COUPLING STEPS TO MUSIC AND METRONOMES AT DIFFERENT TEMPI IN PERSONS WITH CEREBELLAR IMPAIRMENTS AND ITS EFFECTS ON GAIT

L. Moumdjian^1,2, B. Moens², M. Leman², M. Manto³, P. Feys¹

¹Hasselt University, Faculty of Rehabilitation Sciences, Hasselt, Belgium, ²Gent University, Faculty of Arts and Philosophy, Gent, Belgium, ³C.H.U. Charleroi, Charleroi, Belgium

Background: Coupling walking to rhythms has become a topic of recent interest in the field of neurological rehabilitation. In Parkinson’s Disease and Multiple Sclerosis, coupling steps to beats in music and ticks in metronomes have shown to promote a therapeutic advantage of altering walking pattern. The question however arises if these strategies are applicable in persons with cerebellar impairments presenting with ataxia. Given the function of the cerebellum in timing control, this question becomes crucial and of significant relevance, as effective rehabilitation strategies to improve gait ataxia are lacking.

Purpose: The purpose of this study is to investigate if persons with cerebellar impairments (PwCI) would be able to synchronise their walking to auditory stimuli provided at different tempi compared to healthy controls (HC). In addition, we investigate the changes of the gait pattern as a result of coupling.

Methods: A case-control study including 11 PwCI and 7 HC was conducted. Participants were equipped with a custom-made music player (the Djogger) and portable sensors strapped on the ankles (APDM). They were asked to walk in a rectangular pathway to music and metronomes with explicit instructions to synchronise their step to the rhythmic structure in the auditory stimuli at 7 different tempi. These were tempi equal to their natural cadence (0%), and at -12%, -8% -4%, +4%, +8%, + 12% of their natural cadence. All tempi and the blocks of stimuli were randomised. Synchronisation consistency (resultant vector length - RVL) and spatiotemporal gait parameters (cadence, stride length, speed, double support) were computed from each walking trial.

Results: PwCI were able to synchronise, and adapt their gait pattern to the different tempi. HC synchronised more consistently than PwCI (RVL 0.77 compared to 0.52 respectively, p<.0272) while both groups synchronised less consistently when walking to music compared to metronomes (p<.0009) and across the different tempi (p<.0007). There were no significant differences between the groups on the gait outcomes. Significant changes were found at the level of tempi in the outcomes of cadence, stride length and speed, indicating that all participants changed their gait pattern in order to meet the demands of synchrony across tempi. Specific to stimuli, significant changes in double support was found in all participants (p<.0025), where an increase was seen when walking to the metronomes (1.8%), and a decrease when walking to music (-0.9%).

Conclusions: These preliminary results indicate that PwCI were able to synchronise although with more variability that HC. Moreover, the changes in the gait patterns which were undertaken by PwCI in order to comply with the task of synchronising were similar to that of HC. Further work of completing the analysis with a greater sample size is needed, as well as investigating outcomes directed to gait variability.

Implications: PwCI were able to adapt their gait pattern and match the thresholds at higher and lower tempi to both music and metronomes, and thus the preliminary results may be indicative of a potential for the application of strategies using auditory-motor coupling in task-oriented training of walking in PwCI.

Funding acknowledgements: Lousin Moumdjian is funded by an FWO mandate from Belgium.

Keywords:
Auditory-motor coupling
Cerebellar impairments
Gait

Topics:
Neurology
Neurology: stroke

Did this work require ethics approval? Yes

Institution: Hasselt University (central), C.H.U. Charleroi (local)

Committee: Medical ethical committee

Ethics number: B1152021000003