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. 2018 Sep 14;9:755.
doi: 10.3389/fneur.2018.00755. eCollection 2018.

The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients: A Randomized Controlled Trial

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Free PMC article

The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients: A Randomized Controlled Trial

Stefan Mainka et al. Front Neurol. .
Free PMC article

Abstract

The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SP. The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 ± 8.6 years, mean time between stroke and start of study 42.1 ± 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F (2, 34) = 3.864, p = 0.032; partial η2 = 0.205] and cadence [F (2, 34) = 7.656, p = 0.002; partial η2 = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier DRKS00014603.

Keywords: exercise movement techniques; gait; music; music therapy; stroke rehabilitation.

Figures

Figure 1
Figure 1
Patient flow chart of study design. RAS-TT, rhythmic auditory stimulation on treadmill; TT, treadmill training; NDT, neurodevelopmental treatment.
Figure 2
Figure 2
Primary outcome measures: adjusted means of post intervention gait parameters with pre-intervention measures and time between stroke and study entrance as co-varieties. Error bars indicate the standard error. #Statistically significant group difference. *Statistically significant group contrast. (p < 0.05). RAS-TT, rhythmic auditory stimulation with treadmill training; TT, treadmill training; NDT, neurodevelopmental treatment; FGS, fast gait speed test; LOC, gait analysis with locometre.
Figure 3
Figure 3
Adjusted means of post intervention walking distance from the 3 min walking time test with pre-intervention measures and time between stroke and study entrance as co-variates. Error bars indicate the standard error. *Statistically significant group contrast. (p < 0.05). RAS-TT, rhythmic auditory stimulation with treadmill; TT, treadmill training; NDT, neurodevelopment treatment.

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