Posts Tagged Rhythmic Auditory Stimulation

[ARTICLE] The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients: A Randomized Controlled Trial – Full Text

Abstract

The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SP. The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 ± 8.6 years, mean time between stroke and start of study 42.1 ± 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F(2, 34) = 3.864, p = 0.032; partial η2 = 0.205] and cadence [F(2, 34)= 7.656, p = 0.002; partial η2 = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training.

Introduction

About 60% of all stroke patients (SP) have difficulties with walking (). These are often caused by hemiparesis and/or sensory deficits of the lower extremity and/or trunk and are also due to uncoordinated movements. In addition to motor and sensory dysfunctions, symptoms such as spasticity, somato-sensory neglect, and cognitive malfunctioning may further impede walking. Thus, the restoration of gait is often a key focus of rehabilitation efforts, enhancing not only physical activity but also autonomy and participation in everyday life ().

Treadmill training (TT) with and without body weight support has been shown to improve functional gait in stroke patients effectively. A meta-analysis comparing 44 trials (n = 2,658 patients) revealed clear therapeutic effects on gait velocity and walking endurance, the latter only for TT with body weight support (). However, the improvements were identified only for independent walkers while patients who walked with assistance did not show an additional benefit from TT (). Lee’s work () provided evidence that TT with a high walking velocity at the beginning of training is more effective when compared to a stepwise increase in velocity.

Rhythmic-auditory stimulation (RAS) is defined as a therapeutic application of pulsed rhythmic or musical stimulation in order to improve gait or gait related aspects of movement (). It has been demonstrated that SP are able to synchronize their gait pattern to auditory stimulation using music with an embedded metronome (). This led to immediate improvements in stride time and stride length symmetry as well as weight bearing time on the paretic side, while EMG showed a more balanced muscular activation pattern between the paretic and non-paretic sides (). Training effects of RAS for SP were confirmed in a meta-analysis comparing 7 randomized controlled studies (n = 197) that showed improvements in functional gait performance (velocity, cadence, and stride length) (). This work also gave evidence, that a musical stimulation is more effective in improving gait velocity and cadence then the metronome (). Hayden et al. found that RAS became more effective when it is implemented earlier in the rehabilitation program. This provides evidence that the variation in time of the RAS-training during the rehabilitation process may affect the success of the treatment (). The application of RAS on the treadmill (RAS-TT) was evaluated over a 3-week training period by Park et al. In that study metronome stimulation was used for 9 patients with chronic stroke. The results were compared with a group of 10 patients performing over ground RAS walking training (). The RAS-TT group experienced greater improvements in gait velocity ().

While RAS and TT have proven to be effective for gait training in SP, the efficacy of its combination (RAS-TT) in the early course of rehabilitation in SP has not been investigated to date. Therefore, we hypothesized that RAS-TT in the early course of rehabilitation would improve the clinical efficacy of TT for SP. The purpose of the present study was to investigate the functional improvements of gait using a rehabilitation therapy combining RAS and TT in order to assess its clinical efficacy for patients suffering the aftermaths of a stroke.

Materials and methods

Design

The study protocol was approved by the state authorization association for medical issues in Brandenburg, that determined on the 21st of January 2010 that no formal ethics approval was required. Patients gave their informed consent according to the Helsinki declaration.

The study was designed as a prospective, single center three arm clinical study with parallel groups. We enrolled patients who performed either RAS on the treadmill (RAS-TT) or treadmill training alone (TT). A third group that received neurodevelopmental treatment following the Bobath approach (NDT) served as a control group. The patients were randomly assigned to the three training interventions by a person not involved in the study using a block randomization (software randlist). Allocations were placed in sealed sequentially numbered envelopes and were not opened until the actual study inclusion. Thus, the patients, the responsible doctor, the assessing physiotherapist, and study manager were not informed beforehand regarding the group assignment.

We included stroke patients with a hemiparesis of the lower limb (at least 1 muscle group with muscle strength grade <5 as defined by the British Medical Research Council) or with an unsafe and asymmetrical walking pattern (by assessment of a physiotherapist). The patients had to be able to walk independently with assistive devices if necessary for at least 3 min.

Criteria for exclusion were the following: significantly disturbed language perception (marked by either the Aachener Aphasietest or Token Test), cognitive impairment (Mini Mental Status Test <26), major depression or productive psychosis, adjustment disorder with a need for medical treatment, peripheral arterial occlusive disease with walking distance <100 m, and coronary heart disease (instable angina pectoris).

After having passed the diagnostics patients underwent a screening session on the treadmill. There they had to demonstrate a stable and sufficiently ergonomic gait. Candidates with insufficient quality of gait on the treadmill (multimodal neglect or spasticity as assessed by a physiotherapist) were postponed and re-screened every week (Figure (Figure11).

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Figure 1
Patient flow chart of study design. RAS-TT, rhythmic auditory stimulation on treadmill; TT, treadmill training; NDT, neurodevelopmental treatment.

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[Poster] Collaboration of Music and Physical Therapy: Case Study for Treatment of Patient with Chronic Stroke

To evaluate the change in gait speed pre- and post-treatment. To evaluate the change in quality of life pre- and post-treatment. To evaluate the change in outcome measures pre- and post-treatment.

First page of article

via Collaboration of Music and Physical Therapy: Case Study for Treatment of Patient with Chronic Stroke – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Effects of inclined treadmill walking training with rhythmic auditory stimulation on balance and gait in stroke patients – Full Text PDF

Abstract.

[Purpose] The purpose of this study was to determine if an inclined treadmill with rhythmic auditory stimulation gait training can improve balance and gait ability in stroke patients.

[Subjects and Methods] Thirty participants were randomly divided into three groups: inclined treadmill with rhythmic auditory stimulation training group (n=10), inclined treadmill training group (n=10), and treadmill training group (n=10). For all groups, the training was conducted for 4 weeks, 30 minutes per session, 5 times per week. Two subjects dropped out before study completion.

[Results] All variables of balance and gait, except for the timed up and go test in the treadmill group, significantly improved in all groups. Moreover, all variables showed a more significant improvement in the inclined treadmill with rhythmic auditory stimulation group when compared with the other groups. Timed up and go test, Berg balance scale, 6 m walking test, walking speed, and symmetric index were significantly improved in the inclined treadmill group when compared with the treadmill group.

[Conclusion] Thus, for stroke patients receiving gait training, inclined treadmill with rhythmic auditory stimulation training was more effective in maintaining balance and gait than inclined treadmill without rhythmic auditory stimulation or only treadmill training.

INTRODUCTION
Patients with stroke show various muscle abnormalities, including a combination of denervation, disuse, remodeling, and spasticity1). These reduce their balance ability and lead to gait disorders2). Abnormal gaits cause flexion and extension synergy patterns due to compensatory actions of muscles, etc., on the unaffected side, impairment of proprioceptive sensibility, and abnormal coordination of stiffened muscles of the lower limb3). As a substitute of stair climbing exercise, inclined treadmill walking training, which is aimed at improving these gait disorders, is being considered as an essential means for indoor and outdoor movements of the disabled, the elderly, or pregnant women who are unable to use stairs4). However, Rhea et al.5) stated that treadmill walking training, compared with walking on flat ground, is characterized by a shorter step length. Oh, Kim, and Woo6) argued that treadmill walking training has negative effects on gait asymmetry. Sensory elements play an important part in compensating for these weaknesses7), and rhythmic auditory stimulation (RAS) can be used as a complementing intervention8). In this intervention, the external auditory sense of rhythms generates rhythmic and more symmetrical alternate movements in the lower limbs of stroke patients who show gait asymmetry6, 9). Existing studies have not shown consistent results regarding the effects of treadmill walking training on the gait of stroke patients. In particular, with regard to balance and gait, which are essential for the activity and participation of stroke patients, there are no systematic studies showing the effects of inclined treadmill walking training with RAS thus far.[…]

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[WEB SITE] Music and Stroke Therapy: 4 Questions

We spoke with Kyle and Lindsey Wilhelm about their innovative techniques of helping stroke survivors regain their speech and movement.

How does music therapy help stroke survivors with aphasia?

Music therapists often work in collaboration with speech-language pathologists to address speech and language skills with stroke survivors. Survivors who suffer from aphasia may have difficulty speaking, but during therapy discover that they can sing an entire song fluently.

This is because the part of the brain affected by the stroke that controls expressive language (known as Broca’s area) is localized in one area of the brain while music production (singing and playing instruments) and processing (receptive listening) activates multiple areas of the brain.

By using music, the therapist can work on skills using the non-damaged areas of the brain to help the survivor relearn how to do what the damaged area of the brain used to do.

How does music therapy help stroke survivors with their physical therapy? 

Music therapists also collaborate with physical therapists to help survivors regain functioning of both their upper and lower extremities as well as fine and gross motor skills. For example, the music therapy technique Rhythmic Auditory Stimulation (RAS) uses a steady, rhythmic pulse to help the survivor with their gait (walking). The survivor will naturally match the strong rhythmic pulse providing the temporal support to regulate individual steps and motivation to keep going.

How often should a stroke survivor meet with a music therapist?

The key to learning or relearning any skill is repetition. A typical frequency is 1-2 times per week, but additional therapy will likely improve physical and motor skills.

The music therapist can show the survivor ways to incorporate music into exercises prescribed by other therapists at home. By making the exercises more enjoyable, the survivor will be more likely to do them regularly, which can positively affect rehabilitation overall.

How to find a music therapist in your local area.

1) Visit the American Music Therapy Association online directory.

2) Ask your speech therapist for a recommendation.

 

via Music and Stroke Therapy: 4 Questions – StrokeSmart.

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