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The Effects of Rhythmic Auditory Stimulation on Gait Characteristics in an Individual with
Young-Onset Parkinson Disease: A Case Study
Ashley Alteri, SPT; Candice Brown, SPT; Caroline Coleman, SPT; Isaac Ford, SPT;
Larissa Hilgner, SPT; Nick Murad, SPT
Research Advisor: Rumit Singh Kakar, PhD
ABSTRACT:
Background and Purpose: Parkinson disease (PD) is a neurodegenerative disease affecting up to
10 million people worldwide, with 10% having a young-onset PD (YOPD). The most common
signs and symptoms of typical PD (rigidity, tremor, bradykinesia, postural instability, and
dystonia) progress at a slower rate with YOPD. Interlimb asymmetries and temporospatial gait
deviations are byproducts of varied combinations of symptom presentation causing gait
instabilities that may contribute to fall risk in persons with PD. The purpose of this case study
was to assess the impact of a single session of rhythmic auditory stimulation (RAS) during
treadmill walking on upper and lower extremity gait characteristics and symmetries for a patient
with YOPD.
Case Description: Participant was an active 35 year old male diagnosed 6 years ago with tremor
dominant YOPD. At the time of testing, he was in an ‘ON’ phase of his symptom-managing
medications levodopa, monoamine oxidase inhibitors, and dopamine agonists. He displayed
symptoms both axially and bilaterally, with his more involved side being the right. He reported
an untreated right clavicle fracture 9 months ago.
Instrumentation: Noraxon® instrumented pressure treadmill and MR3® software were used to
capture cadence, gait velocity, step length, stance symmetry, and double limb support. The
iPad® application Sparkmotion® was used to measure arm swing angular displacement (ASAD) in
the sagittal plane.
Methodology: Baseline gait variables were collected during 2 min warm-up walk on a treadmill.
Subsequently, the participant performed 10 min of treadmill walking while matching his
cadence to a RAS set 5% above baseline. Data was recorded every 2 min during the
intervention. An immediate post-intervention and a 10 min follow-up data collection were
performed without RAS for the variables of interest.
Outcomes: The greatest differences were noted in single leg stance (SLS) duration symmetry
and ASAD. SLS had a 2% increase in symmetry while ASAD increased 11.6° on the right and
13.4° on the left with no change in symmetry. Additionally, cadence and self-selected velocity
increased by 4 beats per minute and 0.8 m/s respectively. Step lengths increased by 0.03m on
the right and 0.04m on the left without increased symmetry. Double stance increased by 0.6% of
the gait cycle.
Discussion: The findings in this study suggest that a single 10 min treadmill intervention using
RAS can result in immediate improvement in temporospatial gait parameters that potentially
correlate to decreased fall risk in the YOPD population. Results were consistent with those
reported in the literature for effects of RAS on cadence, gait velocity, and step length.
Additionally, RAS can improve ASAD and stance symmetry, which can potentially improve gait
and local dynamic stability. Further research is warranted to test efficacy of RAS with a larger
sample population and overground walking.