Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting.

BACKGROUND: Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input. OBJECTIVE: To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting. METHODS: Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion. RESULTS: Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05). CONCLUSIONS: Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.

GuitarPD: A Randomized Pilot Study on the Impact of Nontraditional Guitar Instruction on Functional Movement and Well-Being in Parkinson's Disease.

Playing musical instruments may have positive effects on motor, emotional, and cognitive deficits in patients with Parkinson's disease (PD). This pilot study examined the feasibility of a six-week nontraditional guitar instruction program for individuals with PD. Twenty-six participants with idiopathic PD (Age: 67.22 ± 8.07; 17 males) were randomly assigned to two groups (intervention first or 6 weeks of usual care control exposure) with stepwise exposure to the guitar intervention condition with cross-over at six weeks. Outcomes were assessed at baseline, 6, 12, and 18 weeks. Twenty-four participants completed the study. Combined analysis of the groups showed significant BDI-II improvement immediately after intervention completion (3.04 points, 95% CI [-5.2, -0.9], p = 0.04). PDQ-39 total quality of life scores improved from baseline to immediately postintervention 5.19 points (95% CI [-9.4, -1.0]) at trend significance (corrected p = 0.07). For Group 1 (exposed to the intervention first), MDS-UPDRS total scores improved by a mean of 8.04 points (95% CI [-12.4, -3.7], p = 0.004) and remained improved at 12 weeks by 10.37 points (95% CI [-14.7, -6.0], p < 0.001). This group also had significant improvements in mood and depression at weeks 6 and 12, remaining significant at week 18 (BDI-II: 3.75, 95% CI [-5.8, -1.7], p = 0.004; NeuroQoL-depression: 10.6, 95% CI [-4.9. -1.4], p = 0.004), and in anxiety at week 6 and week 18 (NeuroQoL; 4.42, 95% CI [-6.8, -2.1], p = 0.004; 3.58, 95% CI [-5.9, -1.2], p = 0.02, respectively). We found clinically and statistically significant improvements in mood/anxiety after 6 weeks of group guitar classes in individuals with PD. Group guitar classes can be a feasible intervention in PD and may improve mood, anxiety, and quality of life.