Sunday, August 7, 2022

Music And Parkinson’s Gait

Clinical Trials For Complementary Therapies In Pd

Biodex Music-Assisted Gait Training and Parkinsons: Wartburg Outpatient Care

Just like they do for medications, clinical trials are also done for complementary therapies. Trials that test complementary therapies in PD can be conducted in a variety of ways, some more rigorous than others. Typically, patients are assessed for different outcome measures depending on the treatment. For example, a study of massage investigated the change in pain level as an outcome measure, whereas studies of acupuncture looked at changes in sleep and depression as outcome measures. The different types of treatments have not been compared to each other, so there is little way of knowing if one edges out the others in terms of effectiveness on any given measure.

In general, however, these modalities are low-risk and typically demonstrate improvement in either a motor or a non-motor symptom. Additional research with larger and more rigorous trials is needed, but it is exciting to realize that there are many possible therapeutic avenues to explore. It is also important to note that complementary therapies are typically not covered by insurance, so they may be out of financial reach for many people with PD. Increased research demonstrating the efficacy of these modalities is the first step in convincing insurance providers that these services are worth covering.

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Filling The Gaps In The Music Therapy

There are still many open questions about how music affects the brain and PD. Pantelyat noted that there are relatively few studies involving large numbers of research subjects that investigate the systematic changes music can have on PD. The studies that have been published generally lack scientific rigor in terms of clinical studies being appropriately designed and powered to detect meaningful differences, he said.

As a result, scientists do not have a clear idea about what kinds of music therapy work best for particular subgroups of the PD population. Increasing this knowledge would improve the targeting and efficacy of music therapy in PD patients.

But Pantelyat remains optimistic.

I am heartened to say, though, when looking at the on music and arts-based interventions, that the overall level of evidence for diseases like PD is rising, said Pantelyat. With a growing body of evidence, music may help bring harmony to the brain and life of patients with Parkinsons disease.

Written and reported by IAM Lab Communications Specialist Richard Sima. Richard received his Ph.D. in neuroscience from Johns Hopkins and is a science writer living in Baltimore, Maryland. This post also appears on IAM Lab.

References

Blood, A. J., & Zatorre, R. J. . Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the national academy of sciences, 98, 11818-11823.

Eeg Recording And Analysis

Brain activity was continuously recorded for 10min while the patient was walking on the GaitTrainer3 in the non_RAS modality, usually 510min after the session started. We used a Brain-Quick System equipped with a standard 19-electrode headset. EEG recording occurred during the third to fifth session and the last gait training session. Patients were prohibited from drinking coffee, smoking, and changing their bedtime during the 3 days prior to EEG recording. This was easily checked, as the participants were in-patients.

EEG were sampled at 512Hz, band-pass filtered between 1 and 200Hz using a zero-phase finite impulse response filter to minimize drifts and a zero-phase FIR filter order=36, referenced to Cz, and notch-filtered at 50Hz to remove the power line noise. Impedances were constantly kept below 5 k for the entire duration of the experiment and data collection. An electro-oculogram with a bipolar montage was also collected.

Data were pre-processed using EEGLab. EEG recordings were first visually inspected to identify and remove data affected by prominent artefacts across all the recording channels. Then, the data were re-filtered between 8 and 40Hz, re-referenced to the common average reference, and decomposed into neural and artifactual components using the Infomax algorithm Independent Component Analysis .

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Dancing Helps Manage Depression

Dancing is one of the most potent ways to connect your mind and body. In recent years, dance-based therapy programs have been used to help improve symptoms of neurological disorders such as Parkinsons, dementia, and depression.

Fortunately for most of us, it doesnt matter how well you move, so long as youre trying to move with the beat. Dancing can take many forms seated, standing, arms-only, etc. However you choose to move, you will feel the benefits!

If you need some guidance, try this seated dancing warm-up from our Victory Summit® Omaha online event.

Music Therapy To Help With Parkinson’s Disease

Music helps keep Parkinson

First off, I am not a doctor or a scientist. I am a physiotherapist who tries hard to make sure your exercise program has function and maybe even some fun built in. I have always enjoying listening, singing, and even dancing around to music. So, I was excited to hear about combining music therapy in the treatment of Parkinsons disease . Anytime I can combine something like that I want to know more.

Lets take a look at a review article. This article was a systematic review of PD and music therapy from 2015-2020. The research reviewed 58 articles, and it included various types of interventions . The researchers grouped the results into areas of potential impact in the areas of movement, communication, emotion, and cognition.

Some of the articles in the review found that music therapy could help with improving movement components such as gait speed, reducing the number of steps, helps with gait freezing, and as a result reduce falls. As a side note one particular study noted that different types of music had different effects on our bodies. For example, classical music had a different effect on gait speed and trunk inclination compared to heavy metal music.

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B: Pick Your Own Music

Now that youve seen the full effects of walking to a beat, take your pick of music.

Below I have laid out a list of songs you can try out that have a range of tempos. There is a slow, medium, and fast playlist. Start walking to a slower song . As you get comfortable, you can increase the tempo.

The end goal is to walk to a beat that is slightly faster than your stride. Not only will this push you to transcend your normal Parkinsonian gait, it will also give you a longer lasting therapeutic effect after you stop listening.

Here are the playlists:

You can, of course, choose your own songs. In fact, once you practice a few times with these songs, I encourage you to start using your own selections .

Either way, I want you to look forward to turning on your iPod or Android, and that means having songs that make you want to dance, to move, to run. If you dont know the tempo of a song you like, you can measure the beats per minute at songbpm.com. If you want to change the tempo of a song that is too fast or too slow, I like to use the app “TempoSlowmo.” You can download it for free in the Apple App Store for your iPod or on Google for your Android.

Good luck. If you have any questions or comments about the post, Id love to see them! Write them in the comment section below and Ill respond as soon as I see it!

Physical Therapy Can Help

In addition to medication, physical therapy can help with walking. There are several strategies that can be used to overcome freezing episodes.

Strategies include taking a high marching step, counting to three before stepping, or walking along to the rhythm of a metronome. Using visual cues such or stepping over a target such as a laser beam or line on the floor can also help with gait.

Assistive devices such as walkers or canes can be helpful in reducing the risk of falling.

Engage with the community by asking a question, telling your story, or participating in a forum.

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Music Therapy Interventions In Parkinsons Disease: The State

Keywords:

Parkinsons disease is a neurological disorder involving the progressive degeneration of the dopaminergic system, which gives rise to movement-related dysfunctions as well as other symptoms, mainly of cognitive and psychological nature. In the latter case, mood disorders prevails frequently causing anxiety and depression in all phases of the disease, sometimes even before the motor symptoms occur.

Aarsland and colleagues report that 35% of the patients affected by PD present depression, whereas Richard states that anxiety is to be found in 40% of the cases.

The literature shows that playing and listening to music may modulate emotions, behaviors, movements, communication, and cognitive factors, modifying the activity of the brain areas involved in the perception and regulation of these aspects .

Music can produce substantial effects on movement-related symptoms as well as psychological ones in PD treatment. Concerning the first aspect, rhythm has a crucial role in rehabilitation, enhancing connections between the motor and auditory systems .

Literature showed how a rhythmic auditory cues-based training can produce a compensation of the cerebello-thalamo-cortical network leading to beneficial effects, for example, improving not only speed and step length but also perceptual and motor timing abilities .

It Improves Mood And Emotional Status In Parkinsons Disease

Cueing gait through music for Parkinson’s disease

Listening to music can have a rewarding effect. When you listen to a song that you like or a song sung by an artist whose voice seems mesmerizing to you, you do tend to experience a sense of elation.

A study published in World Journal of Psychiatry, 2015 reveals that music therapy can alleviate depressive symptoms and improve mood in various neurological disorders.

Pacchetti et al. conducted a study where Parkinsons patients were treated with active music therapy. The therapy involved choral singing, voice exercises and rhythmic as well as free body movements.

Improvement in bradykinesia was observed. Also, music therapy brought about improvement in emotional well being, daily activities and quality of life.

Researchers state that group singing may benefit in Parkinsons by increasing connectedness and flow of social and biological rhythms.

A recent study published in Disability and Rehabilitation, 2016 demonstrated that group singing helped patients manage consequences of their disorder such as low mood, social isolation and communication problems.

Quick Gist: Music therapy can help elevate mood and reduce depressive symptoms in Parkinsons disease patients. Group therapy can help alleviate consequences of the disease such as social isolation.

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Rhythmic Auditory Stimulation Improves Gait In Parkinsons Disease

The major symptom of Parkinsons is a disturbance in gait. This can involve difficulty or hesitation to start walking or moving, freezing of the body, reduced the pace of walking, etc.

These symptoms occur due to the disturbance in internal timing and may even affect the patients perception of time and sensing beats or perform interval based activities such as clapping hands in a sequence to form a rhythm.

Wittwer et al. demonstrated that music improves the speed of walking and length of stride in healthy older adults better than metronome sounds. A recent study in Frontiers in Neuroscience, 2014 demonstrated that high groove music was better than low groove music in gait rehabilitation.

Freedland et al., in 2002, recommended rhythmic auditory stimulation as an add-on therapy to conventional dopamine therapy for Parkinsons.

In 2006, researchers from Belgium demonstrated that rhythmic auditory stimulation improves speed of walking.

However, the frequency of playing the rhythm may have different effects on gait in freezers and non-freezers.

Their study suggested that low-frequency setting may benefit freezers while non-freezers may find 10% higher than normal frequency beneficial.

Further, a study published in PLoS One, 2010 confirmed these findings and proved that neurological music therapy could avoid freezing episodes in Parkinsons patients.

Music And Parkinsons Disease

Music therapy has proven to help patients suffering from Parkinson s disease . Music therapists are Board Certified and have the academic background to work with patients with PD and alleviate their symptoms.

People with PD who work with musical therapist see improvements in cognitive function, speech, movement and mental health.

Music therapy consists of participation in choirs, drumming programs and dance classes.

Music therapy helps individuals with PD I multiple ways that include:

  • Balance:People with PD have trouble maintaining balance. Music therapy helps improve balance by fixing posture and stride length. It also facilitates side-to-side movement.
  • Communication:Singing gives you greater control over articulation and volume. Therapists guide patients through humming exercises that relax vocal fold which have become tense.
  • Cognition:Individuals suffering from Parkinsons dementia experience memory loss and cognitive decline. Listening and singling along to songs from their past can help pick up music cues and assist recall and improve attention span.
  • Mental Health:People with PD often have feelings of depression, anxiety and fatigue. Music allows them to combat such feelings and soothes them emotionally.
  • Social Isolation:Music therapy is usually carried out in groups. Working within a group allows patient reconnect with others and pulls them out of isolation.
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Data Collection Management And Accessibility

MEG data collection is under the responsibility of a trained neurophysiology specialist to ensure data quality and assessment of unplanned data contamination. Motor scales and surveys are being collected by the study investigator who has been thoroughly trained by clinical and research colleagues during past clinical trials. Each measure and scale used in this study is widely used in the research community and has proven reliability and validity in the scientific literature. After collection, data is entered into the local Research Electronic Data Capture database, and data entry is verified by a research assistant non-affiliated to the study. Only complete sets of data will be included in the analysis. Study PI and statistician will have access to the final trial dataset.

Imperfect Treatments For A Complex Disease

Music helps keep Parkinson

As a neurodegenerative disease, PD involves the progressive loss of dopamine-producing neurons. This loss leads to irregular activity and connections in the surviving brain cells, impacting movement coordination. It may also account for non-motor symptoms in PD related to emotion and mood.

Traditionally, physicians prescribe medications that target the dopamine system to compensate for the patients lost dopamine production surgical interventions, such as deep brain stimulation, can also help and are believed to mitigate some of the aberrant brain activity caused by the disease.

Unfortunately, these medications and surgeries become increasingly ineffective with extended treatment in most patients. To address PD and all its complexities, healthcare providers are exploring different treatment strategies to complement more traditional interventions.

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Statistical Methods And Sample Size

We will address our clinical research question by determining whether there is a significant change in fine motor skills following TIMP-RHY, TIMP-NR, and OT due to fine motor training compared to the non-therapy condition. We predict that TIMP-RHY will decrease mean GPT scores to a higher extent than the TIMP-NR and the OT groups. We will use an ANOVA F-test model to test this prediction on the mean GPT score change as well as pairwise contrasts with Tukey-Kramer correction for multiple comparisons to assess where the differences are. We do not expect such changes in the waitlist group due to the absence of fine motor strengthening. Given the large effect size of 0.8 sd/mean seen in other PD studies using the GPT grooved pegboard test as main outcome , we anticipate that our sample size of 25 per group will allow us to determine a group difference of 15% decreased time using the dominant hand and to be comparable to published data . We will also perform exploratory analyses using regression modeling to assess whether sex, age, or disease severity and cortical motor beta power changes are correlated with fine motor tests performance.

We will address our QOL research question by assessing changes in the PDQ-39 and CGI-I scales. As fine motor skills may improve, we expect a decrease in mean total scores after a 5-week TIMP-RHY session and to a lower extent after OT or TIMP-NR sessions. We do not expect a change of QOL mean scores in the waitlist group.

How Does Music Therapy Help In Parkinsons Disease

Parkinsons disease involves progressive dysfunction of dopaminergic neurons resulting in impairment of movement.

  • 5 Conclusion
  • Also, there are psychological symptoms such as anxiety and depression that occur in this disorder. Music can have significant effects on gait, emotions, communication, etc. which makes it therapeutic for such conditions.

    The prime focus of music therapy is rehabilitation or to improve motor function and gait. Internal timing is the mechanism that coordinates and times the movement of our body with our thoughts.

    This internal timing is disturbed in Parkinsons disease patients. The irregular timing affects gait, coordination and causes freezing in patients.

    Music provides an external audible stimulus that serves as a rhythm that coordinates body movements with beats. This rhythm compensates for the internal timing disturbance.

    The therapy involving the use of rhythms as a stimulus to coordinate movement is known as Rhythmic Auditory Stimulation.

    Thaut et al. were the first to prove that rhythm can help improve gait in Parkinsons and this study dates back to 1996.

    Beats in music can be perceived as pulses for a response to patterns. Beats that form rhythm help establish a pattern and once this pattern is established, the individual remembers the rhythm even if the music is not played.

    This phenomenon of learning the rhythm and coordinating movement with it is referred to as entrainment.

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    Retrain And Recover Lost Functional Abilities

    In Canada, music therapy is a regulated and growing discipline of professionals who use the elements of music to work towards goals of development, health and well being within a therapeutic relationship .

    What makes music therapy so unique is its ability to address multiple functional areas of the brain at once. In short, music therapy is a holistic and versatile form of therapy that moves beyond words and taps into something inherent in all of us music and rhythm.

    If you have questions about how music therapy might benefit you or someone you know, contact us to set up free phone consultation or speak to your treating therapist.

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