Purposefulness as a critical factor in functioning, disability and health.

Guided by theoretical frameworks of health and illness such as the International Classification of Functioning, Disability, and Health (ICF), we seek to describe the importance of purposefulness in the context of rehabilitation. We argue that ascribing meaning to life events, particularly changes in health, and acting in a manner that is driven by purpose is a universal characteristic of human beings. The ability to contextualize purposefulness within the broader biopsychosocial model of illness may provide a greater understanding of the relationship of purpose in the process of rehabilitation. We support the notion that purposefulness is an ever-present component throughout our lives and it exists as a convergence of personal factors, past experiences, and our personal narrative. Having a sense of purposefulness and being able to understand the meaning of different aspects of our lives is what allows us to find purpose while experiencing a health condition. More importantly, and in the context of rehabilitation efforts, we believe that if purposefulness can be identified or collectively defined by the individual, then rehabilitation outcomes may be enhanced. In a variety of contexts ranging from disease, aging, severe trauma, and even war, purposefulness and its component elements consistently distinguish themselves as being essential for regaining a sense of direction and facilitating one's response to any health condition.

Gait in younger and older adults during rhythmic auditory stimulation is influenced by groove, familiarity, beat perception, and synchronization demands.

Music-based Rhythmic auditory stimulation (RAS) is a cueing intervention used to regulate gait impairments in conditions such as Parkinson's disease or stroke. Desire to move with music ('groove') and familiarity have been shown to impact younger adult gait while walking with music, and these effects appear to be influenced by individual rhythmic ability. Importantly, these factors have not been examined in older adults. The aim of this study was to determine how gait outcomes during RAS are influenced by musical properties (familiarity, 'groove') in both free and synchronized walking for younger and older adults with good and poor beat perception ability. To do this, participants were randomized to either free or synchronized walking groups. Each participant's gait was assessed on a pressure sensitive walkway during high versus low groove and high versus low familiarity music, as well as metronome, cueing trials. Individual beat perception ability was evaluated using the Beat Alignment Test. Results showed that the effects of synchronization and groove were mostly consistent across age groups. High groove music elicited faster gait in both age groups, with longer strides only among young adults, than low groove music; synchronizing maximized these effects. Older adults with poor beat perception were more negatively affected by unfamiliar stimuli while walking than younger adults. This suggests that older adults, like younger adults, may benefit from synchronized RAS to high groove cues but may be more vulnerable to cognitive demands associated with walking to unfamiliar stimuli. This should be accounted for in clinical implementations of RAS.

The effects of Parkinson's disease, music training, and dance training on beat perception and production abilities.

Humans naturally perceive and move to a musical beat, entraining body movements to auditory rhythms through clapping, tapping, and dancing. Yet the accuracy of this seemingly effortless behavior varies widely across individuals. Beat perception and production abilities can be improved by experience, such as music and dance training, and impaired by progressive neurological changes, such as in Parkinson's disease. In this study, we assessed the effects of music and dance experience on beat processing in young and older adults, as well as individuals with early-stage Parkinson's disease. We used the Beat Alignment Test (BAT) to assess beat perception and production in a convenience sample of 458 participants (278 healthy young adults, 139 healthy older adults, and 41 people with early-stage Parkinson's disease), with varying levels of music and dance training. In general, we found that participants with over three years of music training had more accurate beat perception than those with less training (p < .001). Interestingly, Parkinson's disease patients with music training had beat production abilities comparable to healthy adults while Parkinson's disease patients with minimal to no music training performed significantly worse. No effects were found in healthy adults for dance training, and too few Parkinson's disease patients had dance training to reliably assess its effects. The finding that musically trained Parkinson's disease patients performed similarly to healthy adults during a beat production task, while untrained patients did not, suggests music training may preserve certain rhythmic motor timing abilities in early-stage Parkinson's disease.

Musical enjoyment does not enhance walking speed in healthy adults during music-based auditory cueing.

BACKGROUND: Rhythmic Auditory Stimulation (RAS) involves synchronizing footsteps to music or a metronome to improve gait speed and stability in patients with neurological disorders, such as Parkinson's disease. However, responses to RAS vary across individuals, perhaps because of differences in enjoyment of the music or in musical abilities. RESEARCH QUESTION: Intuitively, musical enjoyment may influence gait responses to RAS, but enjoyment has not been systematically manipulated nor the effects empirically assessed. In addition, differences in beat perception ability are likely to influence gait responses to music, particularly when synchronizing to the beat. Therefore, we asked: how does music enjoyment alter gait, and do gait parameters differ between individuals with good versus poor beat perception ability, specifically when instructed to 'walk freely' versus 'synchronize to the beat'? METHOD: Young adults and older adults walked on a pressure sensor walkway in silence and to music that they had rated as either high or low in enjoyment, as well as a metronome. All stimuli were presented at 15 % faster than baseline cadence. Participants either walked freely to the music or synchronized to the beat. RESULTS: Music enjoyment had no significant effects on gait in either younger or older adults. Compared to baseline, younger adults walked faster (by taking longer strides) to music than the metronome, whereas older adults walked faster (by taking more steps per minute) to the metronome than music. When instructed to synchronize vs. walk freely, young adults walked faster, but older adults walked slower. Finally, regardless of instruction type, young adults with poor beat perception took shorter and slower strides to the music, whereas older adults with poor beat perception took slower strides to the music. SIGNIFICANCE: Beat perception ability, instruction type, and age affect gait more than music enjoyment does, and thus should be considered when optimizing RAS outcomes.

Beat perception ability and instructions to synchronize influence gait when walking to music-based auditory cues.

Synchronizing gait to music-based auditory cues (rhythmic auditory stimulation) is a strategy used to manage gait impairments in a variety of neurological conditions, including Parkinson's disease. However, knowledge of how to individually optimize music-based cues is limited. The purpose of this study was to investigate how instructions to synchronize with auditory cues influences gait outcomes among healthy young adults with either good or poor beat perception ability. 65 healthy adults walked to metronome and musical stimuli with high and low levels of perceived groove (how much it induces desire to move) and familiarity at a tempo equivalent to their self-selected walking pace. Participants were randomized to instruction conditions: (i) synchronized: match footsteps with the beat, or (ii) free-walking: walk comfortably. Participants were classified as good or poor beat perceivers using the Beat Alignment Test. In this study, poor beat perceivers show better balance-related parameters (stride width and double-limb support time) when they are not instructed to synchronize their gait with cues (versus when synchronization was required). Good beat perceivers, in contrast, were better when instructed to synchronize gait (versus when no synchronization was required). Changes in stride length and velocity were influenced by musical properties, in particular the perceived 'groove' (greater stride length and velocity with high- versus low-groove cues) and, in some cases, this interacted with beat perception ability. The results indicate that beat perception ability and instructions to synchronize indeed influence spatiotemporal gait parameters when walking to music- and metronome-based rhythmic auditory stimuli. Importantly, these results suggest that both low groove cues and instructing poor beat perceivers to synchronize may interfere with performance while walking, thus potentially impacting both empirical and clinical outcomes.

Clinical Presentation of Anxiety in Parkinson's Disease: A Scoping Review.

Up to 40% of all individuals with Parkinson's disease (PD) are estimated to experience anxiety that interferes with daily functioning. This article describes research regarding the presentation of anxiety in PD and the influence anxiety has on participation in this population. A scoping review identified 1,635 articles, of which 49 met the inclusion criteria. This review identified that anxiety in PD is often associated with a range of clinical correlates related to demographic and clinical characteristics (age, gender, disease stage, duration, progression), motor symptoms (tremor, bradykinesia, dystonia, freezing of gait, symptom severity), treatment-related complications (on/off fluctuations, on with dyskinesia, unpredictable off), and non-motor symptoms (sleep abnormalities, fatigue, cognitive impairment, depression). These findings can be used to increase clinicians' awareness toward the specific clinical correlates linked to anxiety in PD so that mental health concerns can be detected and addressed more readily in practice.