Musically cued gait-training improves both perceptual and motor timing in Parkinson's disease

Enhancing gait cadence through rhythm-modulated music: A study on healthy adults

BACKGROUND AND OBJECTIVE

Gait disorders stemming from brain lesions or chemical imbalances, pose significant challenges for patients. Proposed treatments encompass medication, deep brain stimulation, physiotherapy, and visual stimulation. Music, with its harmonious structures, serves as a continuous reference, synchronizing muscle activities through neural connections between hearing and motor functions, can show promise in gait disorder management. This study explores the influence of heightened music rhythm on young healthy participants' gait cadence in three conditions: FeedForward (independent rhythm), FeedBack (cadence-synced rhythm), and Adaptive (cadence-controlled musical experience). The objective is to increase gait cadence through rhythm modulation during walking.

METHOD

The study involved 18 young healthy participants (13 males and 5 females) who did not have any gait or hearing disorders. Each participant completed the gait task in the three aforementioned conditions. Each condition was comprised of three sessions: 1) Baseline, where participants walked while listening to the original music; 2) Intervention, changing the music rhythm to affect the gait cadence; and 3) Realign, replaying the original music and measuring the durability of the effect of the Intervention session. The measurement tool was a pair of footwear equipped with push-button switches that transmited the foot-to-ground contact to the LabVIEW® software, all designed by the research team. Repeated measures of ANOVA was employed to evaluate the impact of the sessions and conditions.

RESULTS

In all three conditions, there was a significant effect of music on increasing gait cadence during Intervention and Realign sessions (p < 0.001). Additionally, the immediate impact of music on gait cadence in the Adaptive condition was superior to the other conditions.

CONCLUSION

The study findings indicate that increasing the rhythm of music during walking has a significant impact on gait cadence among young healthy participants. This effect remained significant even after realigning the music to normal. It could be harnessed to support the rehabilitation of individuals with movement disorders characterized by a decrease in movement speed, such as Parkinson's disease. Moreover, the results indicate that the Adaptive method showed promising outcomes, suggesting its potential for further exploration as an effective means to control gait cadence.

Duet synchronization interventions affect social interactions

Humans' complex behavior, such as speech, music, or dance, requires us to coordinate our actions with external sounds as well as with social partners. The presence of a partner can influence individuals' synchronization, and, in turn, social connection with the partner may depend on the degree of synchronization. We manipulated the synchronization quality in intervention conditions to address the causal relationship between observed temporal synchrony and perceived social interaction. Pairs of musician and nonmusician participants first performed a turn-taking task consisting of alternating which partner tapped their melody in synchrony with a metronome (each tap generated the next tone in the melody). In two intervention conditions, participants attempted to synchronize their melodies simultaneously with their partner, either with normal auditory feedback (normal feedback) or randomly placed delayed feedback on 25% of melodic tones (delayed feedback). After each intervention, the turn-taking condition was repeated, and participants completed a questionnaire about connectedness, relationship, and feeling of synchronization with their partner. Results showed that partners' mean asynchronies were more negative following the delayed feedback intervention. In addition, nonmusician partners' tapping variability was larger following the delayed feedback intervention when they had the delayed feedback intervention first. Ratings of connectedness, relationship, and feeling of synchronization with their partner were reduced for all participants after the delayed feedback Intervention. We modeled participants' synchronization performance in the post-intervention turn-taking conditions using delay-coupling oscillator models. Reductions in synchronization performance after delayed feedback intervention were reflected in reduced coupling strength. These findings suggest that turn-taking synchronization performance and social connectedness are altered following short interventions that disrupt synchronization with a partner.

Mobile version of the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA): Implementation and adult norms

Timing and rhythm abilities are complex and multidimensional skills that are highly widespread in the general population. This complexity can be partly captured by the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA). The battery, consisting of four perceptual and five sensorimotor tests (finger-tapping), has been used in healthy adults and in clinical populations (e.g., Parkinson's disease, ADHD, developmental dyslexia, stuttering), and shows sensitivity to individual differences and impairment. However, major limitations for the generalized use of this tool are the lack of reliable and standardized norms and of a version of the battery that can be used outside the lab. To circumvent these caveats, we put forward a new version of BAASTA on a tablet device capable of ensuring lab-equivalent measurements of timing and rhythm abilities. We present normative data obtained with this version of BAASTA from over 100 healthy adults between the ages of 18 and 87 years in a test-retest protocol. Moreover, we propose a new composite score to summarize beat-based rhythm capacities, the Beat Tracking Index (BTI), with close to excellent test-retest reliability. BTI derives from two BAASTA tests (beat alignment, paced tapping), and offers a swift and practical way of measuring rhythmic abilities when research imposes strong time constraints. This mobile BAASTA implementation is more inclusive and far-reaching, while opening new possibilities for reliable remote testing of rhythmic abilities by leveraging accessible and cost-efficient technologies.

Unravelling individual rhythmic abilities using machine learning

Humans can easily extract the rhythm of a complex sound, like music, and move to its regular beat, like in dance. These abilities are modulated by musical training and vary significantly in untrained individuals. The causes of this variability are multidimensional and typically hard to grasp in single tasks. To date we lack a comprehensive model capturing the rhythmic fingerprints of both musicians and non-musicians. Here we harnessed machine learning to extract a parsimonious model of rhythmic abilities, based on behavioral testing (with perceptual and motor tasks) of individuals with and without formal musical training (n = 79). We demonstrate that variability in rhythmic abilities and their link with formal and informal music experience can be successfully captured by profiles including a minimal set of behavioral measures. These findings highlight that machine learning techniques can be employed successfully to distill profiles of rhythmic abilities, and ultimately shed light on individual variability and its relationship with both formal musical training and informal musical experiences.

Dopamine dysregulation in Parkinson's disease flattens the pleasurable urge to move to musical rhythms

The pleasurable urge to move to music (PLUMM) activates motor and reward areas of the brain and is thought to be driven by predictive processes. Dopamine in motor and limbic networks is implicated in beat-based timing and music-induced pleasure, suggesting a central role of basal ganglia (BG) dopaminergic systems in PLUMM. This study tested this hypothesis by comparing PLUMM in participants with Parkinson's disease (PD), age-matched controls, and young controls. Participants listened to musical sequences with varying rhythmic and harmonic complexity (low, medium and high), and rated their experienced pleasure and urge to move to the rhythm. In line with previous results, healthy younger participants showed an inverted U-shaped relationship between rhythmic complexity and ratings, with preference for medium complexity rhythms, while age-matched controls showed a similar, but weaker, inverted U-shaped response. Conversely, PD showed a significantly flattened response for both the urge to move and pleasure. Crucially, this flattened response could not be attributed to differences in rhythm discrimination and did not reflect an overall decrease in ratings. For harmonic complexity, PD showed a negative linear pattern for both the urge to move and pleasure while healthy age-matched controls showed the same pattern for pleasure and an inverted U for the urge to move. This contrasts with the pattern observed in young healthy controls in previous studies, suggesting that both healthy aging and PD also influence affective responses to harmonic complexity. Together, these results support the role of dopamine within cortico-striatal circuits in the predictive processes that form the link between the perceptual processing of rhythmic patterns and the affective and motor responses to rhythmic music.

Individual differences in rhythm perception modulate music-related motor learning: a neurobehavioral training study with children

Rhythm and motor function are intrinsically linked to each other and to music, but the rhythm-motor interplay during music training, and the corresponding brain mechanisms, are underexplored. In a longitudinal training study with children, we examined the role of rhythm predisposition in the fine motor improvements arising from music training, and which brain regions would be implicated. Fifty-seven 8-year-olds were assigned to either a 6-month music training (n = 21), sports training (n = 18), or a control group (n = 18). They performed rhythm and motor tasks, and structural brain scans before and after training were collected. Better ability to perceive rhythm before training was related to less gray matter volume in regions of the cerebellum, fusiform gyrus, supramarginal gyrus, ventral diencephalon, amygdala, and inferior/middle temporal gyri. Music training improved motor performance, and greater improvements correlated with better pre-training rhythm discrimination. Music training also induced a loss of gray matter volume in the left cerebellum and fusiform gyrus, and volume loss correlated with higher motor gains. No such effects were found in the sports and control groups. In summary, children with finer-tuned rhythm perception abilities were prone to finer motor improvements through music training, and this rhythm-motor link was to some extent subserved by the left cerebellum and fusiform gyrus. These findings have implications for models on music-related plasticity and rhythm cognition, and for programs targeting motor function.

An integrated review of music cognition and rhythmic stimuli in sensorimotor neurocognition and neurorehabilitation

This work reviews the growing body of interdisciplinary research on music cognition, using biomechanical, kinesiological, clinical, psychosocial, and sociological methods. The review primarily examines the relationship between temporal elements in music and motor responses under varying contexts, with considerable relevance for clinical rehabilitation. After providing an overview of the terminology and approaches pertinent to theories of rhythm and meter from the musical-theoretical and cognitive fields, this review focuses on studies on the effects of rhythmic sensory stimulation on gait, rhythmic cues' effect on the motor system, reactions to rhythmic stimuli attempting to synchronize mobility (i.e., musical embodiment), and the application of rhythm for motor rehabilitation for individuals with Parkinson's disease, stroke, mild cognitive impairment, Alzheimer's disease, and other neurodegenerative or neurotraumatic diseases. This work ultimately bridges the gap between the musical-theoretical and cognitive science fields to facilitate innovative research in which each discipline informs the other.

Auditory attention measured by EEG in neurological populations: systematic review of literature and meta-analysis

Sensorimotor synchronization strategies have been frequently used for gait rehabilitation in different neurological populations. Despite these positive effects on gait, attentional processes required to dynamically attend to the auditory stimuli needs elaboration. Here, we investigate auditory attention in neurological populations compared to healthy controls quantified by EEG recordings. Literature was systematically searched in databases PubMed and Web of Science. Inclusion criteria were investigation of auditory attention quantified by EEG recordings in neurological populations in cross-sectional studies. In total, 35 studies were included, including participants with Parkinson's disease (PD), stroke, Traumatic Brain Injury (TBI), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS). A meta-analysis was performed on P3 amplitude and latency separately to look at the differences between neurological populations and healthy controls in terms of P3 amplitude and latency. Overall, neurological populations showed impairments in auditory processing in terms of magnitude and delay compared to healthy controls. Consideration of individual auditory processes and thereafter selecting and/or designing the auditory structure during sensorimotor synchronization paradigms in neurological physical rehabilitation is recommended.

Which factors modulate spontaneous motor tempo? A systematic review of the literature

Intentionally or not, humans produce rhythmic behaviors (e.g., walking, speaking, and clapping). In 1974, Paul Fraisse defined rhythmic behavior as a periodic movement that obeys a temporal program specific to the subject and that depends less on the conditions of the action (p. 47). Among spontaneous rhythms, the spontaneous motor tempo (SMT) corresponds to the tempo at which someone produces movements in the absence of external stimuli, at the most regular, natural, and pleasant rhythm for him/her. However, intra- and inter-individual differences exist in the SMT values. Even if several factors have been suggested to influence the SMT (e.g., the age of participants), we do not yet know which factors actually modulate the value of the SMT. In this context, the objectives of the present systematic review are (1) to characterize the range of SMT values found in the literature in healthy human adults and (2) to identify all the factors modulating the SMT values in humans. Our results highlight that (1) the reference value of SMT is far from being a common value of 600 ms in healthy human adults, but a range of SMT values exists, and (2) many factors modulate the SMT values. We discuss our results in terms of intrinsic factors (in relation to personal characteristics) and extrinsic factors (in relation to environmental characteristics). Recommendations are proposed to assess the SMT in future research and in rehabilitative, educative, and sport interventions involving rhythmic behaviors.

Music-based multicomponent exercise training for community-dwelling older adults with mild-to-moderate cognitive decline: a feasibility study

Introduction

This study explored the feasibility and preliminary efficacy of a music-based, multicomponent exercise intervention among community-dwelling older adults with mild-to-moderate cognitive impairment.

Methods

16 older adults aged 85±9 years with mild-to-moderate cognitive impairment received music-based multicomponent exercise training for 20 weeks at an independent living facility. Participants received aerobic, resistance, and balance training paired with beat-accentuated music stimulation. Participants' adherence to the training was tracked down and their cognitive and physical functioning and health-related quality of life were assessed at pre- and post-test.

Results

3 participants withdrew due to unexpected issues unrelated to the intervention and thus 13 participants (7 females) attended an average of 4.6 days/week over 20 weeks and reported high satisfaction with the intervention (90.6%). Participants showed significant improvement in global cognition, cognitive processing speed, and walking endurance/aerobic fitness at post-test.

Discussion

These findings support the feasibility of music-based, multicomponent exercise training for older adults in an independent living facility and set the stage for future studies to test the efficacy of music on physical activity and ensuing health outcomes. We conclude that music-based, multicomponent exercise training can be beneficial for community-dwelling older adults with mild-to-moderate cognitive decline. As a form of rhythmic auditory stimulation, beat-accentuated music can be combined with exercise training to manipulate exercise tempo and may provide a source of motivation to help older adults adhere to exercise.

Aberrant inter-network functional connectivity in drug-naive Parkinson's disease patients with tremor dominant and postural instability and gait difficulty

Background: Insight into neural mechanisms of tremor dominant (TD) and postural instability and gait disorder (PIGD) subtypes in Parkinson's disease (PD) is vital for understanding pathophysiological hypotheses underlying this phenotype. However, network disturbances and their correlation with motor subtypes of PD remain unclear. We aimed to investigate the alterations of intra- and inter-network functional connectivity (FC) in drug-naive PD patients with different motor subtypes. Methods: Resting-state functional magnetic resonance imaging was performed on 25 drug-naive PD patients with TD (PD-TD) and 40 drug-naive PD patients with PIGD (PD-PIGD), and 37 healthy controls (HCs) underwent. The following networks were extracted using independent component analysis: sensorimotor network (SMN), left executive control network (LECN), right executive control network, anterior salience network (aSN), posterior salience network (pSN), ventral attention network (VAN), dorsal attention network (DAN), default mode network (DMN), visual network, and auditory network (AN). We measured FC values within and between these networks. Results: There were no detectable variations in intra-network FC. PD-PIGD group demonstrated lower FC between aSN and pSN, as well as between VAN and DMN, in contrast to PD-TD group. Particularly, the FC strength between VAN and DMN was positively correlated with TD and tremor scores, and the best fitting classification models of TD and PIGD subtypes were based on the FC between aSN and pSN. Compared with HCs, both PD-TD and PD-PIGD patients displayed decreased FC between two SMN subnetworks, while PD-TD patients exhibited increased FC between the SMN subnetwork and pSN, and between LECN and VAN. Furthermore, PD-PIGD patients demonstrated decreased FC between the SMN subnetwork and AN. Conclusions: The altered FC between aSN and pSN can be an imaging marker to distinguish PD-TD from PD-PIGD. We for the first time disclosed that the PD-TD patients compensated by increasing attention resources and the PD-PIGD patients displayed reduced FC between SMN and AN. Our findings provide a basis for identification and precision treatment of PD motor subtypes.

Exploring the use of music to promote physical activity: From the viewpoint of psychological hedonism

Despite the global efforts to encourage people to regularly participate in physical activity (PA) at moderate-to-vigorous intensity, an inadequate number of adults and adolescents worldwide meet the recommended dose of PA. A major challenge to promoting PA is that sedentary or low-active people experience negative shifts in affective valence (feeling bad versus good) in response to moderate-to-vigorous intensity PA. Interestingly, empirical data indicate that listening to music during acute bouts of PA positively alters affective valence (feeling good versus bad), reduces perceived exertion, and improves physical performance and oxygen utilization efficiency. From the viewpoint of the ancient principle of psychological hedonism - humans have ultimate desires to obtain pleasure and avoid displeasure - we elaborate on three putative mechanisms underlying the affective and ergogenic effects of music on acute bouts of PA: (1) musical pleasure and reward, (2) rhythmic entrainment, and (3) sensory distraction from physical exertion. Given that a positive shift in affective valence during an acute bout of PA is associated with more PA in the future, an important question arises as to whether the affective effect of music on acute PA can be carried over to promote long-term PA. Although this research question seems intuitive, to our knowledge, it has been scarcely investigated. We propose a theoretical model of Music as an Affective Stimulant to Physical Activity (MASPA) to further explain the putative mechanisms underlying the use of music to promote long-term PA. We believe there have been important gaps in music-based interventions in terms of the rationale supporting various components of the intervention and the efficacy of these interventions to promote long-term PA. Our specification of relevant mechanisms and proposal of a new theoretical model may advance our understanding of the optimal use of music as an affective, ergogenic, and sensory stimulant for PA promotion. Future directions are suggested to address the gaps in the literature.

Systems Thinking in an era of climate change: Does cognitive neuroscience hold the key to improving environmental decision making? A perspective on Climate-Smart Agriculture

Systems Thinking (ST) can be defined as a mental construct that recognises patterns and connections in a particular complex system to make the "best decision" possible. In the field of sustainable agriculture and climate change, higher degrees of ST are assumed to be associated with more successful adaptation strategies under changing conditions, and "better" environmental decision making in a number of environmental and cultural settings. Future climate change scenarios highlight the negative effects on agricultural productivity worldwide, particularly in low-income countries (LICs) situated in the Global South. Alongside this, current measures of ST are limited by their reliance on recall, and are prone to possible measurement errors. Using Climate-Smart Agriculture (CSA), as an example case study, in this article we explore: (i) ST from a social science perspective; (ii) cognitive neuroscience tools that could be used to explore ST abilities in the context of LICs; (iii) an exploration of the possible correlates of systems thinking: observational learning, prospective thinking/memory and the theory of planned behaviour and (iv) a proposed theory of change highlighting the integration of social science frameworks and a cognitive neuroscience perspective. We find, recent advancements in the field of cognitive neuroscience such as Near-Infrared Spectroscopy (NIRS) provide exciting potential to explore previously hidden forms of cognition, especially in a low-income country/field setting; improving our understanding of environmental decision-making and the ability to more accurately test more complex hypotheses where access to laboratory studies is severely limited. We highlight that ST may correlate with other key aspects involved in environmental decision-making and posit motivating farmers via specific brain networks would: (a) enhance understanding of CSA practices (e.g., via the frontoparietal network extending from the dorsolateral prefrontal cortex (DLPFC) to the parietal cortex (PC) a control hub involved in ST and observational learning) such as tailoring training towards developing improved ST abilities among farmers and involving observational learning more explicitly and (b) motivate farmers to use such practices [e.g., via the network between the DLPFC and nucleus accumbens (NAc)] which mediates reward processing and motivation by focussing on a reward/emotion to engage farmers. Finally, our proposed interdisciplinary theory of change can be used as a starting point to encourage discussion and guide future research in this space.

Music and Brain Circuitry: Strategies for Strengthening Evidence-Based Research for Music-Based Interventions

The neuroscience of music and music-based interventions (MBIs) is a fascinating but challenging research field. While music is a ubiquitous component of every human society, MBIs may encompass listening to music, performing music, music-based movement, undergoing music education and training, or receiving treatment from music therapists. Unraveling the brain circuits activated and influenced by MBIs may help us gain better understanding of the therapeutic and educational values of MBIs by gathering strong research evidence. However, the complexity and variety of MBIs impose unique research challenges. This article reviews the recent endeavor led by the National Institutes of Health to support evidence-based research of MBIs and their impact on health and diseases. It also highlights fundamental challenges and strategies of MBI research with emphases on the utilization of animal models, human brain imaging and stimulation technologies, behavior and motion capturing tools, and computational approaches. It concludes with suggestions of basic requirements when studying MBIs and promising future directions to further strengthen evidence-based research on MBIs in connections with brain circuitry.SIGNIFICANCE STATEMENT Music and music-based interventions (MBI) engage a wide range of brain circuits and hold promising therapeutic potentials for a variety of health conditions. Comparative studies using animal models have helped in uncovering brain circuit activities involved in rhythm perception, while human imaging, brain stimulation, and motion capture technologies have enabled neural circuit analysis underlying the effects of MBIs on motor, affective/reward, and cognitive function. Combining computational analysis, such as prediction method, with mechanistic studies in animal models and humans may unravel the complexity of MBIs and their effects on health and disease.

Magnetic resonance imaging image analysis of the therapeutic effect and neuroprotective effect of deep brain stimulation in Parkinson's disease based on a deep learning algorithm

In order to study the therapeutic neuroprotective effect of deep brain stimulation (DBS) in Parkinson's disease (PD), based on the deep learning algorithm, this study combines with magnetic resonance imaging (MRI) image analysis technology to study the clinical efficacy of DBS in the surgical treatment of PD and the neuroprotective and neurological recovery effects after surgery. Establish a deep learning algorithm model based on MRI image analysis technology, comparison of UPDRS motor status assessment and the improvement of daily life ability before and after DBS surgery, evaluate the accuracy rate and the detection speed of the model. The models constructed in this study have an accuracy rate of more than 90% in the PD detection test, and the detection speed of the algorithm model under the condition of big data is between 60 and 200 ms. DBS significantly improve a series of clinical symptoms in patients with PD. The deep learning algorithm model based on MRI image analysis technology in this paper has a certain effect. DBS operation can improve the symptoms of PD, and has the effect of neuroprotection and neurological recovery.

Rhythmic auditory cueing in atypical parkinsonism: A pilot study

Rhythmic auditory cueing (RAC) can improve gait parameters in neurological disorders such as Parkinson's disease and stroke. However, there is a lack of research on the effects of RAC in patients with atypical parkinsonian disorders (APD). Using a smartphone metronome application, we aimed to investigate the immediate effects of RAC in patients with clinically diagnosed APD, namely Progressive Supranuclear Palsy (PSP-Richardson Syndrome and other variants, PSP-nonRS), Corticobasal Syndrome (CBS), Multiple System Atrophy (MSA), and Dementia with Lewy Bodies (DLB). A total of 46 APD participants (25 PSP, 9 CBS, 8 MSA and 4 DLB; age: mean = 70.17, standard deviation = 7.15) walked at their preferred pace for 2 min without any rhythmic auditory cueing (RAC). Participants then walked the same path for another 2 min with RAC set at a tempo 10% faster than the baseline cadence of each participant. After a 10–15-min break, participants walked the same path for another 2 min without RAC to observe for carryover effects. Gait parameters [cadence (steps/minute), gait velocity (meters/minute), and stride length (centimeters)] were collected at baseline, during RAC, and post-RAC. There was a significant improvement in cadence in all participants from baseline to during RAC and post-RAC (corrected p-values = 0.009 for both). Gait velocity also improved from baseline to during RAC and post-RAC in all participants, although this improvement was not significant after correcting for multiple comparisons. The changes in cadence and gait velocity were most pronounced in PSP. In addition, our exploratory analysis showed that the cadence in the suspected TAU group (PSP+CBS) showed a significant improvement from baseline to during RAC and post-RAC (corr. p-value = 0.004 for both). This pilot study using short-term RAC in APD patients demonstrated improvements in cadence and velocity. There is an urgent need for effective gait rehabilitation modalities for patients with APD, and rhythmic cueing can be a practical and useful intervention to improve their gait pattern.

Parkinsonics: A Randomized, Blinded, Cross-Over Trial of Group Singing for Motor and Nonmotor Symptoms in Idiopathic Parkinson Disease

Introduction

Parkinson's disease (PD) frequently causes communication difficulties due to various voice impairments and there are few treatment options for vocal/communication complaints. We assessed the effects of weekly group singing on PD patients' objective vocal and motoric function, cognition, mood, self-efficacy, and quality of life.

Methods

Thirty-two participants were randomly assigned to either a singing group or a facilitated discussion group weekly over 12 weeks. After 12 weeks, participants crossed over for an additional 12 weeks. Evaluations were performed at baseline and every six weeks for 30 weeks. Objective voice measures included volume/loudness (decibels), held vowel duration, jitter, shimmer, and harmonic-to-noise ratio. Additional outcome measures included patient-centered quality of life, voice-related quality of life, MDS-UPDRS, Montreal Cognitive Assessment, and questionnaires assessing depression, self-efficacy, and overall well-being.

Results

Twenty-six participants (16 M/10F; Hoehn & Yahr stage 2.3 (range 2–3); and age 68.6 (55–89)) completed the study. Across participants in both groups (intention-to-treat analyses), there was significant improvement from baseline in average loudness on the Cookie Theft picture description at 24 weeks (end of interventions), corresponding with improved minimal reading volumes at 24 weeks and 30 weeks (end of study). Similarly, there were improvements in minimal loudness on Rainbow passage reading at 24 and 30 weeks. There were improvements observed in the Emotional Well-Being (mean delta −12.7 points, p = 0.037) and Body Discomfort (mean delta −18.6 points, p = 0.001) domains of the PDQ-39 from baseline to week 24 in the overall cohort and greater improvement in the Communication domain for Group S than Group D after 12 weeks of singing (delta −12.9 points, p = 0.016). Baseline differences between the participant groups (age, gender, Hoehn & Yahr stage, and several voice loudness measures) and observed improvements during the weekly discussion group period limited our ability to attribute all of the above results specifically to singing (per-protocol analyses). No significant changes in other assessed outcome measures were found.

Conclusions

Weekly group singing may improve some aspects of conversational voice volume and quality of life in PD. Some improvements were sustained at least six weeks after interventions ended. Further investigations of the mechanism of benefit and randomized controlled studies (without crossover) to assess the longitudinal effects of singing in PD are necessary.

Decomposing the Effects of Familiarity with Music Cues on Stride Length and Variability in Persons with Parkinson's Disease: On the Role of Covariates

This study aimed to determine the role of cognitive and affective responses to music cues in modulating the effects of familiarity with music on stride length and stride-to-stride variability in people with Parkinson's disease (PD). Using multilevel modeling, people with PD's spatiotemporal gait parameters and self-reported ratings of familiarity, enjoyment, cognitive and physical demand, beats salience of music cues after each walking trial, as well as music reward, were analyzed. Our findings indicate that (1) condition-varying perceived enjoyment and beat salience are positively associated with increased stride length; (2) participants with a greater music reward for mood regulation and emotion evocation show greater stride length changes compared with those with less music reward; (3) condition-varying perceived enjoyment is positively associated with decreases in stride-to-stride variability; and (4) participants with lower cognitive demand of walking with music cues and higher beat salience show lower stride-to-stride variability compared with those with higher cognitive demand and lower beat salience. These results provide behavioral evidence of independent and interactive influences of cognitive and affective responses to music cues on spatiotemporal gait parameters in people with PD.

Rhythmic serious games as an inclusive tool for music-based interventions

Technologies, such as mobile devices or sets of connected sensors, provide new and engaging opportunities to devise music-based interventions. Among the different technological options, serious games offer a valuable alternative. Serious games can engage multisensory processes, creating a rich, rewarding, and motivating rehabilitation setting. Moreover, they can be targeted to specific musical features, such as pitch production or synchronization to a beat. Because serious games are typically low cost and enjoy wide access, they are inclusive tools perfectly suited for remote at-home interventions using music in various patient populations and environments. The focus of this article is in particular on the use of rhythmic serious games for training auditory-motor synchronization. After reviewing the existing rhythmic games, initial evidence from a recent proof-of-concept study in Parkinson's disease is provided. It is shown that rhythmic video games using finger tapping can be used with success as an at-home protocol, and bring about beneficial effects on motor performance in patients. The use and benefits of rhythmic serious games can extend beyond the rehabilitation of patients with movement disorders, such as to neurodevelopmental disorders, including dyslexia and autism spectrum disorder.

Detection and assessment of Parkinson's disease based on gait analysis: A survey

Neurological disorders represent one of the leading causes of disability and mortality in the world. Parkinson's Disease (PD), for example, affecting millions of people worldwide is often manifested as impaired posture and gait. These impairments have been used as a clinical sign for the early detection of PD, as well as an objective index for pervasive monitoring of the PD patients in daily life. This review presents the evidence that demonstrates the relationship between human gait and PD, and illustrates the role of different gait analysis systems based on vision or wearable sensors. It also provides a comprehensive overview of the available automatic recognition systems for the detection and management of PD. The intervening measures for improving gait performance are summarized, in which the smart devices for gait intervention are emphasized. Finally, this review highlights some of the new opportunities in detecting, monitoring, and treating of PD based on gait, which could facilitate the development of objective gait-based biomarkers for personalized support and treatment of PD.

GuitarPD: A Randomized Pilot Study on the Impact of Nontraditional Guitar Instruction on Functional Movement and Well-Being in Parkinson’s Disease

Playing musical instruments may have positive effects on motor, emotional, and cognitive deficits in patients with Parkinson’s disease (PD). This pilot study examined the feasibility of a six-week nontraditional guitar instruction program for individuals with PD. Twenty-six participants with idiopathic PD (Age: 67.22 ± 8.07; 17 males) were randomly assigned to two groups (intervention first or 6 weeks of usual care control exposure) with stepwise exposure to the guitar intervention condition with cross-over at six weeks. Outcomes were assessed at baseline, 6, 12, and 18 weeks. Twenty-four participants completed the study. Combined analysis of the groups showed significant BDI-II improvement immediately after intervention completion (3.04 points, 95% CI [−5.2, −0.9], $p=0.04$ ). PDQ-39 total quality of life scores improved from baseline to immediately postintervention 5.19 points (95% CI [−9.4, −1.0]) at trend significance (corrected $p=0.07$ ). For Group 1 (exposed to the intervention first), MDS-UPDRS total scores improved by a mean of 8.04 points (95% CI [−12.4, −3.7], $p=0.004$ ) and remained improved at 12 weeks by 10.37 points (95% CI [−14.7, −6.0], $p<0.001$ ). This group also had significant improvements in mood and depression at weeks 6 and 12, remaining significant at week 18 (BDI-II: 3.75, 95% CI [−5.8, −1.7], $p=0.004$ ; NeuroQoL-depression: 10.6, 95% CI [−4.9. −1.4], $p=0.004$ ), and in anxiety at week 6 and week 18 (NeuroQoL; 4.42, 95% CI [−6.8, −2.1], $p=0.004$ ; 3.58, 95% CI [−5.9, −1.2], $p=0.02$ , respectively). We found clinically and statistically significant improvements in mood/anxiety after 6 weeks of group guitar classes in individuals with PD. Group guitar classes can be a feasible intervention in PD and may improve mood, anxiety, and quality of life.

Gait in younger and older adults during rhythmic auditory stimulation is influenced by groove, familiarity, beat perception, and synchronization demands

Music-based Rhythmic auditory stimulation (RAS) is a cueing intervention used to regulate gait impairments in conditions such as Parkinson's disease or stroke. Desire to move with music ('groove') and familiarity have been shown to impact younger adult gait while walking with music, and these effects appear to be influenced by individual rhythmic ability. Importantly, these factors have not been examined in older adults. The aim of this study was to determine how gait outcomes during RAS are influenced by musical properties (familiarity, 'groove') in both free and synchronized walking for younger and older adults with good and poor beat perception ability. To do this, participants were randomized to either free or synchronized walking groups. Each participant's gait was assessed on a pressure sensitive walkway during high versus low groove and high versus low familiarity music, as well as metronome, cueing trials. Individual beat perception ability was evaluated using the Beat Alignment Test. Results showed that the effects of synchronization and groove were mostly consistent across age groups. High groove music elicited faster gait in both age groups, with longer strides only among young adults, than low groove music; synchronizing maximized these effects. Older adults with poor beat perception were more negatively affected by unfamiliar stimuli while walking than younger adults. This suggests that older adults, like younger adults, may benefit from synchronized RAS to high groove cues but may be more vulnerable to cognitive demands associated with walking to unfamiliar stimuli. This should be accounted for in clinical implementations of RAS.

At-Home Training With a Rhythmic Video Game for Improving Orofacial, Manual, and Gait Abilities in Parkinson’s Disease: A Pilot Study

Rhythm disorders are consistently reported in Parkinson’s disease (PD). They manifest across motor domains, such as in orofacial (oral diadochokinesis), manual (finger tapping), and gait tasks. It is still unclear, however, whether these disorders are domain- and task-specific, or result from impaired common mechanisms supporting rhythm processing (general dysrhythmia). We tested the possibility that an at-home intervention delivered via a rhythmic video game on tablet improves motor performance across motor domains in PD. Patients with PD (n = 12) played at home a rhythmic video game (Rhythm Workers) on tablet, in which they finger-tapped to the beat of music, for 6 weeks. A control group (n = 11) played an active non-rhythmic video game (Tetris). A third group (n = 10) did not receive any intervention. We measured rhythmic abilities in orofacial, manual and gait motor domains, as well as rhythm perception, before and after the intervention. Patients who performed the rhythmic training improved their orofacial and manual rhythmic performance. This beneficial effect was linked to improved rhythm perception only following the rhythmic training period. We did not observe any improvement in rhythmic abilities in the other two groups. In this pilot study, we demonstrated that at-home intervention with a rhythmic video game using finger tapping can have beneficial effects on motor performance across different motor domains (manual and orofacial). This finding provides evidence of a general dysrhythmia in PD and paves the way to technology-driven interventions aiming at alleviating rhythm-related motor deficits in PD.

Temporal Predictions in Space: Isochronous Rhythms Promote Forward Projections of the Body

A regular rhythmic stimulation increases people's ability to anticipate future events in time and to move their body in space. Temporal concepts are usually prescribed to spatial locations through a past-behind and future-ahead mapping. In this study, we tested the hypothesis that a regular rhythmic stimulation could promote the forward-body (i.e., toward the future) projections in the peri-personal space. In a Visual Approach/Avoidance by the Self Task (VAAST), participants (N = 24) observed a visual scene on the screen (i.e., a music studio with a metronome in the middle). They were exposed to 3 s of auditory isochronous or non-isochronous rhythms, after which they were asked to make as quickly as possible a perceptual judgment on the visual scene (i.e., whether the metronome pendulum was pointing to the right or left). The responses could trigger a forward or backward visual flow, i.e., approaching or moving them away from the scene. Results showed a significant interaction between the rhythmic stimulation and the movement projections (p < 0.001): participants were faster for responses triggering forward-body projections (but not backward-body projections) after the exposure to isochronous (but not non-isochronous) rhythm. By highlighting the strong link between isochronous rhythms and forward-body projections, these findings support the idea that temporal predictions driven by a regular auditory stimulation are grounded in a perception-action system integrating temporal and spatial information.

The effects of Parkinson's disease, music training, and dance training on beat perception and production abilities

Humans naturally perceive and move to a musical beat, entraining body movements to auditory rhythms through clapping, tapping, and dancing. Yet the accuracy of this seemingly effortless behavior varies widely across individuals. Beat perception and production abilities can be improved by experience, such as music and dance training, and impaired by progressive neurological changes, such as in Parkinson’s disease. In this study, we assessed the effects of music and dance experience on beat processing in young and older adults, as well as individuals with early-stage Parkinson’s disease. We used the Beat Alignment Test (BAT) to assess beat perception and production in a convenience sample of 458 participants (278 healthy young adults, 139 healthy older adults, and 41 people with early-stage Parkinson’s disease), with varying levels of music and dance training. In general, we found that participants with over three years of music training had more accurate beat perception than those with less training (p < .001). Interestingly, Parkinson’s disease patients with music training had beat production abilities comparable to healthy adults while Parkinson’s disease patients with minimal to no music training performed significantly worse. No effects were found in healthy adults for dance training, and too few Parkinson’s disease patients had dance training to reliably assess its effects. The finding that musically trained Parkinson’s disease patients performed similarly to healthy adults during a beat production task, while untrained patients did not, suggests music training may preserve certain rhythmic motor timing abilities in early-stage Parkinson’s disease.

Dysfunctional Timing in Traumatic Brain Injury Patients: Co-occurrence of Cognitive, Motor, and Perceptual Deficits

Timing is an essential part of human cognition and of everyday life activities, such as walking or holding a conversation. Previous studies showed that traumatic brain injury (TBI) often affects cognitive functions such as processing speed and time-sensitive abilities, causing long-term sequelae as well as daily impairments. However, the existing evidence on timing capacities in TBI is mostly limited to perception and the processing of isolated intervals. It is therefore open whether the observed deficits extend to motor timing and to continuous dynamic tasks that more closely match daily life activities. The current study set out to answer these questions by assessing audio motor timing abilities and their relationship with cognitive functioning in a group of TBI patients (n = 15) and healthy matched controls. We employed a comprehensive set of tasks aiming at testing timing abilities across perception and production and from single intervals to continuous auditory sequences. In line with previous research, we report functional impairments in TBI patients concerning cognitive processing speed and perceptual timing. Critically, these deficits extended to motor timing: The ability to adjust to tempo changes in an auditory pacing sequence was impaired in TBI patients, and this motor timing deficit covaried with measures of processing speed. These findings confirm previous evidence on perceptual and cognitive timing deficits resulting from TBI and provide first evidence for comparable deficits in motor behavior. This suggests basic co-occurring perceptual and motor timing impairments that may factor into a wide range of daily activities. Our results thus place TBI into the wider range of pathologies with well-documented timing deficits (such as Parkinson’s disease) and encourage the search for novel timing-based therapeutic interventions (e.g., employing dynamic and/or musical stimuli) with high transfer potential to everyday life activities.

Parkinson's disease affects the neural alpha oscillations associated with speech-in-noise processing

Parkinson's disease (PD) has increasingly been associated with auditory dysfunction, including alterations regarding the control of auditory information processing. Although these alterations may interfere with the processing of speech in degraded listening conditions, behavioural studies have generally found preserved speech-in-noise recognition in PD. However, behavioural speech audiometry does not capture the neurophysiological mechanisms supporting speech-in-noise processing. Therefore, the aim of this study was to investigate the neural oscillatory mechanisms associated with speech-in-noise processing in PD. Twelve persons with PD and 12 age- and gender-matched healthy controls (HCs) were included in this study. Persons with PD were studied in the medication off condition. All subjects underwent an audiometric screening and performed a sentence-in-noise recognition task under simultaneous electroencephalography (EEG) recording. Behavioural speech recognition scores and self-reported ratings of effort, performance, and motivation were collected. Time-frequency analysis of EEG data revealed no significant difference between persons with PD and HCs regarding delta-theta (2-8 Hz) inter-trial phase coherence to noise and sentence onset. In contrast, significantly increased alpha (8-12 Hz) power was found in persons with PD compared with HCs during the sentence-in-noise recognition task. Behaviourally, persons with PD demonstrated significantly decreased speech recognition scores, whereas no significant differences were found regarding effort, performance, and motivation ratings. These results suggest that persons with PD allocate more cognitive resources to support speech-in-noise processing. The interpretation of this finding is discussed in the context of a top-down mediated compensation mechanism for inefficient filtering and degradation of auditory input in PD.

Hierarchical control as a shared neurocognitive mechanism for language and music

Although comparative research has made substantial progress in clarifying the relationship between language and music as neurocognitive systems from both a theoretical and empirical perspective, there is still no consensus about which mechanisms, if any, are shared and how they bring about different neurocognitive systems. In this paper, we tackle these two questions by focusing on hierarchical control as a neurocognitive mechanism underlying syntax in language and music. We put forward the Coordinated Hierarchical Control (CHC) hypothesis: linguistic and musical syntax rely on hierarchical control, but engage this shared mechanism differently depending on the current control demand. While linguistic syntax preferably engages the abstract rule-based control circuit, musical syntax rather employs the coordination of the abstract rule-based and the more concrete motor-based control circuits. We provide evidence for our hypothesis by reviewing neuroimaging as well as neuropsychological studies on linguistic and musical syntax. The CHC hypothesis makes a set of novel testable predictions to guide future work on the relationship between language and music.

Vocal learning and flexible rhythm pattern perception are linked: Evidence from songbirds

We can recognize the cadence of a friend’s voice or the rhythm of a familiar song across a wide range of tempi. This shows that our perception of temporal patterns relies strongly on the relative timing of events rather than on specific absolute durations. This tendency is foundational to speech and music perception, but to what extent is it shared by other species? We hypothesize that animals that learn their vocalizations are more likely to share this tendency. Here, we show that a vocal learning songbird robustly recognizes a basic rhythmic pattern independent of rate. Our findings pave the way for neurobiological studies to identify how the brain represents and perceives the temporal structure of auditory sequences.

Rhythm perception is fundamental to speech and music. Humans readily recognize a rhythmic pattern, such as that of a familiar song, independently of the tempo at which it occurs. This shows that our perception of auditory rhythms is flexible, relying on global relational patterns more than on the absolute durations of specific time intervals. Given that auditory rhythm perception in humans engages a complex auditory–motor cortical network even in the absence of movement and that the evolution of vocal learning is accompanied by strengthening of forebrain auditory–motor pathways, we hypothesize that vocal learning species share our perceptual facility for relational rhythm processing. We test this by asking whether the best-studied animal model for vocal learning, the zebra finch, can recognize a fundamental rhythmic pattern—equal timing between event onsets (isochrony)—based on temporal relations between intervals rather than on absolute durations. Prior work suggests that vocal nonlearners (pigeons and rats) are quite limited in this regard and are biased to attend to absolute durations when listening to rhythmic sequences. In contrast, using naturalistic sounds at multiple stimulus rates, we show that male zebra finches robustly recognize isochrony independent of absolute time intervals, even at rates distant from those used in training. Our findings highlight the importance of comparative studies of rhythmic processing and suggest that vocal learning species are promising animal models for key aspects of human rhythm perception. Such models are needed to understand the neural mechanisms behind the positive effect of rhythm on certain speech and movement disorders.

Dance Improves Motor, Cognitive, and Social Skills in Children With Developmental Cerebellar Anomalies

In this multiple single-cases study, we used dance to train sensorimotor synchronization (SMS), motor, and cognitive functions in children with developmental cerebellar anomalies (DCA). DCA are rare dysfunctions of the cerebellum that affect motor and cognitive skills. The cerebellum plays an important role in temporal cognition, including SMS, which is critical for motor and cognitive development. Dancing engages the SMS neuronal circuitry, composed of the cerebellum, the basal ganglia, and the motor cortices. Thus, we hypothesized that dance has a beneficial effect on SMS skills and associated motor and cognitive functions in children with DCA. Seven children (aged 7-11) with DCA participated in a 2-month dance training protocol (3 h/week). A test-retest design protocol with multiple baselines was used to assess children's SMS skills as well as motor, cognitive, and social abilities. SMS skills were impaired in DCA before the training. The training led to improvements in SMS (reduced variability in paced tapping), balance, and executive functioning (cognitive flexibility), as well as in social skills (social cognition). The beneficial effects of the dance training were visible in all participants. Notably, gains were maintained 2 months after the intervention. These effects are likely to be sustained by enhanced activity in SMS brain networks due to the dance training protocol.

About time: Ageing influences neural markers of temporal predictability

Timing abilities help organizing the temporal structure of events but are known to change systematically with age. Yet, how the neuronal signature of temporal predictability changes across the age span remains unclear. Younger (n = 21; 23.1 years) and older adults (n = 21; 68.5 years) performed an auditory oddball task, consisting of isochronous and random sound sequences. Results confirm an altered P50 response in the older compared to younger participants. P50 amplitudes differed between the isochronous and random temporal structures in younger, and for P200 in the older group. These results suggest less efficient sensory gating in older adults in both isochronous and random auditory sequences. N100 amplitudes were more negative for deviant tones. P300 amplitudes were parietally enhanced in younger, but not in older adults. In younger participants, the P50 results confirm that this component marks temporal predictability, indicating sensitive gating of temporally regular sound sequences.

The State of Music Therapy Studies in the Past 20 Years: A Bibliometric Analysis

Purpose: Music therapy is increasingly being used to address physical, emotional, cognitive, and social needs of individuals. However, publications on the global trends of music therapy using bibliometric analysis are rare. The study aimed to use the CiteSpace software to provide global scientific research about music therapy from 2000 to 2019.

Methods: Publications between 2000 and 2019 related to music therapy were searched from the Web of Science (WoS) database. The CiteSpace V software was used to perform co-citation analysis about authors, and visualize the collaborations between countries or regions into a network map. Linear regression was applied to analyze the overall publication trend.

Results: In this study, a total of 1,004 studies met the inclusion criteria. These works were written by 2,531 authors from 1,219 institutions. The results revealed that music therapy publications had significant growth over time because the linear regression results revealed that the percentages had a notable increase from 2000 to 2019 (t = 14.621, P < 0.001). The United States had the largest number of published studies (362 publications), along with the following outputs: citations on WoS (5,752), citations per study (15.89), and a high H-index value (37). The three keywords “efficacy,” “health,” and “older adults,” emphasized the research trends in terms of the strongest citation bursts.

Conclusions: The overall trend in music therapy is positive. The findings provide useful information for music therapy researchers to identify new directions related to collaborators, popular issues, and research frontiers. The development prospects of music therapy could be expected, and future scholars could pay attention to the clinical significance of music therapy to improve the quality of life of people.

How groove in music affects gait

Rhythmic auditory stimulation (RAS) is a gait intervention in which gait-disordered patients synchronise footsteps to music or metronome cues. Musical 'groove', the tendency of music to induce movement, has previously been shown to be associated with faster gait, however, why groove affects gait remains unclear. One mechanism by which groove may affect gait is that of beat salience: music that is higher in groove has more salient musical beats, and higher beat salience might reduce the cognitive demands of perceiving the beat and synchronizing footsteps to it. If groove's effects on gait are driven primarily by the impact of beat salience on cognitive demands, then groove's effects might only be present in contexts in which it is relevant to reduce cognitive demands. Such contexts could include task parameters that increase cognitive demands (such as the requirement to synchronise to the beat), or individual differences that may make synchronisation more cognitively demanding. Here, we examined whether high beat salience can account for the effects of high-groove music on gait. First, we increased the beat salience of low-groove music to be similar to that of high-groove music by embedding metronome beats in low and high-groove music. We examined whether low-groove music with high beat salience elicited similar effects on gait as high-groove music. Second, we examined the effect of removing the requirement to synchronise footsteps to the beat (i.e., allowing participants to walk freely with the music), which is thought to remove the cognitive demand of synchronizing movements to the beat. We tested two populations thought to be sensitive to the cognitive demands of synchronisation, weak beat-perceivers and older adults. We found that increasing the beat salience of low-groove music increased stride velocity, but strides were still slower than with high-groove music. Similarly, removing the requirement to synchronise elicited faster, less variable gait, and reduced bias for stability, but high-groove music still elicited faster strides than low-groove music. These findings suggest that beat salience contributes to groove's effect on gait, but it does not fully account for it. Despite reducing task difficulty by equalizing beat salience and removing the requirement to synchronise, high-groove music still elicited faster, less variable gait. Therefore, other properties of groove also appear to play a role in groove's effect on gait.

Rhythm and groove as cognitive mechanisms of dance intervention in Parkinson's disease

Parkinson's disease (PD) is associated with a loss of internal cueing systems, affecting rhythmic motor tasks such as walking and speech production. Music and dance encourage spontaneous rhythmic coupling between sensory and motor systems; this has inspired the development of dance programs for PD. Here we assessed the therapeutic outcome and some underlying cognitive mechanisms of dance classes for PD, as measured by neuropsychological assessments of disease severity as well as quantitative assessments of rhythmic ability and sensorimotor experience. We assessed prior music and dance experience, beat perception (Beat Alignment Test), sensorimotor coupling (tapping to high- and low-groove songs), and disease severity (Unified Parkinson's Disease Rating Scale in PD individuals) before and after four months of weekly dance classes. PD individuals performed better on UPDRS after four months of weekly dance classes, suggesting efficacy of dance intervention. Greater post-intervention improvements in UPDRS were associated with the presence of prior dance experience and with more accurate sensorimotor coupling. Prior dance experience was additionally associated with enhanced sensorimotor coupling during tapping to both high-groove and low-groove songs. These results show that dance classes for PD improve both qualitative and quantitative assessments of disease symptoms. The association between these improvements and dance experience suggests that rhythmic motor training, a mechanism underlying dance training, impacts improvements in parkinsonian symptoms following a dance intervention.

Auditory decisions in the supplementary motor area

In human speech and communication across various species, recognizing and categorizing sounds is fundamental for the selection of appropriate behaviors. However, how does the brain decide which action to perform based on sounds? We explored whether the supplementary motor area (SMA), responsible for linking sensory information to motor programs, also accounts for auditory-driven decision making. To this end, we trained two rhesus monkeys to discriminate between numerous naturalistic sounds and words learned as target (T) or non-target (nT) categories. We found that the SMA at single and population neuronal levels perform decision-related computations that transition from auditory to movement representations in this task. Moreover, we demonstrated that the neural population is organized orthogonally during the auditory and the movement periods, implying that the SMA performs different computations. In conclusion, our results suggest that the SMA integrates acoustic information in order to form categorical signals that drive behavior.

Music as Add-On Therapy in the Rehabilitation Program of Parkinson's Disease Patients-A Romanian Pilot Study

Music has been proven to have therapeutic potential in neurological disorders, especially Parkinson’s disease (PD), since rhythmic auditory cueing can partially replace the progressive loss of rhythmicity and automaticity. Several reports have highlighted improvements in motor outcomes in PD patients undergoing music therapy, but only a few studies have evaluated non-motor outcomes, such as quality of life (QoL), which deteriorates with disease progression. The current pilot study aims to examine the effects of a multimodal rehabilitation program centered on physical therapy combined with listening to music on self-reported QoL in people with PD, compared to the same rehabilitation program alone. The study was conducted on patients with idiopathic PD who attended a specific rehabilitation program with a duration of 2.5 h daily for 14 days. The patients were divided into the study group (16 patients), who listened to background music during the rehabilitation program sessions, and the control group who did not listen to music during sessions. The patients were assessed using the self-report Parkinson’s Disease Questionnaire (PDQ-39) at the beginning of the program and 1 month after its initiation. The patients in the study group registered greater improvements in five of the eight areas of life assessed by PDQ-39 compared to the control group. In conclusion, listening to music combined with a multimodal rehabilitation program centered on physical therapy may be beneficial for the patients’ quality of life.

BeatWalk: Personalized Music-Based Gait Rehabilitation in Parkinson's Disease

Taking regular walks when living with Parkinson’s disease (PD) has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors (BeatWalk) and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application (30 min/day, 5 days/week). The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% (±28.2) of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.

Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242.

Evaluation of multi-feature auditory deviance detection in Parkinson's disease: a mismatch negativity study

Behavioral studies on auditory deviance detection in patients with Parkinson's disease (PD) have reported contradictory results. The primary aim of this study was to investigate auditory deviance detection of multiple auditory features in patients with PD by means of objective and reliable electroencephalographic (EEG) measurements. Twelve patients with early-stage PD and twelve age- and gender-matched healthy controls (HCs) were included in this study. Patients with PD participated without their regular dopaminergic medication. All subjects underwent an audiometric screening and performed a passive multi-feature mismatch negativity (MMN) paradigm. Repeated-measures analysis of variance (ANOVA) demonstrated no significant differences between patients with PD and HCs regarding MMN mean amplitude and latency for frequency, duration and gap deviants. Nevertheless, a trend towards increased MMN mean amplitude and latency was found in response to intensity deviants in patients with PD compared to HCs. Increased intensity MMN amplitude may indicate that more neural resources are allocated to the processing of intensity deviances in patients with PD compared to HCs. The interpretation of this intensity-specific MMN alteration is further discussed in the context of a compensatory mechanism for auditory intensity processing and involuntary attention switching in PD.

Temporal orienting in Parkinson's disease

Temporal orienting of attention can affect multiple stages of processing to guide adaptive behaviour. We tested whether temporal expectation in different task contexts is compromised in individuals with Parkinson's disease (PD). In Experiment 1 two temporal-orienting tasks were used: a speeded task emphasizing motor preparation and a non-speeded task emphasizing perceptual discrimination using rapid serial visual presentation. In both tasks, auditory cues indicated the likelihood of a target appearing after a short or long interval. In the speeded-response task, participants used the cues to anticipate an easily detectable target stimulus. In the non-speeded perceptual-discrimination task, participants used the cues to help discriminate a target letter embedded in a stream of letters. Relative to healthy participants, participants with PD did not show altered temporal orienting effects in the speeded-response task. However, they were impaired in using temporal cues to improve perceptual discrimination. In Experiment 2, we tested whether the temporal-orienting deficits in the perceptual-discrimination task depended on the requirement to ignore temporally distracting stimuli. We replicated the impaired temporal orienting for perceptual discrimination in an independent group of individuals with PD, and showed the impairment was abolished when individuals were on their dopaminergic medication. In a task without any distracting letters, however, patients off or on medication benefited normally from temporal orienting cues. Our findings suggest that deficits in temporal orienting in individuals with PD interact with specific task demands, such as the requirement to select target from temporally competing distractors.

Effects of rhythmic auditory stimulation on functionality in Parkinson’s disease

Abstract Introduction: Functionality is affected by the clinical characteristics and progression of Parkinson’s disease (PD). Objective: Assess the effects of a therapeutic exercise program associated with music-based rhythmic auditory stimulation (RAS) on the Activities and Participation Profile (APP) related to mobility of people with PD. Methods: Intervention study investigating people with moderate PD recruited from the Hospital das Clínicas of the Federal University of Pernambuco and the Parkinson’s Disease Association of Pernambuco. The APP related to mobility of the participants was assessed based on the International Classification of Functioning Disability and Health (ICF). The APP contains 23 activity/participation items scored from 0 (no problem) to 4 (complete problem). The intervention consisted of 10 outpatient sessions of a therapeutic exercise program associated with music-based RAS, applied using a smartphone application (ParkinSONS®), performed twice a week, with an average duration of 50 minutes per session. Given the metric nature of the variable and its non-normal distribution, Wilcoxon’s test was applied, considering p < 0.05. Results: In the sample of 8 patients, there was a significant decline in APP scores after intervention (p = 0.018*), indicating a positive change. Scores for all the APP activities decreased following the intervention, except for “transferring oneself to the left side while lying down”. Conclusion: In this study, a therapeutic exercise program associated with music-based RAS had a positive effect on the APP related to mobility of people with moderate PD.

Dissonance in Music Impairs Spatial Gait Parameters in Patients with Parkinson's Disease

BACKGROUND

It is known that music influences gait parameters in Parkinson's disease (PD). However, it remains unclear whether this effect is merely due to temporal aspects of music (rhythm and tempo) or other musical parameters.

OBJECTIVE

To examine the influence of pleasant and unpleasant music on spatiotemporal gait parameters in PD, while controlling for rhythmic aspects of the musical signal.

METHODS

We measured spatiotemporal gait parameters of 18 patients suffering from mild PD (50%men, mean±SD age of 64±6 years; mean disease duration of 6±5 years; mean Unified PD Rating scale [UPDRS] motor score of 15±7) who listened to eight different pieces of music. Music pieces varied in harmonic consonance/dissonance to create the experience of pleasant/unpleasant feelings. To measure gait parameters, we used an established analysis of spatiotemporal gait, which consists of a walkway containing pressure-receptive sensors (GAITRite®). Repeated measures analyses of variance were used to evaluate effects of auditory stimuli. In addition, linear regression was used to evaluate effects of valence on gait.

RESULTS

Sensory dissonance modulated spatiotemporal and spatial gait parameters, namely velocity and stride length, while temporal gait parameters (cadence, swing duration) were not affected. In contrast, valence in music as perceived by patients was not associated with gait parameters. Motor and musical abilities did not relevantly influence the modulation of gait by auditory stimuli.

CONCLUSION

Our observations suggest that dissonant music negatively affects particularly spatial gait parameters in PD by yet unknown mechanisms, but putatively through increased cognitive interference reducing attention in auditory cueing.

Accent-induced Modulation of Neural and Movement Patterns during Spontaneous Synchronization to Auditory Rhythms

Human rhythmic movements spontaneously synchronize with auditory rhythms at various frequency ratios. The emergence of more complex relationships—for instance, frequency ratios of 1:2 and 1:3—is enhanced by adding a congruent accentuation pattern (binary for 1:2 and ternary for 1:3), resulting in a 1:1 movement–accentuation relationship. However, this benefit of accentuation on movement synchronization appears to be stronger for the ternary pattern than for the binary pattern. Here, we investigated whether this difference in accent-induced movement synchronization may be related to a difference in the neural tracking of these accentuation profiles. Accented and control unaccented auditory sequences were presented to participants who concurrently produced finger taps at their preferred frequency, and spontaneous movement synchronization was measured. EEG was recorded during passive listening to each auditory sequence. The results revealed that enhanced movement synchronization with ternary accentuation was accompanied by enhanced neural tracking of this pattern. Larger EEG responses at the accentuation frequency were found for the ternary pattern compared with the binary pattern. Moreover, the amplitude of accent-induced EEG responses was positively correlated with the magnitude of accent-induced movement synchronization across participants. Altogether, these findings show that the dynamics of spontaneous auditory–motor synchronization is strongly driven by the multi-time-scale sensory processing of auditory rhythms, highlighting the importance of considering neural responses to rhythmic sequences for understanding and enhancing synchronization performance.

Does a Live Performance Impact Synchronization to Musical Rhythm in Cognitively Impaired Elderly?

BACKGROUND

Music-based interventions appear to be efficient approaches to improve emotional, social, and cognitive functioning of patients with neurodegenerative diseases.

OBJECTIVE

Because benefits seem to increase with patient's motor involvement, we studied sensorimotor synchronization (SMS) abilities of patients with cognitive impairments (Alzheimer's disease, vascular and mixed dementia) and of patients with no evidence of cognitive impairments. More specifically, we compared the impact of a live performance by a musician to a video recording on SMS.

METHODS

SMS to a metronomic or a musical stimulus was assessed while patients watched a live musician or his pre-recorded video.

RESULTS

SMS to a metronome was better than to music but this effect was modulated by the social context. While SMS to a metronome was better when facing a video than a live performance, there was no impact of social context on SMS to music. No group differences of SMS were found.

CONCLUSION

The decrease in SMS to a metronome in a live performance may be due to social pressure. Such a pressure might be removed in pleasant social activities, like moving with music in a group, explaining the lack of effect on SMS to music. We found no performance differences in groups, suggesting relatively spared SMS in cognitively impaired patients. By showing that it is possible to encourage patients to synchronize with others, even when facing a video, our results indicate that SMS can be used as a relevant predictor in clinical trials and open up promising therapeutic options for isolated patients.

Effects of motor style on timing control and EEG waveforms in self-paced and synchronization tapping tasks

We investigated the effects of tapping style on motor performance and neural activity in self-paced and synchronization tapping tasks in three conditions (drum sticking [DS], one-finger tapping [1FT], and four-finger tapping [4FT]). In the synchronization task, participants tapped in synchrony with a metronomic sound. No significant differences were detected in the accuracy of timing control among the tapping styles, whereas larger potentials on EEG waveforms before tap onset were found in 4FT than in DS or 1FT; these may be readiness potentials for the motor commands required to control multiple fingers. As expected, tap intervals were more stable under the synchronization condition than under the selfpaced condition, but no difference was detected in the neural activity evoked before tap onset. Larger neural potentials observed in the early stage after tap onset in DS might be involved in the sensory feedback associated with tool use.

Feasibility of Music-Assisted Treadmill Training in Parkinson's Disease Patients With and Without Deep Brain Stimulation: Insights From an Ongoing Pilot Randomized Controlled Trial

Background: Music-assisted treadmill training (MATT) is a new therapeutic approach for Parkinson's disease (PD) patients, combining treadmill training with rhythmic auditory cueing and visual feedback. PD studies have shown larger positive effects on motor outcomes than usual treadmill training. However, effects on cognition, in contrast, are less clear. Existing studies provided intensive training protocols and included only stable medicated patients. Thus, a pilot randomized controlled trial was designed to analyze the feasibility of a shorter training protocol as well as preliminary effects on cognition, motor function, and patient-centered outcomes in a rehabilitation setting where PD patients with and without deep brain stimulation (DBS) undergo adaptation of medication and DBS settings. Here, we present the results from the feasibility analysis of the still ongoing trial.

Methods: Non-demented PD patients with and without DBS were recruited during their inpatient rehabilitation and randomized to an experimental group (EG; 20 min MATT) or an active control group (CG; 20 min bike ergometer training). The trainings took place for 8 consecutive days and were added to the usual rehabilitation. Feasibility was assessed with the following parameters: patients' study protocol acceptance, study protocol transferability into clinical routine, training-induced adverse events, and patients' training perception.

Results: Thirty-two patients (EG: n = 15; CG: n = 17; 72% DBS) were included. The study protocol was well-accepted (inclusion rate: 84%). It was transferable into clinical routines; dropout rates of 40% (EG) and 18% (CG) were observed. However, an in-depth analysis of the dropout cohort did not reveal intervention-related dropout reasons. The MATT and the standard ergometer training showed no adverse events and were positively perceived by PD patients with and without DBS.

Conclusion: MATT was shown to be a feasible, safe, and enjoyable treatment option in PD patients with and without DBS. Furthermore, the dropout cohort analysis revealed some exciting first insights into possible dropout reasons that go beyond the form of intervention. Therefore, research would benefit from a common practice of dropout analyses, as this would enhance our understanding of patients' therapy adherence and expectations.

Synchronization to auditory and visual beats in Parkinson's disease

The ability to move in synchrony with a perceived regular beat in time is essential for humans to interact with environments in an anticipatory manner, and the basal ganglia have been shown to be preferentially involved in beat processing. Auditory beats are often adopted in assessing the sensorimotor deficiency of patients with Parkinson's disease (PD), which is characterized by basal ganglia dysfunction. Whereas beat synchronization has long been considered to be specific to the auditory modality, recent studies employing moving instead of static visual stimuli have shown comparable synchronization performances of auditory and visual beats. Here, we show that compared with control subjects, synchronization stability of PD patients significantly decreased for beats composed of visual contracting rings but not for beats consisting of auditory tones or static visual flashes. The results revealed specific impairment of visual beat synchronization in PD. Considering the common experience of visuomotor interactions in daily lives of PD patients, the present finding emphasizes the importance of evaluation of visuomotor timing deficiency in PD by employing moving visual stimuli that have ecological relevance.

An Overview of Acoustic-Based Interventions to Improve Motor Symptoms in Parkinson's Disease

Parkinson’s disease (PD) is characterized by motor and cognitive deficits that negatively impact on activities of daily living. While dopaminergic medications are used to attenuate motor symptoms, adjuvant therapies such as acoustic-based non-pharmacological interventions are used as a complement to standard drug treatments. At present, preliminary studies of acoustic-based interventions such as rhythmic-auditory stimulation (RAS) and vibroacoustic therapy (VAT) suggest two competing hypotheses: (1) RAS may recruit alternative motor networks that may bypass faulty spatiotemporal motor networks of movement in PD; or (2) the use of RAS enhances BG function through entrainment of beta oscillatory activities. In this mini review article, we discuss the mechanisms underlying the role of acoustic-based interventions and how it may serve to improve motor deficits such as gait impairments and tremors. We further provide suggestions for future work that may use a combination of RAS, VAT, and physical therapy to improve motor function in PD.

Finger tapping as a proxy for gait: Similar effects on movement variability during external and self-generated cueing in people with Parkinson's disease and healthy older adults

BACKGROUND

Rhythmic auditory cueing has been widely studied for gait rehabilitation in Parkinson's disease (PD). Our research group previously showed that externally generated cues (i.e., music) increased gait variability measures from uncued gait, whereas self-generated cues (i.e., mental singing) did not. These different effects may be due to differences in underlying neural mechanisms that could be discerned via neuroimaging; however, movement types that can be studied with neuroimaging are limited.

OBJECTIVE

The primary aim of the present study was to investigate the effects of different cue types on gait, finger tapping, and foot tapping, to determine whether tapping can be used as a surrogate for gait in future neuroimaging studies. The secondary aim of this study was to investigate whether rhythm skills or auditory imagery abilities are associated with responses to these different cue types.

METHODS

In this cross-sectional study, controls (n=24) and individuals with PD (n=33) performed gait, finger tapping, and foot tapping at their preferred pace (UNCUED) and to externally generated (MUSIC) and self-generated (MENTAL) cues. Spatiotemporal parameters of gait and temporal parameters of finger tapping and foot tapping were collected. The Beat Alignment Task (BAT) and Bucknell Auditory Imagery Scale (BAIS) were also administered.

RESULTS

The MUSIC cues elicited higher movement variability than did MENTAL cues across all movements. The MUSIC cues also elicited higher movement variability than the UNCUED condition for gait and finger tapping.

CONCLUSIONS

This study shows that different cue types affect gait and finger tapping similarly. Finger tapping may be an adequate proxy for gait in studying the underlying neural mechanisms of these cue types.

Future Perspectives on the Relevance of Auditory Markers in Prodromal Parkinson's Disease

Research on auditory processing in Parkinson's disease (PD) has recently made substantial progress. At present, evidence has been found for altered auditory processing in the clinical stage of PD. The auditory alterations in PD have been demonstrated with low-cost and non-invasive assessments that are already used in routine clinical practice. Since auditory alterations have been reported early in disease progression, it would be highly relevant to investigate whether auditory markers could be provided in the prodromal stage of PD. In addition, auditory alterations in early stage PD might be modulated by dopaminergic medication. Therefore, the aim of this review is (1) to summarize the literature on auditory processing in PD with a specific focus on the early disease stages, (2) to give future perspectives on which audiological and electrophysiological measurements could be useful in the prodromal stage of PD and (3) to assess the effect of dopaminergic medication on potential auditory markers in the prodromal stage of PD.