Can Treadmill Training with Musical Cueing in Individuals with Progressive Parkinson’s Disease Improve Ambulation?

The purpose of this study was to measure the effectiveness of a specialized musical composition in combination with treadmill training to impact gait parameters and balance in people with progressive Parkinson’s disease (PD). Incorporation of auditory stimulation, typically via metronome, to improve movement has been successfully used in rehabilitation for decades. Treadmill training, also frequently used in treatment of PD, has shown short- and long-term improvements in stride length, cadence, stance and swing phase. Music assisted therapy utilizing expertly designed musical composition, known as informed composition, has recently become available for use in rehabilitation in collaboration with music therapists. Combination of an informed musical composition with treadmill training was tested to determine if positive improvements were seen in people with PD. The authors hypothesized that the participants would show significant improvements in gait, balance, and confidence with functional mobility. Number of Subjects: Four subjects with a diagnosis of PD were recruited. Three of the four subjects completed the study. Subject 1 was rated to be Hoehn and Yahr stage III and Subjects 2 and 3 were rated stage IV. Materials and Methods: Single subject series research of A0-B-A1 design, where the B phase consisted of combination treadmill training with musical cueing three times per week for six weeks. During each phase, participants were tested three times using the following measures: MiniBESTest, Dynamic Parkinson Gait Scale (DYPAGS), Activities Balance Confidence Scale, 6-minute walk test (MWT), velocity, cadence, and step length. The data was analyzed using a two standard deviation band method to demonstrate statistical significance. Results: Subject 1 demonstrated significant improvements in the MiniBESTest, DYPAGS, 6-MWT, velocity, cadence, step length. Subjects 2 and 3 exhibited less consistent results with all measures and overall larger standard deviations indicating the variety of the outcome measures during testing. Conclusions: Subject 1, the highest functioning participant at baseline, showed significant improvements in gait and balance throughout the intervention. Subjects 2 & 3 demonstrated less improvement as a result of the intervention, however where characterized by greater fluctuation in functional mobility at baseline. These participants required an assistive device for ambulation and had a history of frequent falls. Clinical Relevance: The use of a specialized musical composition in combination with treadmill training could be an effective intervention for improving gait and balance in people with PD earlier in the disease process