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

Samira Gonzalez-Hoelling¹, Rosa Suñer-Soler², Carme Bertran-Noguer³, Gloria Reig-García²

¹Fisioterapeuta, HSS Mutuam Girona, ²Departament d'Infermeria, Universitat de Girona, ³Grup de Recerca en Salut, Universitat de Girona

Corresponding author
Samira Gonzalez-Hoelling, samigonzalezhoelling@gmail.com

Keywords: Music-based rhythmic auditory stimulation, musical therapy, walking ability, physiotherapy, stroke rehabilitation.

Introduction

Global stroke statistics from Thrift (2017) show that gait and balance impairments are common after stroke. Music rhythm can modulate motor performance and become effective for motor control through auditory-motor integration pathways in the brain. (Thaut, 2008, p.85-112) 

Objective

Evaluate the effect of a music-based rhythmic auditory stimulation (RAS) in combination with conventional physiotherapy on gait and balance parameters and walking ability in subacute stroke.

Methodology

This historically 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 gait speed) and walking ability (Functional Ambulation Category scale). Secondary outcomes were trunk control, assistive devices, and functional independence (Functional Independence Measure, Barthel index).

Results

Outcomes clearly improved in the two groups, but 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 showed greater improvement (p = 0.002) than the control group. At patients discharge, 9 (33.3%) subjects in the control group could walk indoors, 7 (25.9%) could walk outdoors independently and 17 (63%) could walk without any assistive device; in the intervention group 15 (53.5%) could walk indoors, 5 (17.9%) could walk outdoors independently and 23 (82.1%) could walk without any assistive device.

Discussion

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 parameter gains, agree to Van Criekinge (2019). A possible explanation might be related not only with the sample size, but also to the lack of reliability and sensitivity of the used measures and scales (Ghai et al., 2019). Only a little research exists about walking outcomes related to the quality of walking as the walking ability (walk indoors, outdoors, climb stairs) and the use of walking assistive devices (Fuji et al., 2020).

Conclusion

Music-based RAS as an additional rehabilitation improves walking ability in subacute stroke. But is there any applicability in community-dwelling when patients go home? Future research in long-term effects of a music-based RAS are needed.

Bibliography

1. Thrift, A.G., Thayabaranathan, T., Howard, G., Howard, V.J., Rothwell, P.M., Feigin, V.L., Norrving, B., Donnan, G.A. & Cadilhac, D. (2017). Global stroke statistics. International Journal of Stroke, 12, 13–32.

2. Thaut, M.H. (2008). Rhythm, Music, and the Brain: Scientific Foundations and Clinical Applications. New York: Taylor and Francis Group.

3. Van Criekinge, T., D'Août, K., O'Brien, J. & Coutinho, E. (2019). The influence of sound-based interventions on motor behavior after stroke: A systematic review. Frontiers in Neurology, 10.

4. Ghai, S. & Ghai, I. Effects of (music-based) rhythmic auditory cueing training on gait and posture post-stroke: A systematic review & dose-response meta-analysis. (2019). Scientific Reports, 9, 1–11.

5. Fujii, R., Sugawara, H., Ishikawa, M. & Fujiwara, T. (2020). Effects of Different Orthoses Used for Gait Training on Gait Function among patients with Subacute Stroke. Progress in Rehabilitation Medicine, 5, 20200023.

Efectos de una estimulación auditiva rítmica con música sobre la marcha y el equilibrio en el ictus subagudo

Samira Gonzalez-Hoelling1, Rosa Suñer-Soler2, Carme Bertran-Noguer3, Gloria Reig-García2

1Fisioterapeuta, HSS Mutuam Girona, 2Departament d'Infermeria, Universitat de Girona, 3Grup de Recerca en Salut, Universitat de Girona

Autor para correspondencia

Samira Gonzalez-Hoelling, samigonzalezhoelling@gmail.com

Palabras clave: Estimulación rítmica auditiva con música, musicoterapia, funcionalidad de la marcha, fisioterapia, rehabilitación del ictus.

Introducción

Las estadísticas globales de accidentes cerebrovasculares de Thrift (2017) muestran que los trastornos de la marcha y el equilibrio son comunes después del accidente cerebrovascular. El ritmo musical puede modular el rendimiento motor y llegar a ser eficaz para el control motor a través de las vías de integración auditivo-motoras en el cerebro. (Thaut, 2008, p.85-112)