The Use of Footstep Sounds as Rhythmic Auditory Stimulation for Gait Rehabilitation in Parkinson’s Disease: A Randomized Controlled Trial

Abstract

BackgroundThe use of rhythmic auditory stimulation (RAS) has been proven useful in the management of gait disturbances associated with Parkinson’s disease (PD). Typically, the RAS consists of metronome or music-based sounds (artificial RAS), while ecological footstep sounds (ecological RAS) have never been used for rehabilitation programs.ObjectiveThe aim of this study was to compare the effects of a rehabilitation program integrated either with ecological or with artificial RAS.MethodsAn observer-blind, randomized controlled trial was conducted to investigate the effects of 5 weeks of supervised rehabilitation integrated with RAS. Thirty-eight individuals affected by PD were randomly assigned to one of the two conditions (ecological vs. artificial RAS); thirty-two of them (age 68.2 ± 10.5, Hoehn and Yahr 1.5–3) concluded all phases of the study. Spatio-temporal parameters of gait and clinical variables were assessed before the rehabilitation period, at its end, and after a 3-month follow-up.ResultsThirty-two participants were analyzed. The results revealed that both groups improved in the majority of biomechanical and clinical measures, independently of the type of sound. Moreover, exploratory analyses for separate groups were conducted, revealing improvements on spatio-temporal parameters only in the ecological RAS group.ConclusionOverall, our results suggest that ecological RAS is equally effective compared to artificial RAS. Future studies should further investigate the role of ecological RAS, on the basis of information revealed by our exploratory analyses. Theoretical, methodological, and practical issues concerning the implementation of ecological sounds in the rehabilitation of PD patients are discussed.Clinical Trial Registration, identifier NCT03228888.

An Initial Investigation of the Responsiveness of Temporal Gait Asymmetry to Rhythmic Auditory Stimulation and the Relationship to Rhythm Ability Following Stroke

“…This study employed the commonly used metronome cue for RAS delivery, though recent work has demonstrated the benefit of RAS that uses footstep sounds instead ( 46 , 47 ). The use of footstep sounds is equally effective in improving motor recovery scores and more effective than metronome cueing for improving spatiotemporal gait parameters such as speed, cadence, and step length for individuals with Parkinson's disease ( 48 ). Given its relation to the motor task being performed, it is possible the use of footstep sounds as RAS may facilitate the rhythmic perception of individuals with weak ability who attempt to match their gait to the cue.…”

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

“…Open-loop studies have most widely utilized auditory or visual forms of cues to improve gait in people with PD. While auditory cues have most often been delivered as rhythmic auditory stimulation (RAS) or metronome beats in accordance to the user's preferred gait speed or cadence [36,[42][43][44][45][46], other types of cues such as highly rhythmic music or verbal instructions have also been investigated in some of the studies [43,44,47]. Most forms of visual cueing present lines or markers on the floor as targets for foot placement.…”

“…Studies of open-loop cueing used as a therapeutic modality have demonstrated short-term and long-term gait improvements [41][42][43]48,[58][59][60][61]. Short-term studies investigated immediate effects with and without different cue interventions [62][63][64].…”

“…Laboratory-based long-term training studies compared walking with cues to without cues [50]. One long-term auditory cueing study investigated differences between ecological-based footstep cues (sound recorded while walking on gravel) to artificially synthesized RAS [43] and compared walking with auditory cues to walking with visual cues [40]. In the studies that presented cues as training, cues were provided progressively [65] or in combination with physical therapy improved step time variability [59], posture and bradykinesia [66], stride length, gait speed, and cadence [42].…”

The Study of Visual-Auditory Interactions on Lower Limb Motor Imagery

“…The MNS involvement has been improved by the object-oriented visual stimulus (Li et al, 2015 ). The MNS has been proved as a crucial role during the ecological stimuli (Murgia et al, 2015 , 2016 , 2018 ; Sors et al, 2015 ; Pizzera et al, 2017 ), and furthermore, the ecological visual and auditory stimuli can effectively affect complex movements (Kennel et al, 2014 ; Camponogara et al, 2016 ; Murgia et al, 2017 ). The rhythmic auditory stimulation is also indicated to facilitate gait rehabilitation (Thaut et al, 1993 , 1996 ; Pau et al, 2016 ; Dalla Bella et al, 2017 ; Bailey et al, 2018 ).…”