Journal of Research in Rehabilitation Sciences

The Effects of Rhythmic Auditory Stimulation with Different Tempos on Spatio-Temporal Parameters and Gait Symmetry in Patients with Multiple Sclerosis: A Quasi-Experimental Study

Document Type : Original Articles

Authors

1 PhD Candidate, Department of Sports Biomechanics and Injuries, School of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran

2 Professor, Department of Sports Biomechanics and Injuries, School of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran

3 Associate Professor, Department of Sport Biomechanics, School of Physical Education and Sports Sciences, Shahid Bahonar University, Kerman, Iran

10.48305/jrrs.2023.41771.1041

Abstract

Introduction: Rhythmic auditory stimulation has been used clinically as a therapeutic intervention to improve gait function in patients with various neurological diseases. Therefore, the purpose of the present study was to investigate the effects of rhythmic auditory stimulation with different tempos on spatio-temporal parameters and gait symmetry in patients with multiple sclerosis (MS).
Materials and Methods: The present study participants included 13 women diagnosed with MS (EDSS: 3.5-5.5) and 14 healthy women. Walking of the subjects was examined under 4 different modes: baseline gait without rhythmic auditory stimulation and gait with rhythmic auditory stimulation at -10%, 0%, and +10% of the baseline tempo, applied in random order. A motion capture system with 6 cameras was used to collect kinematic data.
Results: The results of independent sample t-test showed that people with MS walked slower, shorter distance, and spent a greater percentage of a gait cycle in double support phase than healthy control subjects. Furthermore, the findings showed that with an increase in tempo, the parameters of stance duration, swing duration, double support duration, stride duration, and stride length decrease, and cadence increases. The results of repeated measures ANOVA showed that auditory rhythmic stimulation significantly improves the gait symmetry index compared to the condition of the gait without auditory rhythmic stimulation.
Conclusion: The findings of this study showed that the subjects who participated in this study adjusted well to the changing tempo, and gait improvement was also found at different tempos. Therefore, our findings suggest that rhythmic auditory stimulation has the potential to be a safe, effective, and low-cost intervention for gait disturbance in patients with MS. 

Keywords

Main Subjects

  1. Prins M, Schul E, Geurts J, van d, V, Drukarch B, van Dam AM. Pathological differences between white and grey matter multiple sclerosis lesions. Ann N Y Acad Sci 2015; 1351: 99-113.
  2. Tallantyre EC, Bo L, Al-Rawashdeh O, Owens T, Polman CH, Lowe JS, et al. Clinico-pathological evidence that axonal loss underlies disability in progressive multiple sclerosis. Mult Scler 2010; 16(4): 406-11.
  3. Barin L, Salmen A, Disanto G, Babacic H, Calabrese P, Chan A, et al. The disease burden of multiple sclerosis from the individual and population perspective: Which symptoms matter most? Mult Scler Relat Disord 2018; 25: 112-21.
  4. Comber L, Galvin R, Coote S. Gait deficits in people with multiple sclerosis: A systematic review and meta-analysis. Gait Posture 2017; 51: 25-35.
  5. Sosnoff JJ, Sandroff BM, Motl RW. Quantifying gait abnormalities in persons with multiple sclerosis with minimal disability. Gait Posture 2012; 36(1): 154-6.
  6. Plotnik M, Wagner JM, Adusumilli G, Gottlieb A, Naismith RT. Gait asymmetry, and bilateral coordination of gait during a six-minute walk test in persons with multiple sclerosis. Sci Rep 2020; 10(1): 12382.
  7. Socie MJ, Sosnoff JJ. Gait variability and multiple sclerosis. Mult Scler Int 2013; 2013: 645197.
  8. Kalron A. Association between gait variability, falls and mobility in people with multiple sclerosis: A specific observation on the EDSS 4.0-4.5 level. NeuroRehabilitation 2017; 40(4): 579-85.
  9. Bot JC, Barkhof F, Polman CH, Nijeholt GJ, de G, V, Bergers E, et al. Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology 2004; 62(2): 226-33.
  10. Alashram AR, Annino G, Mercuri NB. Rhythmic auditory stimulation in gait rehabilitation for traumatic brain and spinal cord injury. J Clin Neurosci 2019; 69: 287-8.
  11. Thaut MH, Abiru M. Rhythmic auditory stimulation in rehabilitation of movement disorders: A review of current research. Music Perception 2010; 27(4): 263-9.
  12. Shin J, Chung Y. The effects of treadmill training with visual feedback and rhythmic auditory cue on gait and balance in chronic stroke patients: A randomized controlled trial. NeuroRehabilitation 2022; 51(3): 443-53.
  13. Rolak LA. Multiple sclerosis: it's not the disease you thought it was. Clin Med Res 2003; 1(1): 57-60.
  14. Baram Y, Miller A. Glide-symmetric locomotion reinforcement in patients with multiple sclerosis by visual feedback. Disabil Rehabil Assist Technol 2010; 5(5): 323-6.
  15. Baram Y, Miller A. Auditory feedback control for improvement of gait in patients with Multiple Sclerosis. J Neurol Sci 2007; 254(1-2): 90-4.
  16. Conklyn D, Stough D, Novak E, Paczak S, Chemali K, Bethoux F. A home-based walking program using rhythmic auditory stimulation improves gait performance in patients with multiple sclerosis: A pilot study. Neurorehabil Neural Repair 2010; 24(9): 835-42.
  17. Spaulding SJ, Barber B, Colby M, Cormack B, Mick T, Jenkins ME. Cueing and gait improvement among people with Parkinson's disease: A meta-analysis. Arch Phys Med Rehabil 2013; 94(3): 562-70.
  18. Raglio A. Music therapy interventions in Parkinson’s disease: The state-of-the-art. Front Neurol 2015; 6: 185.
  19. Altenmuller E, Schlaug G. Apollo's gift: New aspects of neurologic music therapy. Prog Brain Res 2015; 217: 237-52.
  20. Thaut MH, McIntosh GC, Rice RR, Miller RA, Rathbun J, Brault JM. Rhythmic auditory stimulation in gait training for Parkinson's disease patients. Mov Disord 1996; 11(2): 193-200.
  21. Lee S, Lee K, Song C. Effects of rhythmic auditory stimulation (RAS) on gait ability and symmetry after stroke. J Phys Ther Sci 2012; 24(4): 311-4.
  22. Lee Y, Shin S. Improvement of gait in patients with stroke using rhythmic sensory stimulation: A case-control study. J Clin Med 2022; 11(2): 425.
  23. Suh JH, Han SJ, Jeon SY, Kim HJ, Lee JE, Yoon TS, et al. Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients. NeuroRehabilitation 2014; 34(1): 193-9.
  24. Kitatani R, Umehara J, Hirono T, Yamada S. Rhythmic auditory stimulation during gait adaptation enhances learning aftereffects and savings by reducing common neural drives to lower limb muscles. J Neurophysiol 2022; 128(5): 1324-36.
  25. Thaut MH, Stephan KM, Wunderlich G, Schicks W, Tellmann L, Herzog H, et al. Distinct cortico-cerebellar activations in rhythmic auditory motor synchronization. Cortex 2009; 45(1): 44-53.
  26. Cha Y, Kim Y, Chung Y. Immediate effects of rhythmic auditory stimulation with tempo changes on gait in stroke patients. J Phys Ther Sci 2014; 26(4): 479-82.
  27. Manca A, Peruzzi A, Aiello E, Cereatti A, Martinez G, Deriu F, et al. Gait changes following direct versus contralateral strength training: A randomized controlled pilot study in individuals with multiple sclerosis. Gait Posture 2020; 78: 13-8.
  28. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983; 33(11): 1444-52.
  29. Salehi R, Mofateh R, Mehravar M, Negahban H, Tajali S, Monjezi S. Comparison of the lower limb inter-segmental coordination during walking between healthy controls and people with multiple sclerosis with and without fall history. Mult Scler Relat Disord 2020; 41: 102053.
  30. Pau M, Leban B, Massa D, Porta M, Frau J, Coghe G, et al. Inter-joint coordination during gait in people with multiple sclerosis: A focus on the effect of disability. Mult Scler Relat Disord 2022; 60: 103741.
  31. Naderi S, Mohammadipour F, Amir Seyfaddini MR. Kinematics of lower extremity during forward and backward walking on different gradients. Physical Treatments 2017; 7(2): 71-8. [In Persian].
  32. Shafizadeh M, Watson PJ, Mohammadi B. Intra-limb coordination in gait pattern in healthy people and multiple sclerosis patients. Clinical Kinesiology 2013; 67(3): 32-8.
  33. Zeni JA, Jr., Richards JG, Higginson JS. Two simple methods for determining gait events during treadmill and overground walking using kinematic data. Gait Posture 2008; 27(4): 710-4.
  34. Sadeghi H, Allard P, Prince F, Labelle H. Symmetry and limb dominance in able-bodied gait: A review. Gait Posture 2000; 12(1): 34-45.
  35. Tura A, Raggi M, Rocchi L, Cutti AG, Chiari L. Gait symmetry and regularity in transfemoral amputees assessed by trunk accelerations. J Neuroeng Rehabil 2010; 7: 4.
  36. Thaut MH. Neural basis of rhythmic timing networks in the human brain. Ann N Y Acad Sci 2003; 999: 364-73.
  37. Thaut MH, Kenyon GP. Rapid motor adaptations to subliminal frequency shifts during syncopated rhythmic sensorimotor synchronization. Hum Mov Sci 2003; 22(3): 321-38.
  38. Erra C, Mileti I, Germanotta M, Petracca M, Imbimbo I, De Biase A, et al. Immediate effects of rhythmic auditory stimulation on gait kinematics in Parkinson's disease ON/OFF medication. Clin Neurophysiol 2019; 130(10): 1789-97.
  39. Gonzalez-Hoelling S, Bertran-Noguer C, Reig-Garcia G, Suner-Soler R. Effects of a music-based rhythmic auditory stimulation on gait and balance in subacute stroke. Int J Environ Res Public Health 2021; 18(4).
  40. Shahraki M, Sohrabi M, Taheri Torbati HR, Nikkhah K, NaeimiKia M. Effect of rhythmic auditory stimulation on gait kinematic parameters of patients with multiple sclerosis. J Med Life 2017; 10(1): 33-7.
  41. Kwak EE. Effect of rhythmic auditory stimulation on gait performance in children with spastic cerebral palsy. J Music Ther 2007; 44(3): 198-216.
  42. Wagenaar RC, Beek WJ. Hemiplegic gait: a kinematic analysis using walking speed as a basis. J Biomech 1992; 25(9): 1007-15.
  43. Amatachaya S, Keawsutthi M, Amatachaya P, Manimmanakorn N. Effects of external cues on gait performance in independent ambulatory incomplete spinal cord injury patients. Spinal Cord 2009; 47(9): 668-73.
  44. Thompson WF, Schellenberg EG, Husain G. Arousal, mood, and the Mozart effect. Psychol Sci 2001; 12(3): 248-51.
Journal of Research in Rehabilitation Sciences
Volume 18, Issue 1
2022
Pages 92-99
  • Receive Date: 11 May 2023
  • Revise Date: 31 August 2023
  • Accept Date: 04 September 2023