rhythmic auditory stimulation has been shown to do which of the following in cardiac rehab patients

An intervention with rhythmic auditory stimulation can be beneficial to improve gait parameters in people in the acute phase as well as in the chronic phase after stroke by increasing gait speed, improving step length of the affected side and cadence, and improving static balance.

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What is auditory rhythmic stimulation for gait training?

The purpose of this study was to use Rhythmic Auditory Stimulation (RAS) for children with spastic cerebral palsy (CP) in a clinical setting in order to determine its effectiveness in gait training for ambulation. RAS has been shown to improve gait performance in patients with significant gait deficits. All 25 participants (6 to 20 years old ...

Can auditory rhythmic stimulation improve Functional gait in cerebral palsy?

Feb 24, 2017 · Training based on rhythmic auditory stimulation (RAS) can improve gait in patients with idiopathic Parkinson’s disease (IPD). Patients …

How does auditory stimulation affect the central motor impulse?

Jun 11, 2018 · Rhythmic auditory cueing has been shown to enhance gait performance in several movement disorders. The “entrainment effect” generated by the stimulations can enhance auditory motor coupling and instigate plasticity. However, a consensus as to its influence over gait training among patients with multiple sclerosis is still warranted.

What is rhythmic-auditory stimulation (RAS)?

An intervention with rhythmic auditory stimulation can be beneficial to improve gait parameters in people in the acute phase as well as in the chronic phase after stroke by increasing gait speed,...

What is rhythmic auditory stimulation?

Rhythmic-auditory stimulation (RAS) is defined as a therapeutic application of pulsed rhythmic or musical stimulation in order to improve gait or gait related aspects of movement (5).14 Sept 2018

What is rhythmic cueing?

What is Rhythmic Speech Cueing (RSC)? RSC is a rate-control technique that uses auditory rhythm- in metronome form or embedded in music-to cue speech. How does it work? The impelling and anticipatory action of a rhythmic stimulus sequence can help initiate speech.

What is Ras physiotherapy?

Rhythmic Auditory Stimulation (RAS) is a music therapy technique that has been shown to improve walking patterns and mobility outcomes in adults with neuro-disabilities.

What is auditory rhythm?

By auditory cueing, I refer to the process whereby movement is synchronized to sound. Auditory cues can guide movement through their temporal structure to which movement can be aligned, and although these cues are usually rhythmic, this is not strictly necessary.

How do you do rhythmic auditory stimulation?

The patient walks barefoot 10 m 3 times at his preferred speed or 7 min. The cadence is calculated (steps/minute) The rhythm of the metronome adjusts to the patient's cadence. The auditory rhythmic stimulus is applied, and the patient is asked to synchronize his footsteps with the rhythm.

What is gait training exercises?

Gait training is a set of exercises that are specifically implemented by your physical therapist to help you walk better. The exercises involve improving motion in your lower extremity joints, improving strength and balance, and mimicking the repetitive nature of your legs that occur while walking.14 Mar 2022

What is visual cueing in Parkinson's disease?

Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinson's disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task.

What is the highest frequency of auditory rhythmic signaling?

It has been shown that the highest auditory rhythmic signaling, i.e. A constant auditory stimulus at a frequency of 110% of the normal cadence of the patient, increases the accuracy of the central motor impulse and therefore the impulse force of the nerve over which the command is issued. Consequently, the regulation of the skeletal muscles by the central nervous system can reinforce the coordination between agonizing-antagonist muscles.

What is the way in which gait adjusts to the acoustic stimulus?

The way in which gait adjusts to the acoustic stimulus is called auditory-motor coordination. Knowing the ability of auditory-motor coordination of a patient allows the physical therapist to modify the metronome to achieve the most optimal coupling between gait and rhythm and therefore obtain better results in the modification of gait parameters through acoustic rhythmic stimulation.

How does synchronization affect walking?

Achieving this synchronization results in instantaneous and prolonged effects that are transferred to various characteristics or parameters of the gait:[2] 1 Increases step length, cadence, and symmetry[1][2] 2 Improves the functional walking ability manifested by increasing gait speed and therefore produces faster walking and longer strides. [1]

What is gait training?

Gait training in the rehabilitation of different movement disorders has had multiple treatment approaches, one of the most current and with greater evidence of effectiveness for its facilitating effect for functional walking is auditory rhythmic signaling, acoustic rhythmic cueing or auditory rhythmic stimulation. In which acoustic rhythms produced by metronomes or previously selected music, signal the cadence during walking so that the patient synchronizes their footsteps with the rhythm or stimulus heard.

What are the levels of the motor control system that are required to achieve gait?

To achieve gait, inputs are required from various levels of the motor control system: cerebral cortex, brainstem, cerebellum, and central nervous system. In addition, the ability to modify the gait with the acoustic rhythms depends on how well the gait is linked to the rhythm and the effectiveness of the acoustic rhythms to modify the gait depends on the speed of the metronome.

How many metronomes are used to sign the pace of 2 steps per stride?

2 metronomes can be used to sign the pace of 2 steps per stride: according to evidence [2]the gait can be modulated more effectively when both footsteps are signaled using a different tone for each heel shock stimulus (440 Hz left foot ) (1000 Hz right), this generates greater stability in auditory-motor coordination.

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When was the study protocol approved?

The study protocol was approved by the state authorization association for medical issues in Brandenburg, that determined on the 21st of January 2010 that no formal ethics approval was required. Patients gave their informed consent according to the Helsinki declaration.

How many times a week was RAS TT performed?

The three interventions RAS-TT, TT and NDT were performed five times a week over of 4 weeks. All interventions were carried out as a single therapy with individual instruction from a physiotherapist.

What are the challenges of idiopathic Parkinson's disease?

Gait and balance disorders are major therapeutic challenges in idiopathic Parkinson’s disease (IPD) as they strongly impact the activities of daily living, and are a growing economic burden for the health care system 1. Gait deteriorates over time, impairing mobility, limiting independence, and reducing quality of life 2. The increased likelihood of falls 3, 4 is a major reason for morbidity and disability in IPD 5 leading to fractures and head injuries that may be fatal 6. Unfortunately, gait and balance disorders respond poorly to long-term dopamine replacement therapy 1, 7. Therefore, additional non-pharmacological interventions to improve ga it in IPD have been increasingly explored 8.

What is the y axis of MCGT?

The y-axis is the probability that a patient displays a positive response to MCGT. The three values indicated on the x-axis correspond to the mean values of each variable +/− 1 SD calculated from the tested sample of patients.

Does RAS help with Parkinson's?

Training based on rhythmic auditory stimulation (RAS) can improve ga it in patients with idiopathic Parkinson’s disease (IPD). Patients typically walk faster and exhibit greater stride length after RAS. However, this effect is highly variable among patients, with some exhibiting little or no response to the intervention.

How do auditory stimuli help with arm recovery?

Background: External auditory stimuli have been widely used for recovering arm function post-stroke. Rhythmic and real-time auditory stimuli have been reported to enhance motor recovery by facilitating perceptuomotor representation, cross-modal processing, and neural plasticity. However, a consensus as to their influence for recovering arm function post-stroke is still warranted because of high variability noted in research methods. Objective: A systematic review and meta-analysis was carried out to analyze the effects of rhythmic and real-time auditory stimuli on arm recovery post stroke. Method: Systematic identification of published literature was performed according to PRISMA guidelines, from inception until December 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Results: Of 1,889 records, 23 studies which involved 585 (226 females/359 males) patients met our inclusion criteria. The meta-analysis revealed beneficial effects of training with both types of auditory inputs for Fugl-Meyer assessment (Hedge's g: 0.79), Stroke impact scale (0.95), elbow range of motion (0.37), and reduction in wolf motor function time test (−0.55). Upon further comparison, a beneficial effect of real-time auditory feedback was found over rhythmic auditory cueing for Fugl-meyer assessment (1.3 as compared to 0.6). Moreover, the findings suggest a training dosage of 30 min to 1 h for at least 3–5 sessions per week with either of the auditory stimuli. Conclusion: This review suggests the application of external auditory stimuli for recovering arm functioning post-stroke.

How does auditory information affect motor performance?

The role of auditory information on perceptual-motor processes has gained increased interest in sports and psychology research in recent years. Numerous neurobiological and behavioral studies have demonstrated the close interaction between auditory and motor areas of the brain, and the importance of auditory information for movement execution, control, and learning. In applied research, artificially produced acoustic information and real-time auditory information have been implemented in sports and rehabilitation to improve motor performance in athletes, healthy individuals, and patients affected by neurological or movement disorders. However, this research is scattered both across time and scientific disciplines. The aim of this paper is to provide an overview about the interaction between movement and sound and review the current literature regarding the effect of natural movement sounds, movement sonification, and rhythmic auditory information in sports and motor rehabilitation. The focus here is threefold: firstly, we provide an overview of empirical studies using natural movement sounds and movement sonification in sports. Secondly, we review recent clinical and applied studies using rhythmic auditory information and sonification in rehabilitation, addressing in particular studies on Parkinson’s disease and stroke. Thirdly, we summarize current evidence regarding the cognitive mechanisms and neural correlates underlying the processing of auditory information during movement execution and its mental representation. The current state of knowledge here reviewed provides evidence of the feasibility and effectiveness of the application of auditory information to improve movement execution, control, and (re)learning in sports and motor rehabilitation. Findings also corroborate the critical role of auditory information in auditory-motor coupling during motor (re)learning and performance, suggesting that this area of clinical and applied research has a large potential that is yet to be fully explored.

What is TGA in stroke?

Temporal gait asymmetry (TGA) is a persistent post-stroke gait deficit. Compared to conventional gait training techniques, rhythmic auditory stimulation (RAS; i.e., walking to a metronome) has demonstrated positive effects on post-stroke TGA. Responsiveness of TGA to RAS may be related to several factors including motor impairment, time post-stroke, and individual rhythm abilities. The purpose of this study was to investigate the relationship between rhythm abilities and responsiveness of TGA when walking to RAS. Assessed using behavioral tests of beat perception and production, participants with post-stroke TGA (measured as single limb support time ratio) were categorized according to rhythm ability (as strong or weak beat perceivers/producers). We assessed change in TGA between walking without cues (baseline) and walking while synchronizing footsteps with metronome cues. Most individuals with stroke were able to maintain or improve TGA with a single session of RAS. Within-group analyses revealed a difference between strong and weak rhythm ability groups. Strong beat perceivers and producers showed significant reduction (improvement) in TGA with the metronome. Those with weak ability did not and exhibited high variability in the TGA response to metronome. Moreover, individuals who worsened in TGA when walking to metronome had poorer beat production scores than those who did not change in TGA. However, no interaction between TGA improvement when walking to metronome and rhythm perception or production ability was found. While responsiveness of TGA to RAS did not significantly differ based on strength of rhythm abilities, these preliminary findings highlight rhythm ability as a potential consideration when treating post-stroke individuals with rhythm-based treatments.

What are the principles of neurorehabilitation?

What are the principles underlying effective neurorehabilitation? The aim of neurorehabilitation is to exploit interventions based on human and animal studies about learning and adaptation, as well as to show that the activation of experience-dependent neuronal plasticity augments functional recovery after stroke. Instead of teaching compensatory strategies that do not reduce impairment but allow the patient to return home as soon as possible, functional recovery might be more sustainable as it ensures a long-term reduction in impairment and an improvement in quality of life. At the same time, neurorehabilitation permits the scientific community to collect valuable data, which allows inferring about the principles of brain organization. Hence neuroscience sheds light on the mechanisms of learning new functions or relearning lost ones. However, current rehabilitation methods lack the exact operationalization of evidence gained from skill learning literature, leading to an urgent need to bridge motor learning theory and present clinical work in order to identify a set of ingredients and practical applications that could guide future interventions. This work aims to unify the neuroscientific literature relevant to the recovery process and rehabilitation practice in order to provide a synthesis of the principles that constitute an effective neurorehabilitation approach. Previous attempts to achieve this goal either focused on a subset of principles or did not link clinical application to the principles of motor learning and recovery. We identified 15 principles of motor learning based on existing literature: massed practice, spaced practice, dosage, task-specific practice, goal-oriented practice, variable practice, increasing difficulty, multisensory stimulation, rhythmic cueing, explicit feedback/knowledge of results, implicit feedback/knowledge of performance, modulate effector selection, action observation/embodied practice, motor imagery, and social interaction. We comment on trials that successfully implemented these principles and report evidence from experiments with healthy individuals as well as clinical work.

How does music help with stroke?

Music-based therapy for rehabilitation induces neuromodulation at the brain level and improves the functional recovery. In line with this, musical rhythmicity improves post-stroke gait. Moreover, an external distractor also helps stroke patients to improve locomotion. We raised the question whether music with irregular tempo (arrhythmic music), and its possible influence on attention would induce neuromodulation and improve the post-stroke gait. We tested music-induced neuromodulation at the level of a propriospinal reflex, known to be particularly involved in the control of stabilized locomotion; after stroke, the reflex is enhanced on the hemiparetic side. The study was conducted in 12 post-stroke patients and 12 controls. Quadriceps EMG was conditioned by electrical stimulation of the common peroneal nerve, which produces a biphasic facilitation on EMG, reflecting the level of activity of the propriospinal reflex between ankle dorsiflexors and quadriceps (CPQ reflex). The CPQ reflex was tested during treadmill locomotion at the preferred speed of each individual, in 3 conditions randomly alternated: without music vs. 2 arrhythmic music tracks, including a pleasant melody and unpleasant aleatory electronic sounds (AES); biomechanical and physiological parameters were also investigated. The CPQ reflex was significantly larger in patients during walking without sound, compared to controls. During walking with music, irrespective of the theme, there was no more difference between groups. In controls, music had no influence on the size of CPQ reflex. In patients, CPQ reflex was significantly larger during walking without sound than when listening to the melody or AES. No significant differences have been revealed concerning the biomechanical and the physiological parameters in both groups. Arrhythmic music listening modulates the spinal excitability during post-stroke walking, restoring the CPQ reflex activity to normality. The plasticity was not accompanied by any clear improvement of gait parameters, but the patients reported to prefer walking with music than without. The role of music as external focus of attention is discussed. This study has shown that music can modulate propriospinal neural network particularly involved in the gait control during the first training session. It is speculated that repetition may help to consolidate plasticity and would contribute to gait recovery after stroke.

What is gait asymmetry?

Asymmetry is a cardinal symptom of gait post-stroke that is targeted during rehabilitation. Technological developments have allowed accelerometers to be a feasible tool to provide digital gait variables. Many acceleration-derived variables are proposed to measure gait asymmetry. Despite a need for accurate calculation, no consensus exists for what is the most valid and reliable variable. Using an instrumented walkway (GaitRite) as the reference standard, this study compared the validity and reliability of multiple acceleration-derived asymmetry variables. Twenty-five post-stroke participants performed repeated walks over GaitRite whilst wearing a tri-axial accelerometer (Axivity AX3) on their lower back, on two occasions, one week apart. Harmonic ratio, autocorrelation, gait symmetry index, phase plots, acceleration, and jerk root mean square were calculated from the acceleration signals. Test-retest reliability was calculated, and concurrent validity was estimated by comparison with GaitRite. The strongest concurrent validity was obtained from step regularity from the vertical signal, which also recorded excellent test-retest reliability (Spearman's rank correlation coefficients (rho) = 0.87 and Intraclass correlation coefficient (ICC21) = 0.98, respectively). Future research should test the responsiveness of this and other step asymmetry variables to quantify change during recovery and the effect of rehabilitative interventions for consideration as digital biomarkers to quantify gait asymmetry.

How does hemiparesis affect gait?

Background Hemiparesis is a common disabling consequence of stroke that leads to abnormal gait patterns marked by asymmetries in step length, stance, and swing phases. Asymmetric gait patterns are correlated with decreased gait velocity and increased susceptibility to falls that can lead to serious injuries and hospitalizations. Objective In this single group, before and after study, treatment with the iStrideTM gait device, designed to improve the gait patterns of individuals with hemiparesis, is adapted to the home environment. Previously tested in clinical settings, this study investigates if using the iStrideTM gait device within the home environment can provide safe and effective gait treatment for individuals with hemiparetic gait impairments caused by stroke. Methods Twelve 30-minute sessions of walking on the device were administered in each participant’s home environment. Twenty-one participants who were more than one-year post-stroke received the treatment. The Ten-Meter Walk Test, Timed Up and Go Test, Berg Balance Scale, Functional Gait Assessment, and Stroke Specific Quality of Life Scale were performed before and one week after treatment. Safety, treatment plan compliance, and subjective responses were also recorded during the study period. Results Results demonstrate statistically significant improvement on all five outcome measures from before treatment to one week after the last treatment session (p < 0.01) using two-tailed paired t-tests. 76% of participants improved beyond the small meaningful change or minimal detectable change on three or more outcome measures. 67% of participants improved clinically in gait speed and on at least one of the fall risk assessment inventories. 81% of the participants were able to perform the treatment in their home without assistance before the end of week three. Conclusions The results indicate that the iStrideTM gait device can facilitate effective, safe, and home-accessible gait treatment opportunities for individuals with hemiparesis from stroke.

What are the processes of time perception, timing, and sensorimotor synchronization?

These fundamental abilities of humans and animals are an essential component of many cognitive processes: speech, memory, attention, planning, and forecasting. Violations of the processes of timing and sensorimotor integration and synchronization accompany some disorders in the motor and cognitive spheres: speech and language problems, autism, ADHD, neurodegenerative diseases, memory disorders. Many brain structures are involved in the implementation of timing processes: motor cortex, cerebellum, basal ganglia, some brain stem structures. The emotional valence and arousal of stimuli change the subjective perception of their duration. It is important to note the positive role of training time and rhythm perception and movements to rhythmic sounds and music in the rehabilitation process.

What is the role of the basal ganglia in synchronization?

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.

Why is musicality a complex problem?

Human musicality is a complex problem because it involves the coupling of multiple exogenous and endogenous signals with different physical properties. The synchronization of these signals translates into specific behaviors. The study of this synchronization, based on the physical properties of two oscillatory bodies, is the first step in understanding the behaviors associated with rhythmic auditory stimuli. In recent years, different neurorehabilitation therapies have emerged for motor pathologies involving music. However, the neurophysiological bases that describe the coupling phenomenon are not yet fully understood. In this article, two theories are addressed that attempt to explain the convergence of the auditory system and the motor system according to new neuroanatomical, neurophysiological and artificial neural network findings. It also reflects on the different approaches to a complex problem in cognitive neuroscience and the need for a study model for the different motor behaviors evoked by auditory stimuli.

What are the principles of neurorehabilitation?

What are the principles underlying effective neurorehabilitation? The aim of neurorehabilitation is to exploit interventions based on human and animal studies about learning and adaptation, as well as to show that the activation of experience-dependent neuronal plasticity augments functional recovery after stroke. Instead of teaching compensatory strategies that do not reduce impairment but allow the patient to return home as soon as possible, functional recovery might be more sustainable as it ensures a long-term reduction in impairment and an improvement in quality of life. At the same time, neurorehabilitation permits the scientific community to collect valuable data, which allows inferring about the principles of brain organization. Hence neuroscience sheds light on the mechanisms of learning new functions or relearning lost ones. However, current rehabilitation methods lack the exact operationalization of evidence gained from skill learning literature, leading to an urgent need to bridge motor learning theory and present clinical work in order to identify a set of ingredients and practical applications that could guide future interventions. This work aims to unify the neuroscientific literature relevant to the recovery process and rehabilitation practice in order to provide a synthesis of the principles that constitute an effective neurorehabilitation approach. Previous attempts to achieve this goal either focused on a subset of principles or did not link clinical application to the principles of motor learning and recovery. We identified 15 principles of motor learning based on existing literature: massed practice, spaced practice, dosage, task-specific practice, goal-oriented practice, variable practice, increasing difficulty, multisensory stimulation, rhythmic cueing, explicit feedback/knowledge of results, implicit feedback/knowledge of performance, modulate effector selection, action observation/embodied practice, motor imagery, and social interaction. We comment on trials that successfully implemented these principles and report evidence from experiments with healthy individuals as well as clinical work.

What is SOAR in music therapy?

Music therapists (MT) can individualize auditory protocols but for a physical therapist (PT) to incorporate PSE into treatment, a new tool is needed. The Synchronized Optimization Auditory Rehabilitation (SOAR) tool is a new software created to simulate PSE techniques and allow for customization depending on the individual’s reaction to the cue. The purposes were to evaluate the validity of the SOAR tool with RAS and the interrater reliability between disciplines’ application of the SOAR tool. Day one - MT measured gait parameters during no cue, RAS, and SOAR tool. Day two - PT measured gait parameters while using the SOAR tool. A moderate to high correlation between RAS and the SOAR tool on gait was found. The interrater reliability between the MT and PT was high. These finding suggest the SOAR tool is an additional auditory cue delivery tool that PTs could use in the treatment of individuals with PD when auditory cues are deemed appropriate and a MT is not an available member of the interdisciplinary rehabilitation team.

What is DBS in neurology?

Deep brain stimulation (DBS) consists in the surgical implantation of needle electrodes, connected to an implantable pulse generator, in specific targets of the brain in order to manage, among other, tremor, slowness, stiffness, and walking problems caused by idiopathic Parkinson's disease (iPD) ( 1 ). DBS is particularly indicated when drug response deteriorates, the OFF periods worsen, the patient develops intolerable medication–induced dyskinesias with refractory motor fluctuations or tremor, there is not a significant improvement with regard to dopaminergic medication (<30%), and only modest improvement are appreciable during ON–state. DBS is contraindicated in patients over 75 years, with severe/malignant comorbidity considerably reducing life expectancy, chronic immunosuppression, distinct brain atrophy, and severe psychiatric disorder ( 2, 3 ).

How often do you do treadmill training?

Patients practiced one session of RAS-assisted treadmill training and one session of conventional physio therapy once a day, 6 days a week, for 1 month.

Does RAs help with gait?

Our work suggests that RAS-assisted gait training coupled to conventional physiotherapy is an effective tool to improve gait performance in patients with PD with and without DBS. Interestingly, patients with DBS achieved better results concerning gait velocity and stability. Specifically, patients with DBS may have benefited more from this approach compared to those without DBS owing to a more focused and dynamic re–configuration of sensorimotor beta oscillations related to gait secondary to DBS effects on RAS gait training plus conventional physiotherapy. Potentiating DBS using RAS gait training plus conventional physiotherapy may help restoring a residually altered beta–band response profile despite DBS intervention, thus better tailoring the gait rehabilitation of PD patients submitted to DBS.

Is there a limitation to the small sample enrolled and the relatively high standard deviation values in some post answer

First, the small sample enrolled and the relatively high standard deviation values in some post-treatment measures may have limited the significance of some outcome measure changes. However, this was a pilot, case–control study aimed at preliminary assessing the effectiveness of RAS training in patients with PD using DBS.

What are the effects of dopamine agonists?

Dopamine agonists in the brain have a similar effect to levodopa since they bind to dopaminergic postsynaptic receptors. Dopamine agonists were initially used for patients experiencing on-off fluctuations and dyskinesias as a complementary therapy to levodopa, but they are now mainly used on their own as an initial therapy for motor symptoms with the aim of delaying motor complications. When used in late PD, they are useful at reducing the off periods. Dopamine agonists include bromocriptine, pergolide, pramipexole, ropinirole, piribedil, cabergoline, apomorphine, and lisuride .

What is the gold standard treatment for Parkinson's disease?

Furthermore, the gold-standard treatment varies with the disease state . People with Parkinson's, therefore, often must take a variety of medications to manage the disease's symptoms. Several medications currently in development seek to better address motor fluctuations and nonmotor symptoms of PD.

Why is palliative care important?

The aim of palliative care is to achieve the maximum quality of life for the person with the disease and those surrounding him or her. Some central issues of palliative are caring for patients at home while adequate care can be given there, reducing or withdrawing dopaminergic drug intake to reduce drug side effects and complications, preventing pressure ulcers by management of pressure areas of inactive patients, and facilitating the patient's end-of-life decisions for the patient, as well as involved friends and relatives.

What is needed for Parkinson's disease?

Management of Parkinson's disease due to the chronic nature of Parkinson's disease (PD), a broad-based program is needed that includes patient and family education, support-group services, general wellness maintenance, exercise, and nutrition. At present, no cure for the disease is known, but medications or surgery can provide relief from ...

When did levodopa become available?

It entered clinical practice in 1967, and the first large study reporting improvements in people with Parkinson's disease resulting from treatment with levodopa was published in 1968 . Levodopa brought about a revolution in the management of PD.

Does levodopa cause motor problems?

Most people eventually need levodopa and later develop motor complications. The on-off phenomenon is an almost invariable consequence of sustained levodopa treatment in patients with Parkinson's disease. Phases of immobility and incapacity associated with depression alternate with jubilant thaws.

Does selegiline increase dopamine levels?

Monoamine oxidase inhibitors ( selegiline and rasagiline) increase the level of dopamine in the basal ganglia by blocking its metabolization. They inhibit monoamine oxidase-B (MAO-B) which breaks down dopamine secreted by the dopaminergic neurons. Therefore, reducing MAO-B results in higher quantities of L-DOPA in the striatum. Similarly to dopamine agonists, MAO-B inhibitors improve motor symptoms and delay the need of taking levodopa when used as monotherapy in the first stages of the disease, but produce more adverse effects and are less effective than levodopa. Evidence on their efficacy in the advanced stage is reduced, although it points towards them being useful to reduce fluctuations between on and off periods. Although an initial study indicated selegiline in combination with levodopa increased the risk of death, this has been later disproven.

Abstract

Healthy gait dynamics are characterized by the presence of fractal, persistent stride-to-stride variations, which become more random with Parkinson’s disease (PD). Rhythmic auditory stimulation with fractal beat-to-beat variations can change gait dynamics in people with PD toward more persistence.

Acknowledgments

The authors thank Connor Wicks for his help during data collection. This work was supported by the UNMC Skate-a-thon for Parkinson’s fund, the NASA Nebraska Space Grant Fellowship, and the Center for Research in Human Movement Variability of the University of Nebraska at Omaha, NIH ( P20GM109090 ).

Introduction

• Gait training in the rehabilitation of different movement disorders has had multiple treatment approaches, one of the most current and with greater evidence of effectiveness for its facilitating effect for functional walking is auditory rhythmic signaling, acoustic rhythmic cueing or auditory rhythmic stimulation. In which acoustic rhythms produced...

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