Rhythm Perturbations in Acoustically Paced Treadmill Walking After Stroke

Background. In rehabilitation, acoustic rhythms are often used to improve gait after stroke. Acoustic cueing may enhance gait coordina-tion by creating a stable coupling between heel strikes and metronome beats and provide a means to train the adaptability of gait coordi-nation to environmental changes, as required in everyday life ambulation. Objective. To examine the stability and adaptability of auditory–motor synchronization in acoustically paced treadmill walking in stroke patients. Methods. Eleven stroke patients and 10 healthy controls walked on a treadmill at preferred speed and cadence under no metronome, single-metronome (pacing only paretic or nonparetic steps), and double-metronome (pacing both footfalls) conditions. The stability of auditory–motor synchronization was quanti-fied by the variability of the phase relation between footfalls and beats. In a separate session, the acoustic rhythms were perturbed and adaptations to restore auditory–motor synchronization were quantified. Results. For both groups, auditory–motor synchronization was more stable for double-metronome than single-metronome conditions, with stroke patients exhibiting an overall weaker coupling of footfalls to metronome beats than controls. The recovery characteristics following rhythm perturbations corroborated the stability find-ings and further revealed that stroke patients had difficulty in accelerating their steps and instead preferred a slower-step response to restore synchronization. Conclusions. In gait rehabilitation practice, the use of acoustic rhythms may be more effective when both foot-falls are paced. In addition, rhythm perturbations during acoustically paced treadmill walking may not only be employed to evaluate the stability of auditory–motor synchronization but also have promising implications for evaluation and training of gait adaptations in neu