THE EFFECT OF RHYTHMIC AUDITORY STIMULATION TEMPO SHIFTS APPLICATION ON GAIT PARAMETERS IN CHRONIC STROKE PATIENTS: A PILOT STUDY

J. Hamzeh¹, M. Ballout¹, S. Al Neyadi¹, M.C. Baradhi¹, F. Ayoubi¹

¹Antonine University (UA), Department of Physical Therapy, Baabda, Lebanon

Background: Stroke is the second leading cause of death worldwide and results in significant morbidities in one third of its survivors, which makes it a huge concern in the medical field (1). Among the most disabling and prevalent consequences are gait disturbances (2). Despite the presence of several evidence-based rehabilitation approaches none has shown superiority over the other up till this current day. Yet, Rhythmic Auditory Stimulation (RAS) has evolved as a promising effective method to target gait impairments and pathologic patterns (3). RAS is still an approach being refined, certain studies showed that varying tempos would result in more significant improvements in gait compared to utilizing only baseline tempo, yet this remains under investigation (4,5).

Purpose: The aim of this study is to evaluate whether applying various rhythmic auditory stimulation tempos would result in more significant and clinically beneficial evolution in the studied gait parameters compared to baseline training alone in chronic stroke patients.

Methods: After obtaining informed consent and ethical approval for the study, ten participants diagnosed with chronic stroke and meeting eligibility criteria were enrolled in the protocol which consisted of a within subject experiment. The participants were instructed to walk without any stimulation to calculate baseline data. Then they were asked to walk under baseline tempo which was obtained from their self-selected cadence. Afterwards, they walked under three randomly assigned tempos (-10%, +10%, and +20%) and finally without any stimulation. The overall duration of the session was 45 minutes including rest time and functional conventional treatment, the protocol consisted of twelve sessions. IBM SPSS version 24 was used for data analysis and Kinovea software was used for gait analysis in addition to 10-m walk test.

Results: Paired sample t-test and repeated measures ANOVA followed by post hoc analysis were used to study the variables and report findings. All assumptions were checked respectively. All studied spatiotemporal parameters improved significant across time (p<0.05). Variations in improvement and evolution in different variables were detected in some of the studied variables upon changing tempos (p<0.05). Kinovea is a valid tool as reported by other studies in quantifying different gait parameters.

Conclusions: Utilizing various tempos results in more significant changes in several gait parameters. For instance, applying faster tempos led to more significant improvements in cadence and velocity, while applying slower tempos improved symmetry more significantly. Thus, various tempos should be used in a targeted manner to induce significant changes in hemiplegic gait patterns. Further studies should focus on the long-term effects of various RAS tempos and their induced physiological processes.

Implications: Stroke is a burden in the medical field, and when it comes to the neurological system, physical therapists are masters in understanding and dealing with its variant challenging issues. Such a study presents an innovative technique which should be well structured to target specific physiological responses to combat the burden of stroke. Additionally, we presented the utilization of a valid and reliable software to advance gait analysis and aim to develop such crucial methods for assessment, diagnostic, and treatment roles and planning.

Funding acknowledgements: No Funding was allocated for this research project

Keywords:
Stroke
Rehabilitation
Gait

Topics:
Neurology: stroke
Innovative technology: information management, big data and artificial intelligence
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Antonine University

Committee: CEUA

Ethics number: CEUA 056