Effects of a Music-Based Rhythmic Auditory Stimulation on Gait and Balance in Subacute Stroke

Abstract

Gait and balance impairments are common after stroke. This study aimed to evaluate the effect of a music-based rhythmic auditory stimulation (RAS) in combination with conventional physiotherapy on gait parameters and walking ability in subacute stroke. This single-blind, historical controlled trial, included 55 patients who had suffered a stroke within the three weeks prior to enrolment. Patients from 2018 (n = 27) were assigned as the historical control group whereas 2019 patients (n = 28) received music-based RAS three times a week. Both groups received 11 h of conventional physiotherapy per week during hospitalization. Primary outcomes were gait and balance parameters (Tinetti test and Timed Up&Go test) and walking ability (Functional Ambulation Category scale). Secondary outcomes were trunk control, assistive devices, functional independence (Functional Independence Measure, Barthel index), and stroke severity and disability (modified Rankin scale, National Institutes of Health Stroke Scale). Results: No between-group differences were identified for gait and balance parameters nor for secondary outcomes. Significant between-group differences were observed in the Functional Ambulation Category: the intervention group (Δmean ± SD; 3.43 ± 1.17) showed greater improvement (p = 0.002) than the control group (Δmean ± SD; 2.48 ± 1.09). Compared with conventional physiotherapy alone, our results suggest that the walking ability of subacute stroke patients might be improved with music-based RAS combined with conventional physiotherapy, but this treatment is not more effective than conventional physiotherapy in obtaining gait and balance gains.

Impact of Music Therapy on Gait After Stroke

“…However, only six of the eight studies reported clear results of a positive outcome on gait ability from direct application of MST [15][16][17]19,20,22]. The cases conducted by Hayden and Gonzalez-Hoelling et al both reported findings that were unclear and showed no observable distinctions between experimental and control groups [18,21]. The MST interventions implemented to reveal positive outcomes included daily listening, MMF, RAS, and therapy sessions involving physical movement with music in the background or as direct usage [15][16][17]19,20,22].…”

“…Eight studies investigating music therapy in stroke rehabilitation were included in the review, of which four conducted RAS, one conducted MMF, one conducted R-MT, and two conducted more individually defined music interventions [15][16][17][18][19][20][21][22]. The majority of included studies -six of the eight -reported positive outcomes on gait measures among stroke patients who received music or rhythmic therapies [15][16][17]19,20,22].…”

“…The majority of included studies - six of the eight - reported positive outcomes on gait measures among stroke patients who received music or rhythmic therapies [ 15 - 17 , 19 , 20 , 22 ]. The findings of the remaining two studies, conducted by Hayden et al and Gonzalez-Hoelling et al, were unclear; improvements were observed in both the study groups and the control groups with no evident distinctions [ 18 , 21 ]. Both Hayden et al and Gonzalez-Hoelling et al acknowledged the clinical feasibility of music-based therapies and recommend further study to investigate the effectiveness of such therapies on gait.…”

“…Both Hayden et al and Gonzalez-Hoelling et al acknowledged the clinical feasibility of music-based therapies and recommend further study to investigate the effectiveness of such therapies on gait. Both of the aforementioned studies conducted RAS interventions, and although improvements were observed in patients’ one-limb stance, cadence, velocity, stride length, and posture head tilt as well as their Functional Ambulation Category, statistically significant differences were not evident with the respective control groups [ 18 , 21 ].…”

Comparative Efficacy of Active Group Music Intervention versus Group Music Listening in Alzheimer’s Disease

“…Music might be used for rehabilitation purposes since it may change the activity of many brain structures (e.g., related to sensory-motor processing, motivation, affect, attention, and memory) and induce plastic changes in some brain networks [5,6]. Additionally, at the neurochemical level, music stimuli influence the function of stress and arousal systems [7].…”