was iterated twice, with the second version of it achieving a rating of 75 when assessed by participants through the System Usability Scale (SUS). After another iteration field trials were performed and the mobile application was rated with an average 78.6 using SUS. Participants rated two website mock-ups, one for health professionals and another for end-users, as good except from minor issues related to visual design (e.g. font size), which were resolved in the final version. CONCLUSION: The high ratings obtained in the evaluation of the BeatHealth system demonstrate the benefit of applying a user centered design methodology which involves stakeholders from the very beginning. Other important lessons were learned through the process of design and development of the system, such as the importance of motivational aspects, the techniques which work best, and the extra care that has to be taken when evaluating non-functional mock-ups with end users.