Wednesday, October 19, 2011

Treadmill Training with Music Cueing: a New Approach for Parkinson's gait facilitation

Reference: Treadmill Training with Music Cueing: a New Approach for Parkinson's gait facilitation
Author: Dootchai Chaiwanichsiri, Wuttinganok Wangno, Wasuwat Kitisomprayoonkul, Roongroj Bhidayasiri
Source: Asian Biomedicine Volume 5, No. 5 October 2011; 649-654
DOI: 10.5372/1905-0505.086
This article describes the effects of musical cueing on treadmill training within a randomized single-blind controlled trial of thirty male Parkinson's disease (PD) patients. Participants eligible for the study were males between the ages of 60-80 years of age, diagnosed as idiopathic PD, Hoehn and Yahr stage 2-3, and possessing good cognitive function on Thai Mental State Examination, stable symptoms with unmodified anti-parkinsonian medication throughout the study, and independent walking skills without any aids. As well, there could not be any other existing medical conditions among the patients, nor could they have participated in any previous training during the previous two months, and good hearing and vision were imperative.
Participants were divided into three randomized groupings, each containing ten members: Group A, B, and C. Group A completed treadmill training with music cueing for three days/week and a home walking program for three days/week; treadmill training for three days/week combined with a home walking program three days/week was prescribed to group B, and group C participated in six days of home walking/week. Each treadmill session consisted of ten minutes of stretching exercise followed by twenty minutes of treadmill walking with long steps at each participants' preferred speed. Once the appropriate gait was selected, the pace was adjusted 5-10% faster, to the degree that the patients could still maintain an appropriate gait without difficulties or missteps. The music cue involved the use of five relaxing green music pieces which were chosen and modified by stretching or retracting the tempo using a computer music program manager. In group A, the treadmill speed was measured by an electric metronome, which was then matched with prepared music of a corresponding tempo. Participants were trained to walk in step with the rhythm of music on the treadmill, and were given MP3 recordings to take home and use during their home practice. Subjects’ home practice included a ten minute stretching exercise followed by twenty minutes of walking, which was monitored by a stretching handbook and walking diary.
Two physicians and one research assistant performed regular evaluations of participants that included interviews about medical history, gait and balance assessments, tests on step length and stride length, walking speed over 6-meter walking sections, and calculation of step cadence.
An assessment of the data collected throughout the study confirmed significant improvement to step and stride length only in group A, which was maintained to the end of the eight week study. Group A also showed the greatest increases in speed and balance, as compared between all three groups. Although one participant in this group fell during one of the at-home training sessions, he was still able to continue with the study, and did not sustain any injuries from the fall.
The enhancement to PD patients’ gait that members of participant group A displayed confirm the effectiveness of auditory cues, such as music, to module the gait pattern of an individual. External motor cues provided through the use of a 6-week intensive treadmill training sessions also increased the stride length and walking speed of those with mild to moderate cases of PD. During these sessions, the speed of the treadmill was increased in increments related to the patient’s ability to maintain gait. Evidence, however, shows that dual tasks, such as auditory and attentional cues, when used in synchronicity, can be detrimental to gait pattern in PD sufferers. Those patients who were given music cues, though, were able to follow the music-treadmill training without any difficulties, and compared to the use of a metronome, had a more therapeutic effect. Therefore, participants who walked with music cues were able to maintain a faster cadence than those who walked to the sound of metronomic cueing. The relaxation and positive emotions that result from music can also be linked to the overall improvements of music to PD patients, as typically, these are deficient areas, as well.
Conclusively, the use of auditory rhythmic musical cues can be used to improve gait and balance, through treadmill-training, for mild to moderate PD sufferers. Additionally, improvements to gait training, as well as to mood and adherence are other applications where musical cueing combined by treadmill walking can be effective.

This trial study, which measured the effectivity of musical cueing combined with treadmill training among Parkinson's Disease sufferers, affected me in an overwhelming way. I have always been a staunch advocate of practicing "music for music's sake" and not as an enabler or a tool to facilitate other learning or to accomplish other extrinsic goals. I do not promote or support the claims that music makes you smarter or that music should be used to build mathematical skills, and have always lumped music therapy in this same category--one that relies upon music to do something beyond simply existing. However, through my encounters with research that shows the transformative effects that music can have on one's overall health, I am evaluating my own value system and beginning to question why should music not be used to its full potential. In accordance, I am looking at the ways through which musical practices can improve the quality of one's health and thus, one's life, and realizing that it is a more indispensable component to our lives than just music on its own.

Several thoughts arise as I reflect on these results. For starters, the benefits that the participating PD patients encountered after an 8-week trial of treadmill training using musical cues hopeful to individuals suffering with PD, as well as other diseases which attack cognitive function, such as dementia and Alzheimer's disease, and possibly even victims of stroke. If music proves an effective tool for remoulding one's brain, forcing in-tact cerebral areas to assume the functions that the primary control-centres no longer support, there is future potential for rehabilitation in a myriad of situations. Patients who are experiencing depression, anxiety or even Post Traumatic Stress Disorder (PTSD) stand to benefit from the therapeutic benefit of music. I am fascinated to conduct my own trials with individuals suffering from the early onset of both dementia and Parkinson's disease, and also, to test the effectivity of music in more pronounced cases of Alzheimer's. It is ironic, that, in an age of medical advancements technological developments, which are occurring at an alarming rate, the Western societal acceptance of music as a means of healing is only in its developing stages. Music education, therefore, needs to be an all-encompassing goal of not only developing musicians for aesthetic purposes, but also developing music for the health of body, mind and spirit. 

1 comment:

Alicia_Ritmundi said...

Hi Andrea,
I sincerely appreciated your honesty in the "reevaluation" of your belief system, in regards to music having another function, aside from listening and creation.

"The use of auditory rhythmic musical cues can be used to improve gait and balance, through treadmill-training, for mild to moderate PD sufferers. Additionally, improvements to gait training, as well as to mood and adherence are other applications where musical cueing combined by treadmill walking can be effective."

I value this quote immensely, as it exemplifies the creative means in which music can be applied to various medical demographics, to increase their quality of life. Furthermore, with the inclusion of music with other therapies, such as physical therapy, brings another dimension in recovery to the patient. It should also be taken into consideration that some patients have a more sensibility and response to music in recovery, and the results of this study demonstrates this.