Short Term Effects of Rhythmic Auditory Stimulation with Body Weight Supported Treadmill Training on Gait and Balance in Individuals with Incomplete Spinal Cord Injury

Background: Rhythmic auditory stimulation and body weight supported treadmill training both are standardized gait rehabilitation techniques. However there is limited literature evaluating the effect of rhythmic auditory stimulation and its combination with gait training in spinal cord injury. Aim of this study is to determine the short term effectiveness of rhythmic auditory stimulation with body weight supported treadmill training on gait and balance in individuals with incomplete Spinal Cord Injury. Method: A randomized control study design. 8 subjects with incomplete spinal cord injury who met the inclusion criteria were randomly allocated into two groups: Experimental and Control. Subjects in experimental group were given body weight supported treadmill training with rhythmic auditory stimulation. Subjects in Control Group were given Body weight supported treadmill training alone. Both the groups received conventional rehabilitation as well. Both groups received training for 30 minutes, five times a week for two weeks (10 sessions). Outcome Measures: Gait parameters i.e. cadence, velocity, step length were measured using the Biodex Gait Trainer 2TM, level of walking performance measured using Walking Index for Spinal Cord Injury II, and balance was evaluated using Prokin 252NTM , Berg Balance Scale, and Activity specific Balance Confidence scale. Results: No significant improvement was found on gait parameters i.e. cadence, velocity, step length which were measured using the Gait Trainer, level of walking performance measured using WISCI II, and balance which was evaluated using Prokin 252NTM , Berg Balance Scale, and Activity specific Balance Confidence scale. Conclusion: Rhythmic auditory stimulation didn’t have any positive effect on gait training in incomplete spinal cord injured patients. Further studies are warranted to explore the entrainment effects of rhythmic auditory stimulation in spinal cord injured individuals on gait rehabilitation. Keywords: Rhythmic Auditory Stimulation (RAS), Body Weight Supported Treadmill Training (BWSTT), Metronome, Incomplete spinal cord injury, Biodex Gait Trainer 2.0, Prokin 252N

Effects of Multi-Directional Step-Up Training with Rhythmic Auditory Stimulation on Gait and Balance Ability in Stroke Patients

The purpose of this study was to investigate the effects of multi-directional step-up training with rhythmic auditory stimulation on gait and balance ability in stroke patients and also to help develop fall prevention and exercise programs for returning to daily life after stroke. The intervention method was randomly assigned to sixteen stroke patients, eight patients each in the experimental group and the control group. The experimental group carried out multi-directional step-up training with rhythmic auditory stimulation, and the control group performed only multi-directional step-up training. The training proceeded twelve times for 30 minutes for four weeks, and functional gait assessment, 10-meter walk test, and dynamic (by the Berg balance scale) and static (by Balancia software, Mintosys, Korea) balance ability assessments were conducted to examine the effect of the training on improving balance and gait ability. The study compared and analyzed the differences in the amount of change within the groups before and after training, and the differences in the amount of change between the two groups. Both groups showed more improved results after training than before in all assessments that measured gait and balance ability (p < 0.05). However, the experimental group showed a greater difference in the amount of change in every gait and balance ability assessment compared to the control group. (p < 0.05). Therefore, multi-directional step-up training can be an efficient intervention to improve the gait and balance ability of stroke patients and when accompanied by rhythmic auditory stimulation, the effectiveness could be maximized.

Effects of a Music-Based Rhythmic Auditory Stimulation on Gait and Balance in Subacute Stroke

Gait and balance impairments are common after stroke. This study aimed to evaluate the effect of a music-based rhythmic auditory stimulation (RAS) in combination with conventional physiotherapy on gait parameters and walking ability in subacute stroke. This single-blind, historical controlled trial, included 55 patients who had suffered a stroke within the three weeks prior to enrolment. Patients from 2018 (n = 27) were assigned as the historical control group whereas 2019 patients (n = 28) received music-based RAS three times a week. Both groups received 11 h of conventional physiotherapy per week during hospitalization. Primary outcomes were gait and balance parameters (Tinetti test and Timed Up&Go test) and walking ability (Functional Ambulation Category scale). Secondary outcomes were trunk control, assistive devices, functional independence (Functional Independence Measure, Barthel index), and stroke severity and disability (modified Rankin scale, National Institutes of Health Stroke Scale). Results: No between-group differences were identified for gait and balance parameters nor for secondary outcomes. Significant between-group differences were observed in the Functional Ambulation Category: the intervention group (Δmean ± SD; 3.43 ± 1.17) showed greater improvement (p = 0.002) than the control group (Δmean ± SD; 2.48 ± 1.09). Compared with conventional physiotherapy alone, our results suggest that the walking ability of subacute stroke patients might be improved with music-based RAS combined with conventional physiotherapy, but this treatment is not more effective than conventional physiotherapy in obtaining gait and balance gains.

EOG Elicited by Rhythmic Auditory Predicts the Depth of Sedation During Sevoflurane Anesthesia

Background: Several electroencephalographic (EEG) variables have been used to estimate changes in human brain electrical activity during changing states of consciousness as a clinical monitoring tool to anesthesia and sedation. However, the EEG signal is weak and extremely susceptible to suppression interference. The use of EEG variables as anesthesia monitors is still controversial. Recent studies have shown a new language paradigm that elicited rhythmic brain responses and ocular muscle activity tracking sentence rhythms in speech. Electrooculogram (EOG) driven by rhythmic auditory stimulation has a larger amplitude than EEG variables and a higher temporal resolution than event-related brain potentials, which may be a potential monitor of anesthetic depth.Methods: Twenty-five patients inhaled sevoflurane via laryngeal mask for induction of anesthesia. The initial concentration of sevoflurane was set to 0.4% and increased by 0.1% every 1 min until loss of consciousness. During the entire operation, rhythmic auditory stimulation was presented binaurally to elicit ocular muscle activity.Results: When the end-tidal sevoflurane concentration (Etsevo) was low, the EOG had a significant spectral peak at 0.5 Hz, which is the same frequency as the rhythmic auditory stimulation, and then the peak value of EOG decreased with the increase of Etsevo. Peak value of EOG spectrum under the rhythmic auditory stimulation (PERA) showed significant differences in different depth of sedation (wakefulness: 84.0 ± 22.8, light sedation: 47.0 ± 27.7, deep sedation: 10.9 ± 16.5, P<0.01). PERA is correlated well with Etsevo (-0.75, P<0.01) and was able to predict the sedation depth during the induction period of anesthesia well (PK = 0.92 ± 0.08).Conclusion: We found that the ocular muscle activity synchronizes to the rhythmic auditory stimulation structures during induction with sevoflurane. With the increase of Etsevo, the synchronizing ability of the ocular electricity to rhythmic auditory stimulation gradually weakens and eventually disappears. Based on this evidence, the EOG driven by a rhythmic auditory stimulation may be a new and reliable approach to characterize and predict anesthetic depth objectively. Trial registration: The research project was registered at chictr.org.cn (ChiCTR1900026590, 2019/10/15).

Feasibility of a rhythmic auditory stimulation gait training in community-dwelling adults after TBI: A case report

BACKGROUND: Traumatic brain injury has multiple impacts on gait including decreased speed and increased gait variability. Rhythmic auditory stimulation (RAS) gait training uses the rhythm and timing structure of music to train and ultimately improve slow and variable walking patterns. OBJECTIVE: To describe the feasibility of RAS gait training in community-dwelling adults with traumatic brain injury (TBI). A secondary objective is to report changes in spatiotemporal gait parameters and clinical measures of balance and walking endurance. METHODS: Two individuals with a TBI participated in nine sessions of gait training with RAS over a 3-week period. At baseline, post-training and 3-week follow-up, spatiotemporal parameters of walking were analyzed at preferred pace, maximum pace and dual-task walking conditions. Secondary outcomes included the Community Balance and Mobility Scale and the 6-Minute Walk Test. Feasibility was assessed using reports of physical fatigue, adverse event reporting, and perceived satisfaction. RESULTS: Both participants completed all 9 planned intervention sessions. The sessions were well tolerated with no adverse events. Participant 1 and 2 exhibited different responses to the intervention in line with the therapeutic goals set with the therapist. Participant 1 exhibited improved speed and decreased gait variability. Participant 2 exhibited reduced gait speed but less fatigue during the 6MWT. CONCLUSIONS: RAS was found to be a safe and feasible gait intervention with the potential to improve some aspects of gait impairments related to gait speed, gait variability, dynamic balance and walking endurance. Further investigation including a pilot randomized controlled trial is warranted.