The Exercise Files: Rehabilitation Programs That Engage Rhythmic Movement
Posted on August 19, 2016 | By Madeleine Hackney | 2 responses
You may have heard that movement programs that include auditory cues, in the form of metronome or music (aka, Rhythmic Auditory Stimulation or RAS) might help movements for people with PD. In PD, RAS with metronome beats has been used to improve walking. Studies have shown the positive effects of RAS on the symptoms of freezing of gait and walking qualities like velocity, stride length, and cadence (Song, Zhou, Cao, Ding, Chen, & Zhang, 2015). RAS might help walking because what someone with PD hears and timing of the given movement may be controlled by the same brain structures and neuronal connections (Benoit, Dalla Bella, Farrugia, Obrig, Mainka, & Kotz, 2014).
Music employed during exercise may help improve some mobility function in individuals with PD. Recently Bella and colleagues trained PD participants to synchronize their walking movement to familiar folk music without lyrics. A bell cued participants’ movement. Findings included increased walking speed and stride length, but also strong gains in movement synchronization and perceptual awareness on tasks that were just slightly different (Bella, Benoit, Farrugia, Schwartze, & Kotz, 2015). PD research could benefit from studies conducted with stroke survivors, particularly with regard to using Music-supported therapy (MST) (Rodriguez-Fornells A ,et al, Annals NY Acad Sci 2012). MST uses musical instrument playing to treat paresis (weakness) of the upper limb and adheres to four principles:
1. massive repetition and exercising simple finger and arm movements,
2. audio-motor coupling and integration (i.e., coordinating sounds with movement; movements are reinforced with immediate auditory feedback supporting precise timing and control of movements),
3. shaping (i.e., adapting complexity of movements to ability and progress of the individual), and
4. emotion-motivation effects (i.e., increased motivation of participants due to playfulness and emotional impact of making music and acquiring a new skill).
After 4 weeks of MST in combination with usual care, chronic stroke participants assigned to MST showed improvements on a test of arm motor function in comparison to a control group (Tong, Forreider, Sun, Geng, Zhang, Du et al., 2015). Additionally, a case study revealed audio-motor coupling when a patient passively listened to unfamiliar and trained melodies. Specifically, before MST, only the auditory cortices (the areas of the brain that process hearing) were activated; after MST, motor regions were also activated (Rojo, Amengual, Juncadella, Rubio, Camara, Marco-Pallares et al., 2011). These findings lend further evidence that musical and movement training as part of rehabilitation can make changes on a brain level, even for those with neurological impairment.
Get your groove on.
One drawback to using RAS is that some individuals with PD may have an impaired perception of beat timing. A lot of people with and without PD complain they just cannot hear the beat. However, this can be remedied by some musical and rhythmic training with a good teacher (contact me for details!) But a very simple, and quick approach is using music with very distinctive beats that the person with PD can recognize or using music that is very familiar to that individual. Leow et al. (2014) examined the impact of how recognizable the beat is in order to effectively improve walking cadence and other aspects of walking by comparing ‘high groove” (i.e., music with a strong and consistent beat) to “low groove’ music. Individuals with poorer perception of beat timing were helped by high groove music because they could easily recognize the main beat. Leow et al. also showed that more familiar music elicited less variable strides, faster walking and better synchronization with the music (Leow, Rinchon, & Grahn, 2015). These findings are highly relevant to group exercise, dance exercise, dance- or music-based rehabilitation because poor or good beat perception will affect walking when synchronized to music (Leow, Parrott, & Grahn, 2014). How strong and/or recognizable the musical beat is and familiarity with musical selections might therefore be considerations for your dance, or exercise classes, or physical therapy sessions. That said, please don’t be afraid to try new things or listen to new musical genres! You can grow in other ways by listening to unfamiliar music. This information is provided to you to better inform your approaches to exercise when you’re on your own.
Other cues that make use of other sensory modalities, like the visual and proprioceptive senses have been examined, but auditory cues are admittedly currently better researched (Francois, Grau-Sanchez, Duarte, & Rodriguez-Fornells, 2015). A meta-analysis recently demonstrated that music-based therapy, including dance, positively affects PD walking and walking-related activities (de Dreu, van der Wilk, Poppe, Kwakkel, & van Wegen, 2012). We use dance as an example of a rehabilitative movement approach that is not that well understood. For example, we do not exactly know what goes on at a neural level regarding the interplay of many external cues across multiple sensory modalities. Proprioceptive (knowing where you are in space) and kinesthetic (being aware of your movement) information based on tactile cues are actually crucial for motor adaptation and dance performance. Visual cues no doubt play a role in postural control, navigation, and emotional understanding, as well as having a curious positive effect on freezing. Auditory cues (e.g., percussion or other musical rhythms) play a strong role in guidance of movement. We believe rehabilitation regimens like dance, dance-exercise, boxing and other rhythmic training likely provide a synergistic multisensory ‘helper’ to motor skills training for individuals with neurological conditions. Many questions remain about the best cues to use when, for whom, and for how long. As usual, more study is needed!