Step into the New Year with the IM Gait Mate

Brain Bloggin' with Dr. Kevin McGrew

Brain Clock Research Bytes #3: Timing-based interventions improve gait (Parkinson's), stroke rehab, and golf

http://www.ticktockbraintalk.blogspot.com/

Abstract: Patients with Parkinson’s disease (PD) walk with a shortened stride length and high stride-to-stride variability, a measure associated with fall risk. Rhythmic auditory stimulation (RAS) improves stride length but the effects on stride-to-stride variability, a marker of fall risk, are unknown. The effects of RAS on stride time variability, swing time variability and spatial-temporal measures were examined during 100-m walks with the RAS beat set to 100 and 110% of each subject’s usual cadence in 29 patients with idiopathic PD and 26 healthy age-matched controls. Carryover effects were also evaluated. During usual walking, variability was significantly higher (worse) in the patients with PD compared with the controls (P < 0.01). For the patients with PD, RAS at 100% improved gait speed, stride length and swing time (P < 0.02) but did not significantly affect variability. With RAS at 110%, reductions in variability were also observed (P < 0.03) and these effects persisted 2 and 15 min later. In the control subjects, the positive effects of RAS were not observed. For example, RAS increased stride time variability at 100 and 110%. These results demonstrate that RAS enables more automatic movement and reduces stride-to-stride variability in patients with PD. Further, these improvements are not simply a by-product of changes in speed or stride length. After walking with RAS, there also appears to be a carryover effect that supports the possibility of motor plasticity in the networks controlling rhythmicity in PD and the potential for using RAS as an intervention to improve mobility and reduce fall risk.

The original Libkuman et al. (2002) study (well designed IMHO) demonstrating the positive effects of the brain-clock based Groove treament (based on the Interactive Metronome technology) on improved golf performance. [see conflict of interest disclosure post]

Abstract: In this experiment, the authors investigated the influence of training in timing on performance accuracy in golf. During pre- and posttesting, 40 participants hit golf balls with 4 different clubs in a golf course simulator. The dependent measure was the distance in feet that the ball ended from the target. Between the pre- and posttest, participants in the experimental condition received 10 hr of timing training with an instrument that was designed to train participants to tap their hands and feet in synchrony with target sounds. The participants in the control condition read literature about how to improve their golf swing. The results indicated that the participants in the experimental condition significantl improved their accuracy relative to the participants in the control condition, who did not show any improvement. We concluded that training in timing leads to improvement in accuracy, and that our results have implications for training in golf as well as other complex motor activities.

And yet another positive RAS stroke study by the Thaut et al. (2007) research group

Abstract: Objectives: The effectiveness of 2 different types of gait trainingi n stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath-based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35). Methods.Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender,and lesion site. Motor function in both groups was preassessed by the Barthel Index and the Fugl-Meyer Scales. Results. Pre- to posttest measures showed a significant improvement in the RAS group for velocity (P = .006), stride length (P = .0001), cadence (P = .0001) and symmetry (P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence. Conclusions. The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.