Gait improvement via rhythmic stimulation in Parkinson’s disease is linked to rhythmic skills

Abstract

Training based on rhythmic auditory stimulation (RAS) can improve gait in patients with idiopathic Parkinson’s disease (IPD). Patients typically walk faster and exhibit greater stride length after RAS. However, this effect is highly variable among patients, with some exhibiting little or no response to the intervention. These individual differences may depend on patients’ ability to synchronize their movements to a beat. To test this possibility, 14 IPD patients were submitted to RAS for four weeks, in which they walked to music with an embedded metronome. Before and after the training, patients’ synchronization was assessed with auditory paced hand tapping and walking to auditory cues. Patients increased gait speed and stride length in non-cued gait after training. However, individual differences were apparent as some patients showed a positive response to RAS and others, either no response, or a negative response. A positive response to RAS was predicted by the synchronization performance in hand tapping and gait tasks. More severe gait impairment, low synchronization variability, and a prompt response to a stimulation change foster a positive response to RAS training. Thus, sensorimotor timing skills underpinning the synchronization of steps to an auditory cue may allow predicting the success of RAS in IPD.

Rhythm disturbances as a potential early marker of Parkinson’s disease in idiopathic REM sleep behavior disorder

“…10 The battery has proven sensitive to rhythm deficits in a variety of conditions including PD. 7,[23][24][25] The tests lasted 15-20 min and no special training was needed.…”

Individualization of music‐based rhythmic auditory cueing in Parkinson's disease

“…However, there are indications that the success of rhythmic cueing may vary significantly among individuals. 21,29 Rhythmic auditory cueing may not be the best strategy to improve gait for all patients. For example in a recent study in which 14 patients with PD were submitted to a 1-month music-based training with rhythmic auditory cues, only some patients positively responded to cueing (e.g., showing increased gait velocity).…”

“…Others were either not influenced by the training or showed worsened gait performance (i.e., slower velocity) after the training period. 29 This variability of the effectiveness of cueing training is not totally surprising. PD is by definition very heterogeneous.…”

“…33,39 However, even in a group of patients with PD, which is quite homogeneous in terms of motor symptoms (i.e., with comparable severity), rhythmic abilities vary quite considerably. 29,33,39 Despite having PD, some patients reveal quite spared rhythmic skills that may allow them to benefit from an external temporally predictable cue.…”

“…A synchronization score, from 0 to 1, also referred to as "synchronization consistency," 32,57 indicated how well participants aligned their footfalls to the beats. 29,55,58 A score of 0 referred to lack of alignment between the footfalls and the beats while 1 indicated perfectly consistent alignment (maximal phase locking of the steps to the beat). Beat perception was tested with the Beat Alignment Test (BAT), 59 taken from the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA).…”