Russo M1, Russo EF1, Cannone M1, Calabrò RS2, Filoni S1
1Fondazione Centri di Riabilitazione Padre Pio Onlus, Gli Angeli di Padre Pio, San Giovanni Rotondo, Italy, 2IRCCS Centro Neurolesi 'Bonino-Pulejo', Messina, Italy
Background: Multiple sclerosis (MS) is a neurological inflammatory demyelinating disease that affects people´s walking, participation and quality of life.
Neurologic Music Therapy (NMT), developed by Michael Taut, is a program of therapeutic application of music that makes use of Rhythmic Auditory Stimulation (RAS) and Patterned Sensory Enhancement (PSE) to modify the intrinsically cadenced signals as the gait. NMT has been adopted in diseases such as Stroke, Head Injury, Cerebral Palsy and Parkinson´s disease, but only few studies have been conducted in MS patients.
Purpose: To evaluate the variations of the walking pattern in a MS patient with Music Assisted Therapy (MAT), based on the studies that show non-rhytmic elements in music can be applied to improve not only temporal gait measures such as stride length and gait velocity, but functional movements such as arm swing, hip flexion, and postural alignment and on the integration of a library of informed music into an instrumented treadmill.
Methods: The patient L.E. 34 years old, suffering from secondarily progressive MS since 2004; she has spastic paraparesis, balance deficit, deficiency of the deambulation, alva and neurogenic bladder.
L.E. was subjected to a walking training with instrumental treadmill combined with MAT, consisting of 20 sessions with a cadence three-weekly, lasting 30 minutes.
The device used was the Biodex Gait Trainer 3 with integrated informed music. The patient during the hospitalization also performed traditional physiotherapy.
The patient was evaluated pre (T0) and post-training (T1) with the following clinical scales: 10 Meter Walking Test (10MWT), Time Up and Go test (TUG), 6 Minute Walking Test (6MWT), Motricity Index(MI), Modified Ashworth Scale (MAS), Modified Barthel Index (mBI), Walking Handicap Scale (WHS), Functional Ambulation Classification (FAC).
It has also been assessed the static postural balance by using the Prokin PK252 (Tecnobody) performing stabilometric and Romberg test. In addition, the patient was also subjected to kinematic analysis of the gait with the Bts Smart DX.
Results: Clinical scales: mBI (T0: 72, T1: 76), MAS, MI (T0_DX: 71.5, T0_SX: 69, T1_DX: 85, T1_SX: 76.5), FAC (T0: 2, T1: 4), 10 mWT (T0: 0.44m/s, T1: 0.59m/s), 6mWT (T0: 117m, T1: 160m), TUG (T0: 22.2s, T1: 17.2s), WHS (T0: 3, T1: 4).
From the static postural balance test: total length trajectory (T0: 480mm, T1: 456mm), ellipse area (T0: 809mm2, T1: 417mm2), Romberg_length (T0: 200, T1: 246), Romberg_area (T0: 607, T1: 487).
From the gait analysis data: the speed has passed from 16.3%height/s to 24.2%height/s to be related to an increase in cadence (T0: 46steps/min, T1: 55steps/min) and the length of the cycle (T0: 43%height, T1: 55%height).
Conclusion(s): The patient has experienced an improvement in walking performance. It is hypothesized that these modifications are due to variations in the motor control induced by the combination MAT and treadmill.
Implications: The training is feasible and safe intervention to improve exercise capacity and QoL for patients with MS. It would be desirable to provide patients with the piece of music in mp3 to be listened to during the deambulation in domestic and social environments.
Keywords: Music Assisted Therapy, Multiple Sclerosis, Gait training
Funding acknowledgements: This research received no sources of funding
Neurologic Music Therapy (NMT), developed by Michael Taut, is a program of therapeutic application of music that makes use of Rhythmic Auditory Stimulation (RAS) and Patterned Sensory Enhancement (PSE) to modify the intrinsically cadenced signals as the gait. NMT has been adopted in diseases such as Stroke, Head Injury, Cerebral Palsy and Parkinson´s disease, but only few studies have been conducted in MS patients.
Purpose: To evaluate the variations of the walking pattern in a MS patient with Music Assisted Therapy (MAT), based on the studies that show non-rhytmic elements in music can be applied to improve not only temporal gait measures such as stride length and gait velocity, but functional movements such as arm swing, hip flexion, and postural alignment and on the integration of a library of informed music into an instrumented treadmill.
Methods: The patient L.E. 34 years old, suffering from secondarily progressive MS since 2004; she has spastic paraparesis, balance deficit, deficiency of the deambulation, alva and neurogenic bladder.
L.E. was subjected to a walking training with instrumental treadmill combined with MAT, consisting of 20 sessions with a cadence three-weekly, lasting 30 minutes.
The device used was the Biodex Gait Trainer 3 with integrated informed music. The patient during the hospitalization also performed traditional physiotherapy.
The patient was evaluated pre (T0) and post-training (T1) with the following clinical scales: 10 Meter Walking Test (10MWT), Time Up and Go test (TUG), 6 Minute Walking Test (6MWT), Motricity Index(MI), Modified Ashworth Scale (MAS), Modified Barthel Index (mBI), Walking Handicap Scale (WHS), Functional Ambulation Classification (FAC).
It has also been assessed the static postural balance by using the Prokin PK252 (Tecnobody) performing stabilometric and Romberg test. In addition, the patient was also subjected to kinematic analysis of the gait with the Bts Smart DX.
Results: Clinical scales: mBI (T0: 72, T1: 76), MAS, MI (T0_DX: 71.5, T0_SX: 69, T1_DX: 85, T1_SX: 76.5), FAC (T0: 2, T1: 4), 10 mWT (T0: 0.44m/s, T1: 0.59m/s), 6mWT (T0: 117m, T1: 160m), TUG (T0: 22.2s, T1: 17.2s), WHS (T0: 3, T1: 4).
From the static postural balance test: total length trajectory (T0: 480mm, T1: 456mm), ellipse area (T0: 809mm2, T1: 417mm2), Romberg_length (T0: 200, T1: 246), Romberg_area (T0: 607, T1: 487).
From the gait analysis data: the speed has passed from 16.3%height/s to 24.2%height/s to be related to an increase in cadence (T0: 46steps/min, T1: 55steps/min) and the length of the cycle (T0: 43%height, T1: 55%height).
Conclusion(s): The patient has experienced an improvement in walking performance. It is hypothesized that these modifications are due to variations in the motor control induced by the combination MAT and treadmill.
Implications: The training is feasible and safe intervention to improve exercise capacity and QoL for patients with MS. It would be desirable to provide patients with the piece of music in mp3 to be listened to during the deambulation in domestic and social environments.
Keywords: Music Assisted Therapy, Multiple Sclerosis, Gait training
Funding acknowledgements: This research received no sources of funding
Topic: Neurology; Neurology: multiple sclerosis; Robotics & technology
Ethics approval required: No
Institution: IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
Ethics committee: Local ethics committee
Reason not required: ethical approval was not necessary as gait training is usually performed in MS patients
All authors, affiliations and abstracts have been published as submitted.
