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RHYTHMIC AUDITORY STIMULATION

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julie palmer

on 1 May 2013

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Transcript of RHYTHMIC AUDITORY STIMULATION

Rhythmic Auditory Stimulation Rhythmic Auditory Stimulation
Why it works! Occupational Therapy's
Role So let's get moving! Identify the usefulness of rhythmic auditory stimulation (RAS), in occupational therapy interventions.
Explain how RAS can help in reducing the risk of falls in patients with Parkinson's disease.

NMT is an evidenced-based practice with treatment techniques founded on the neuroscience model of music perception and on the production and influence of music on FUNCTIONAL changes in non-musical brain and behavior functions.

The American Music Therapy Association notes that music therapy is recognized as a viable treatment option, including in federal law and by accrediting agencies. It is included in the Older Americans Act Amendments of 1992 and the Individuals with Disabilities Education Act, and recognized by the Rehabilitation Accreditation Commission and the Joint Commission on the Accreditation of Health Care Organizations.

"The timing aspects of music, and it's rhythmic components, influence temporal regulation of movement.
Rhythm is best described as a sensory timer that uses the connections between the auditory and motor systems in the brain
to influence time control in movement."
(Rhythm, Music and the Brain. Thaut, Michael. 2005.) Rhythmic Auditory Stimulation (RAS) Can be performed in the client's home.
Cost effective and accessible to the patient.
Non-invasive treatment that has no side-effects.
Client can choose the music based on personal preferences.
Reimbursable by some insurance companies, if a doctor prescribes it. Benefits of RAS
Michael Thaut, Ph.D., and his colleagues at Colorado State University suggest that the sensitivity of our motor systems to influences from sounds may have developed during human evolution so we could use the way we process what we hear to enhance our ability to organize and control our movements. Our basic auditory-arousal mechanisms (for example, our movements in reaction to a sudden loud noise) operate primarily through the amygdala in the brain’s limbic system and may have originated in adaptive evolutionary processes, namely, the fight-or-flight response.






(Rhythm, Music and the Brain. Thaut, Michael. 2005.) Neurological Music Therapy (NMT) Patients could be asked to perform tasks during therapy
while listening to progressively faster or slower music,
adjusting the tempo to facilitate the best functional movement.
Just by adding a little music, with that “just right” beat,
can help reduce the shuffling and freezing that happens in the parkinsonian gait. This would allow the patient to enjoy a nice walk outside in the fresh air, without worrying that will suddenly freeze while crossing a busy street. By Julie Palmer Possible uses of RAS in OT: Learning Objectives
RAS uses musical auditory cues with specific rhythmic patterns to help facilitate gait training in patients who have freezing episodes, imbalance or dysfunctional muscle control.

RAS takes advantage of the brain’s own plasticity, and the CNS’s natural entrainment to rhythm to achieve goals. Auditory cues can be in the form of a metronome beat or accenting beats in musical selections, which cue gait characteristics, such as step cadence, stride length, velocity, and stride duration. Occupational
Everywhere we go-o
People wanna know-o
What is OT
So we tell them
We're not RTs
Recreations their thang
We're not nursing
You’ll wipe your own butt clean
We're not PT
We’re O T A’s
We’ll our boards with straight A's
Let me hear you shout HooRay! Parkinson's Disease (PD) Levodopa (L-dopa)
increases the amount of dopamine in the body
helps improve mobility issues associated with PD
Side effects are nausea, vomiting, low blood pressure,
involuntary movements, and restlessness.

The period of effectiveness from each dose may begin to shorten, called the wearing-off effect.
Another potential problem is referred to as the on-off effect-sudden, unpredictable changes in movement, from normal to parkinsonian movement and back again, possibly occurring several times during the day. Studies have shown that RAS can improve the spatiotemporal features of gait in patients with Parkinson's disease (Ruebenstein et al., 2002; Lim et al., 2005). When using RAS, administered in the form of a metronome, gait and stride length improved in PD patients in both the on and off states. When it was administered at a rate equal to or 10% higher than the baseline step rate of the patient, it increased stride length and gait speed
(Howe et al., 2003; Willems et al., 2006). This suggests that because RAS sets the pace, it can act like an external rhythm generator and help restore normal rhythmicity, thus reducing stride-to-stride variability. Everywhere we go-o
People wanna know-o
What is OT
So we tell them
We're not RTs
Recreations their thang
We're not nursing
You’ll wipe your own butt clean
We're not PT
They don't even smell clean
We're not Security Guards
And we don’t tow cars
We’re O T A’s
We’ll pass the boards with straight A’s
Let me hear you shout YAY!
Increases dopamine levels in the body and improves the patient's mobility.
The most common side effects are nausea, vomiting, low blood pressure, involuntary movements, and restlessness. The period of effectiveness from each dose may begin to shorten, called the wearing-off effect. Another potential problem is referred to as the on-off-effect that causes sudden, unpredictable changes in movement, from normal to parkinsonian movement and back again, possibly occurring several times during the day. This is the reason why some patient's choose alternative methods of treatments, like RAS. Levodopa (L-dopa) for movement!
An occupational therapist’s main goal is to enhance people’s quality of life by removing or reducing barriers that limit their ability to carry out routine activities.







Because of problems with balance, people with PD are at greater risk for falls and broken bones so it's very important to keep this in mind when selecting the tempo for the musical cues. References

Thaut, M.H., McIntosh, G.C. (2006). Rhythmic auditory training in sensorimotor rehabilitation of people with Parkinson’s Disease. Neurorehabilitation & Neural Repair, 20, 81.

Thaut MH. In: Rhythm, music, and the brain: Scientific foundations and clinical applications. Thaut MH, editor. New York: Routledge; Taylor and Francis Group; 2005. Music in therapy and medicine: from social science to neuroscience; pp. 113–136.

Hurt, C.P., Rice, R.R., McIntosh, G.C., & Thaut, M.H. (1998). Rhythmic auditory stimulation in gait training for patients with traumatic brain injury. Journal of Music Therapy, 35, 228-241.

YouTube video Neurological music therapy technique that is commonly used with patients who have Parkinson's disease. Music can communicate directly with our brain to enable movement, humans can physically map music with cerebral temporal coding in order to make sense of rhythm and musical motion.
Music can therefor be used as a tool to help patients learn, maintain or re-gain functional life skills, such as movement, attention or communication. Rhythmic auditory stimulation (RAS) Neurological music therapy (NMT) Evidenced based practice with treatment techniques based on the production and influence of music on functional changes in non-musical brain and behavioral functions. Using the timing cue of rhythm to retrain the speed of specific human movements, RAS is based on the concept of the brain's ability to re-wire and repair itself after injury and disease. It also takes into account the CNS's natural entrainment to rhythm to achieve goals. The American Music Therapy Association recognizes this form of music therapy as a viable treatment option, including federal law and by accreditation agencies. It's included in the Older Americans Act Amendments of 1992 and the Individuals with Disabilities Education Act, and it's also recognized by the Rehabilitation Accreditation of Health Care Organizations. Parkinson's disease (PD) Degenerative disease of the CNS that causes a gradual loss of ability to totally control bodily movements. Nerve cells in the basil ganglia are damaged or destroyed in PD, these cells make and use a brain chemical called dopamine, a neurotransmitter that sends messages to other parts of the brain to coordinate body movements. This destruction causes the levels of dopamine to decrease, interrupting the normal messaging system between the brain and body. As soon as 80% of these cells are damaged, symptoms of Parkinson's begin to appear. After viewing this presentation, students will be able to: The therapist provides a rhythmic beat at a prescribed tempo to help the patient train movements that are intrinsically or biologically rhythmic, such as walking or dancing.
Initially, the therapist matches the rhythm tempo to the patient’s current walking cadence. Gradually, the therapist makes systematic increases in the rhythm tempo, so the patient can achieve a more functional gait.
The human auditory system is quick to detect auditory patterns, such as a simple, repeating rhythmic beat. Due to strong connections between the auditory system and the body’s motor system, any type of movement (i.e., walking or speaking) will automatically synchronize with the beat that is being heard. The movement then occurs at the same speed or frequency as the rhythmic beat, making the movement more stable and regular.

flexed posture
shuffling steps
decreased stride length regulation
reduced foot clearance during swing phase
increased cadence
freezing of gait

Because Parkinson's disease usually develops slowly, most people who have it can usually live a long and relatively healthy life. Common gait dysfunctions in PD: So how do you use RAS? Music Provides a Framework References Research:
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