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NeuroRehabilitation 34 (2014) 193–199 DOI:10.3233/NRE-131008 IOS Press
Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients Jee Hyun Suha , Soo Jeong Hana,∗ , Seo Young Jeona , Ho Jeong Kima , Jeong Eun Leeb , Tae Sik Yoona and Hyun Ju Chongc a Department
of Rehabilitation Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea of Rehabilitation Medicine, Seonam Hospital, Seoul, Republic of Korea c Department of Music Therapy, Ewha Womans University, Seoul, Republic of Korea b Department
Abstract. BACKGROUND: Rhythmic auditory stimulation (RAS) improves gait velocity, cadence, and stride length in hemiplegic stroke patients, yet little is known about the effectiveness of RAS on standing balance. OBJECTIVES: To examine and compare the effectiveness on standing balance and gait parameter of two different types of gait trainings, gait training with RAS versus gait training without RAS, was compared in two groups of hemiplegic stroke patients over a three-week period (RAS group, n = 8; control group = 8). METHODS: Sixteen hemiplegic stroke patients were included in the study. Standing balance was measured by using Biosway® . Stride length, gait velocity, and cadence were calculated from the number of steps and required time for a 10 m-walk. RESULTS: Pre- to post-test measures showed a significant improvement in RAS group for overall stability index (p = 0.043), mediolateral index (p = 0.006), anteroposterior index (p = 0.016), gait velocity (p = 0.012), stride length (p = 0.03) and cadence (p = 0.012) over the control group. CONCLUSIONS: The results of this study showed that RAS was an effective therapeutic method to improve gait velocity, stride length, cadence, and standing balance in hemiplegic stroke patients. Keywords: Rhythmic auditory stimulation, stroke, balance, gait, rehabilitation
1. Introduction For patients with stroke, asymmetrical standing postures and difficulties in walking are common problems, due to several factors including weakness in muscle strength, asymmetry in weight distribution, impaired proprioception, exaggerated stretch reflexes, spasticity, and impaired motor control (Brandstater et al., 1983). ∗ Address
for correspondence: Soo Jeong Han, Department of Rehabilitation Medicine, School of Medicine, Ewha Womans University, 1071 An-Yang-Cheon Ro, Yang-Cheon Gu, Seoul 158-710, Republic of Korea. Tel.: +82 2 2650 5035; Fax: +82 2 2650 5145; E-mail: [email protected].
As controlling one’s posture and balance while walking is essential after stroke, standing balance training which helps shift the weight to the paretic side is helpful (Lee et al., 2012). Recent data suggest rehabilitation processes involving movements which are highly repetitive and rhythmically patterned are particularly effective in gait training for stroke patients, possibly facilitating long-term improvements in the sensorimotor cortex related to motor learning (Asanuma et al., 1991; Buetefisch et al., 1991). For enhancing rhythmical patterns of movement, rhythmic auditory stimulation (RAS) has been proposed. RAS affects motor control skills by stimulating the sense of rhythm through sound
1053-8135/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
NeuroRehabilitation 34 (2014) 193–199 DOI:10.3233/NRE-131008 IOS Press
Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients Jee Hyun Suha , Soo Jeong Hana,∗ , Seo Young Jeona , Ho Jeong Kima , Jeong Eun Leeb , Tae Sik Yoona and Hyun Ju Chongc a Department
of Rehabilitation Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea of Rehabilitation Medicine, Seonam Hospital, Seoul, Republic of Korea c Department of Music Therapy, Ewha Womans University, Seoul, Republic of Korea b Department
Abstract. BACKGROUND: Rhythmic auditory stimulation (RAS) improves gait velocity, cadence, and stride length in hemiplegic stroke patients, yet little is known about the effectiveness of RAS on standing balance. OBJECTIVES: To examine and compare the effectiveness on standing balance and gait parameter of two different types of gait trainings, gait training with RAS versus gait training without RAS, was compared in two groups of hemiplegic stroke patients over a three-week period (RAS group, n = 8; control group = 8). METHODS: Sixteen hemiplegic stroke patients were included in the study. Standing balance was measured by using Biosway® . Stride length, gait velocity, and cadence were calculated from the number of steps and required time for a 10 m-walk. RESULTS: Pre- to post-test measures showed a significant improvement in RAS group for overall stability index (p = 0.043), mediolateral index (p = 0.006), anteroposterior index (p = 0.016), gait velocity (p = 0.012), stride length (p = 0.03) and cadence (p = 0.012) over the control group. CONCLUSIONS: The results of this study showed that RAS was an effective therapeutic method to improve gait velocity, stride length, cadence, and standing balance in hemiplegic stroke patients. Keywords: Rhythmic auditory stimulation, stroke, balance, gait, rehabilitation
1. Introduction For patients with stroke, asymmetrical standing postures and difficulties in walking are common problems, due to several factors including weakness in muscle strength, asymmetry in weight distribution, impaired proprioception, exaggerated stretch reflexes, spasticity, and impaired motor control (Brandstater et al., 1983). ∗ Address
for correspondence: Soo Jeong Han, Department of Rehabilitation Medicine, School of Medicine, Ewha Womans University, 1071 An-Yang-Cheon Ro, Yang-Cheon Gu, Seoul 158-710, Republic of Korea. Tel.: +82 2 2650 5035; Fax: +82 2 2650 5145; E-mail: [email protected].
As controlling one’s posture and balance while walking is essential after stroke, standing balance training which helps shift the weight to the paretic side is helpful (Lee et al., 2012). Recent data suggest rehabilitation processes involving movements which are highly repetitive and rhythmically patterned are particularly effective in gait training for stroke patients, possibly facilitating long-term improvements in the sensorimotor cortex related to motor learning (Asanuma et al., 1991; Buetefisch et al., 1991). For enhancing rhythmical patterns of movement, rhythmic auditory stimulation (RAS) has been proposed. RAS affects motor control skills by stimulating the sense of rhythm through sound
1053-8135/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
