Rhythmic auditory cueing to improve walking in patients with neurological conditions other than Parkinson’s disease – what is the evidence?

Abstract

Purpose: To investigate whether synchronising over-ground walking to rhythmic auditory cues improves temporal and spatial gait measures in adults with neurological clinical conditions other than Parkinson’s disease. Method: A search was performed in June 2011 using the computerised databases AGELINE, AMED, AMI, CINAHL, Current Contents, EMBASE, MEDLINE, PsycINFO and PUBMED, and extended using hand-searching of relevant journals and article reference lists. Methodological quality was independently assessed by two reviewers. A best evidence synthesis was applied to rate levels of evidence. Results: Fourteen studies, four of which were randomized controlled trials (RCTs), met the inclusion criteria. Patient groups included those with stroke (six studies); Huntington’s disease and spinal cord injury (two studies each); traumatic brain injury, dementia, multiple sclerosis and normal pressure hydrocephalus (one study each). The best evidence synthesis found moderate evidence of improved velocity and stride length of people with stroke following gait training with rhythmic music. Insufficient evidence was found for other included neurological disorders due to low study numbers and poor methodological quality of some studies. Conclusion: Synchronising walking to rhythmic auditory cues can result in short-term improvement in gait measures of people with stroke. Further high quality studies are needed before recommendations for clinical practice can be made.

Implications for Rehabilitation

• Gait training using synchronisation of walking to rhythmic auditory cues may improve stride length and velocity in people with stroke.

• Further research is needed before recommendations regarding the use of rhythmic auditory cueing for patients with neurological disorders other than Parkinson’s disease can be made.

Keywords::

• Acoustic simulation
• gait
• neurologic gait disorder
• rhythmic auditory cueing

Declaration of Interest: The authors report no conflict of interest.

Appendix

Appendix 1.  Search strategy and yield from each included database.

Appendix 2

Best evidence synthesis [33]

Strong evidence

Provided by consistent, statistically significant findings in outcome measures in at least two high quality RCTs^a.

Moderate evidence

Provided by consistent, statistically significant findings in outcome measures in at least one high quality RCT and at least one low quality RCT or high quality CCT^a.

Limited evidence

Provided by consistent, statistically significant findings in outcome measures in at least one high quality RCT or provided by consistent, statistically significant findings in outcome measures in at least two high quality CCTs (in the absence of high quality RCTs).

Indicative findings

Provided by consistent, statistically significant findings in outcome and/or process measures in at least one high quality CCT or low quality RCT^a (in the absence of high quality RCTs) or provided by consistent, statistically significant findings in outcome and/or process measures in at least two non-controlled studies with sufficient quality (in the absence of RCTs and CCTs).

No or insufficient evidence

In the case that results of eligible studies do not meet the criteria for one of the above stated levels of evidence or in the case of conflicting (statistical significant positive and statistical significant negative) results among RCTs and CCTs or in the case of no eligible studies.

^aIf the number of studies that show evidence is <0% of the total number of studies found within the same category of methodological quality and study design (RCT, CCT or other design) no evidence will be stated.

RCT, randomised controlled trial; CCT, controlled clinical trial.