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Rhythmic Auditory Stimulation in Gait Training

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Taylor Marcum

on 9 April 2015

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Transcript of Rhythmic Auditory Stimulation in Gait Training

RAS in Patients with Parkinson's Disease
One of the most characteristic signs of Parkinson's disease is bradykinesia and shuffling gait with shortened stride lengths and also with a decreased cadence.
High stride to stride variability is also an issue with Parkinson's disease patients
The gait deficiencies that are seen in Parkinson's disease are often resistant to pharmacological treatments and drug therapy.
One of the nonpharmacologic treatment options is rhythmic auditory stimulation through visual and auditory cues to facilitate locomotion and increased gait speed.
RAS in Patients who suffered Strokes
RAS has the same physiologic effects on patients who suffered strokes compared to people who suffer from Parkinson's disease
Showed improvements over a 3 week period in:
-gait speed
-stride length
-gait symmetry
RAS in the Clinic
Free Metronome Apps for phones and tablets
-Pro Metronome Tempo Keeping
-Real Metronome Free
Music from phone

-Studies show that RAS has an effect on gait in many different types of patients in the clinic
-Offers a temporary effect for patient's with Parkinson's disease, but may provide longer term benefits for patients with strokes
-Easy thing to use in the clinic and to incorporate into gait training during treatment sessions

Rhythmic Auditory Stimulation in Gait Training
Taylor Marcum, SPT
Langston University
Doctor of Physical Therapy Program
Class of 2015
The purpose of this presentation is to inform the audience of the uses of rhythmic auditory stimulation in the gait training of patients with Parkinson's or who suffered a stroke.
By the end of this presentation, the audience will be able to:
-Define rhythmic auditory stimulation and recall its connection to the motor system
-Formulate a treatment plan for a patient who could benefit from rhythmic auditory stimulation
What is Rhythmic Auditory Stimulation?
Rhythmic Auditory Stimulation (RAS) has multiple definitions, but can be summed up as:

a technique using the physiological effects of auditory rhythm or music on the motor system to improve the control of movement through rhythmic auditory cues synchronize motor responses into stable time relationships
1. Thaut, M., Abiru, M. Rhythmic Auditory Stimulation in Rehabilitation of Movement Disorders: A Review of Current Research.
Music Perception
. 2010. 27(4): 263-269.
2. Thaut, M., McIntosh, G., Rice, R., Miller, R., Rathbun, J., and Brault, J. Rhythmic Auditory Stimulation in Gait Training for Parkinson's Disease Patients.
Movement Disorders
. 1996. 11(2): 193-200.
3. Hausdorff, J., Lowenthal, J., Herman, T., Gruendlinger, L., Peretz, C., Giladi, N. Rhythmic Auditory stimulation modulates gait variability in Parkinson's disease. European J of Neuroscience
4. Cha, Y., Kim, Y., Chung, Y. Immediate Effects of Rhythmic Auditory Stimulation with Temp Changes on Gait in Stroke Patients. 2014.
J Phys Ther Sci
. 26: 479-482
5. Thaut et al. Rhythmic Auditory Stimulation Improves Gait More than NDT/Bobath Training in Near-Ambulatroy Patients Early Poststroke: A Single-Blind, Randomized Trial.
Neurorehabilitation and Neural Repair
. 2007; 21(5)457-461.
RAS has been used in the treatment of patients with:

Parkinson's Disease
Cerebral Palsy
Traumatic Brain Injury
Uses of Rhythmic Auditory Stimulation
How Rhythmic Auditory Stimulation Works
Reference 1
-RAS works due to its effect on the motor system
-Evidence has shown that the auditory and motor systems connect across a variety of cortical, subcortical, and spinal levels
-The auditory system projects into motor structures in the brain and in turn creates entrainment between rhythmic signal and the motor response
Reference 2, 3
Results from studies showed that when rhythmic auditory stimulation was used in gait training in patient's with Parkinson's disease, the patients experienced:
-improved velocity
(both flat and inclined surfaces by 25%)
-improved stride length
-changes in Vastus Lateralis muscle activation period

Reference: 4
Research showed in patients who suffered from strokes, RAS showed to have an effect on the cerebral activity that induces synchronization of movement to the rhythm through sensory stimulation
It was also shown that in patient's who suffered stroke, that with RAS as a person tries to synchronize their movements to the beat that concentration and motor control are promoted.
RAS Techniques
Begin with a baseline cadence assessment to determine baseline beats per minute (bpm)
Increase cadence by 5% in increments as indicated without compromising posture or dynamic stability.
Gradually fade the cues to train for independent carryover
Reference 5
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