Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis

Shashank Ghai, Ishan Ghai, Gerd Schmitz, Alfred O Effenberg, Shashank Ghai, Ishan Ghai, Gerd Schmitz, Alfred O Effenberg

Abstract

The use of rhythmic auditory cueing to enhance gait performance in parkinsonian patients' is an emerging area of interest. Different theories and underlying neurophysiological mechanisms have been suggested for ascertaining the enhancement in motor performance. However, a consensus as to its effects based on characteristics of effective stimuli, and training dosage is still not reached. A systematic review and meta-analysis was carried out to analyze the effects of different auditory feedbacks on gait and postural performance in patients affected by Parkinson's disease. Systematic identification of published literature was performed adhering to PRISMA guidelines, from inception until May 2017, on online databases; Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE and PROQUEST. Of 4204 records, 50 studies, involving 1892 participants met our inclusion criteria. The analysis revealed an overall positive effect on gait velocity, stride length, and a negative effect on cadence with application of auditory cueing. Neurophysiological mechanisms, training dosage, effects of higher information processing constraints, and use of cueing as an adjunct with medications are thoroughly discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance motor performance and quality of life in the parkinsonian community.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
PRISMA flow chart for the inclusion of studies.
Figure 2
Figure 2
Funnel plot for Hedge’s g and standardized effect for each value in the meta-analysis. Each of the effect is represented in the plot as a circle. Funnel boundaries represent area where 95% of the effects are expected to lie if there were no publication biases. The vertical line represents the mean standardized effect of zero. Absence of publication bias is represented by symmetrically distributed effects around the line.
Figure 3
Figure 3
Risk of bias across studies.
Figure 4
Figure 4
Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on gait velocity among parkinsonian patients. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative effect size indicated reduction in gait velocity; a positive effect size indicated enhancement in gait velocity. (FP: Fast paced, SP: Slow paced, Fz: Freezers, NFz: Non-Freezers, ON: with medications, OFF: without medications, INC: Inclined training, T: Treadmill training, FP T: Fast paced training, I: Isosynchrounous cueing, Rn: Random, BL Biological variability, RAC: Rhythmic auditory cueing).
Figure 5
Figure 5
Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on stride length among parkinsonian patients. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative effect size indicated reduction in stride length; a positive effect size indicated enhancement in stride length. (FP: Fast paced, SP: Slow paced, Fz: Freezers, NFz: Non-Freezers, ON: with medications, OFF: without medications, INC: Inclined training, T: Treadmill training, FP T: Fast paced training, I: Isosynchrounous cueing, Rn: Random, BL Biological variability, RAC: Rhythmic auditory cueing).
Figure 6
Figure 6
Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on cadence among parkinsonian patients. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative effect size indicated reduction in step frequency; a positive effect size indicated enhancement in step frequency. (FP: Fast paced, SP: Slow paced, Fz: Freezers, NFz: Non-Freezers, ON: with medications, OFF: without medications, INC: Inclined training, T: Treadmill training, FP T: Fast paced training, I: Isosynchrounous cueing, Rn: Random, BL Biological variability, RAC: Rhythmic auditory cueing, step frequency: number of steps/minute).

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