The Effect of Rhythmic Auditory Stimulation on Gait Parameters
Can using RAS improve outcomes in seniors?
Ambulation is an important function of the musculoskeletal system, and in physical therapy, some consider gait as a sixth vital sign (Larson et al., 2023). In this setting, it is crucial to assess the environment and recognize the challenging situations wherein specific gait proficiencies are required. This assists therapists in drawing up their treatment plans to address the patient’s needs adequately. For example, running at a certain pace may be a suitable goal for a younger patient, and considering sports involvement after the primary rehabilitation phase may be critical to ensure that the patient’s quality of life is maintained. This is in stark contrast to working with seniors, where community ambulation would be the likely need of the patient. However, community ambulation is a generic term, and as we will see, there is an element of complexity that we sometimes overlook.
Current recommendations are that people walk between 8 and 10,000 steps per day, but people who have suffered neuromuscular conditions like stroke may have their steps drastically reduced; for example, a CVA hemiplegic gets about 5,500 steps per day. This may lead to deconditioning, an increase in disability, and reduced participation in daily life; thus, it is our duty to intervene effectively.
In their study entitled “Variable Cadence Gait Training Outcomes Using Rhythmic Auditory Stimulation Embedded in Older Adults’ Preferred Music,” Larson et al. (2023) investigated whether RAS would improve gait training outcomes in older adults. Their study group considered everyday community/social activities that were challenging for older individuals, such as catching an elevator before the doors closed, walking quickly to catch a bus about to depart, and maintaining the speeds at which companions may be walking either by speeding up or slowing down.
The use of RAS serves as a rhythmic cue for activities like walking. It encourages the person to synchronize the timing of heel strike with the beat (Larson et al., 2023). Neurologic studies have found that RAS stimulates the spinal neurons via the reticulospinal, corticocerebellar, and efferent cerebellar-spinal pathways, thus reducing reaction time.
The study used a meticulous screening and methodology wherein patients underwent a number of physical and cognitive tests. The team also recorded baseline cadence and other gait parameters. Music technicians were brought in to control the tempo of the music chosen by participants that would accompany them during their training. Only the music’s tempo was altered without reducing the music quality. In addition certain beats were emphasized to assist the patient with recognizing the auditory stimulus to which his/her movement was being paced.
The patients underwent 14 weeks of training with a frequency of twice-weekly sessions. By simply manipulating the tempo of the music, the team found concrete and permanent changes to the patients’ gait parameters. Patients walked faster, with better cadence, step length, balance, and other spatiotemporal parameters. Out of the 14 recruited in the study, 11 showed a clinically significant change in their gait parameters, while three subjects did not show any change. Interestingly, the three who did not show change were already walking better and faster than the rest of the eleven at the start of the study. Thus, one can ask whether the response is dose-dependent and whether it is effective in those with normal or near-normal gait parameters.
In conclusion, the proposition is exciting to consider applying clinically. In addition to improved physical response, there was also a mental aspect wherein patients expressed joy and satisfaction with their treatment sessions.
*Abstract available at following link.
Larson, C. A., Roth, E. A., Sterenberg Mahon, A. J., Crinion, M., Fischer, K., Yim, S. H., & Smith, A. K. (2023). Variable Cadence Gait Training Outcomes Using Rhythmic Auditory Stimulation Embedded in Older Adults' Preferred Music. Journal of aging and physical activity, 31(5), 721–732. https://doi.org/10.1123/japa.2021-0516
From all of us at Syllabi Educational Consultancy, we wish you a Happy Physical Therapy Day on September 8. We hope you consider making your environment more disability-friendly and rehabilitation-conscious!