Rhythmic Auditory Stimulation in Gait Training for Patients with Traumatic Brain Injury
Corene P. Hurt MM, MT-BC
Ruth R. Rice MS, PT
Gerald C. McIntosh, MD
Michael H. Thaut PhD, RMT
Center for Biomedical Research in Music Colorado State University
Vol. XXXV, No. 4, Winter. 1998 229
Rhythmic auditory stimulation (RAS) was studied in a fre quency entrainment design and as a therapeutic stimulus to facilitate gait patterns in 8 traumatically brain injured individ uals (5 male/3 female; mean age 30 ± 5 years) with persisting gait disorder, 4-24 months postinjury During entrainment, with RAS frequency matched to baseline cadence, velocity and stride symmetry both increased by an average of 18%. increases contributing to the velocity improvement were seen in both stride length (7%) and cadence (8%). With RAS ac ceterated 5% over the fast walking step rate of the patients, 5 patients could entrain to a higher step frequency. The 2 pa tients with the slowest baseline gait velocity could not entrain to faster RAS frequencies. After 5 weeks of daily RAS train ing, 5 patients’ mean velocity increased significant/y (p < .05) by 51% (38.8 m/min to 57.6 m/min; p< .43). Cadence (+16%) and stride length (+29%) also showed statistically significant improvement. Stride symmetry improved non significant/y by 12%.
The purpose of this study was to examine the use of rhythmic au ditory stimulation (RAS) to cue gait patterns of patients with trau matic brain injury who were no longer making progress toward conventional physical therapy goals. An important aspect of well coordinated movement involves proper timing. Rhythmic facilita tion to enhance timing of gait movement could improve velocity, cadence, stride length, and symmetry, as has been previously demonstrated in gait training with stroke (Staum, 1983; Thaut, Rice, & McIntosh, 1997) and Parkinson’s disease patients (Thaut et al., 1996).
Traumatic Brain Injury (TBI), because of injury to motor and sensory systems, often results in functional deficits in posture, stance, and gait. A patient with spastic hemiparesis may have de creased standing balance because of trunk instability, resulting in an inability to shift weight in order to ambulate safely. Weak hip flexors and ankle dorsiflexors may result in impaired swing through of the limb, and inadequate toe clearance during the swing phase of the gait cycle. Spasticity or contracture may limit range of motion at the hip, knee, and ankle. Patients with damage to the basal ganglia often exhibit stooped posture and shuffling gait, and patients with proprioceptive damage may have difficulty with foot placement and balance. Ataxia in gait also may be present in TBI, resulting in a widened base of support with irregular step length, and weaving from side to side (Ashley & Krych, 1995). Cur rent gait training has met the needs of patients with TBI with only limited success. Research investigating and supporting gait reha bilitation techniques is necessary in order to improve gait deficits in traumatic brain injury through the most effective and under stood method.
In examining the use of rhythmic auditory stimulation (RAS) to assist in sensory motor processing, it is necessary to first under stand rhythm as an element in music whose perceptual and physi ological attributes can influence control of movement. In relation ship to therapy this understanding must be extended to the question of how rhythm can be used in gait rehabilitation to facilitate desired motor responses....