Brain structural change and gait decline: a longitudinal population-based study. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. Gait improvement in patients with cerebral palsy by visual and auditory feedback Effects of emotionally charged auditory stimulation on gait performance in the elderly: a preliminary study. Interrater reliability and convergent validity of the American Academy for Cerebral Palsy and Developmental Medicine methodology for conducting systematic reviews. Interactive Rhythmic Auditory Stimulation Reinstates Natural 1/f Timing in Gait of Parkinson's Patients Rhythmic auditory stimulation modulates gait variability in Parkinson's disease. Internal vs external generation of movements: differential neural pathways involved in bimanual coordination performed in the presence or absence of augmented visual feedback Changes in gait patterns induced by rhythmic auditory stimulation for adolescents with acquired brain injury. Rhythmic auditory stimulation in gait training for Parkinson's disease patients. Targeting dopa-sensitive and dopa-resistant gait dysfunction in Parkinson's disease: selective responses to internal and external cues. Effect of rhythmic auditory stimulation on gait performance in children with spastic cerebral palsy. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. A Home-Based Program Using Patterned Sensory Enhancement Improves Resistance Exercise Effects for Children With Cerebral Palsy Effects of physical guidance and knowledge of results on motor learning: support for the guidance hypothesis. Reliability of the PEDro scale for rating quality of randomized controlled trials. Balance, balance confidence, and health-related quality of life in persons with chronic stroke after body weight-supported treadmill training. Biologically-variable rhythmic auditory cues are superior to isochronous cues in fostering natural gait variability in Parkinson's disease. Music enhances performance and perceived enjoyment of sprint interval exercise. Aquatic aerobic exercise for children with cerebral palsy: a pilot intervention study
OBJECTIVES To investigate longitudinal associations between changes in brain structure and gait decline  . DESIGN Longitudinal . SETTING Population -based Tasmanian Study of Cognition and Gait . PARTICIPANTS Two hundred twenty-five individuals aged 60 to 86 ( mean age 71.4 ± 6.8 ) r and omly selected from the electoral roll with baseline and follow-up data . MEASUREMENTS Volumes of gray matter , white matter , hippocampi , and white matter lesions ( WML ) were estimated using automated segmentation from magnetic resonance imaging ( MRI ) .  Gait variables were measured using a computerized walkway . Linear regression was used to estimate the association between change in brain MRI measures and change in gait . Time between measurements , age , sex , BMI , education level , total intracranial volume , baseline infa rcts , and medical history were used as baseline covariates . RESULTS Mean follow-up was 30.6 months . White matter atrophy was associated with a decline in gait speed ( P = .001 ) , step length ( P = .005 ) , and cadence ( P = .001 ) . WML progression was associated with a decline in gait speed ( P = .04 ) , and its association with decline in step length was stronger with greater baseline age ( P for interaction = .04 ) . Hippocampal atrophy was associated with a decline in gait speed ( P = .006 ) and step length ( P = .001 ) . Total gray matter atrophy was associated with decline in cadence in those with cerebral infa rcts ( P for interaction = .02 ) . CONCLUSION These are the first longitudinal data demonstrating the relative contributions of brain atrophy and WML progression to gait decline in older people . Effect modification according to age and infa rcts suggests a contribution of reduced physiological and brain reserve . Interventions targeting brain health may be important in preventing mobility decline in older people CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke Visual and auditory feedback cues have been shown to improve gait and balance in patients with movement disorders , such as Parkinson 's disease and multiple sclerosis . Subsequently , closed-loop virtual reality was used to enhance the gait improvement effect of such cues . Objectives : To study the effects of gait training with visual and auditory feedback cues on the walking abilities of patients with gait disorders due to cerebral palsy . Methods : Visual and auditory feedback cues were generated by a wearable accelerometry-driven device . Ten r and omly selected patients with gait disorders due to cerebral palsy trained with visual feedback cues while ten such patients trained with auditory feedback cues . Baseline performance ( walking speed and stride length along a 10 m straight track ) was measured before device use . Following 20min training with the device , performance without the device was measured again and compared to the baseline performance . Results : For patients training with visual feedback , the average improvement in walking speed was 21.70%+/−36.06 % and in stride length 8.72%±9.47 % . For patients training with auditory feedback , average improvement in walking speed was 25.43%±28.65 % and in stride length 13.58%±13.10 % . Conclusion : Visual and auditory feedback cues can improve gait parameters in patients with gait disorders due to cerebral palsy OBJECTIVES To evaluate the effect of a novel divided attention task-walking under auditory constraints-on gait performance in older adults and to determine whether this effect was moderated by cognitive status . DESIGN Validation cohort . SETTING General community . PARTICIPANTS Ambulatory older adults without dementia ( N=104 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES In this pilot study , we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 r and omly assigned conditions : 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds . RESULTS The mean age of subjects was 80.6±4.9 years , and 63 % ( n=66 ) were women .  The mean velocity during normal walking was 97.9±20.6cm/s , and the mean cadence was 105.1±9.9 steps/min . The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor ( cognitively intact and minimal cognitive impairment groups ) and a 1-within factor ( type of auditory stimuli ) . In both happy and sad auditory stimulation trials , cognitively intact older adults ( n=96 ) showed an average increase of 2.68cm/s in gait velocity ( F1.86,191.71=3.99 ; P=.02 ) and an average increase of 2.41 steps/min in cadence ( F1.75,180.42=10.12 ; P<.001 ) as compared with trials without auditory stimulation . In contrast , older adults with minimal cognitive impairment ( Blessed test score , 5 - 10 ; n=8 ) showed an average reduction of 5.45cm/s in gait velocity ( F1.87,190.83=5.62 ; P=.005 ) and an average reduction of 3.88 steps/min in cadence ( F1.79,183.10=8.21 ; P=.001 ) under both auditory stimulation conditions . Neither baseline fall history nor performance of activities of daily living accounted for these differences . CONCLUSIONS Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment . A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals , but lead to decompensation in those with minimal cognitive impairment . Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints AIM The aim of this study was to evaluate the interrater reliability and convergent validity of the American Academy for  Cerebral Palsy and Developmental Medicine  's ( AACPDM ) methodology for conducting systematic review s ( group design studies ) . METHOD Four clinicians independently rated 24 articles for the level of evidence and conduct using AACPDM methodology . Study conduct was also assessed using the Effective Public Health Practice Project scale . Raters were r and omly assigned to one of two pairs to resolve discrepancies . The level of agreement between individual raters and pairs was calculated using kappa ( α=0.05 ) and intraclass correlations ( ICCs ; α=0.05 ) . Spearman 's rank correlation coefficient was calculated to evaluate the relationship between raters ' categorization of quality categories using the two tools . RESULTS There was acceptable agreement between raters ( κ=0.77 ; p<0.001 ; ICC=0.90 ) and between assigned pairs ( κ=0.83 ; p<0.001 ; ICC=0.96 ) for the level of evidence ratings . There was acceptable agreement between pairs for four of the seven conduct questions ( κ=0.53 - 0.87 ) . ICCs ( all raters ) for conduct category ratings ( weak , moderate , and strong ) also indicated good agreement ( ICC=0.76 ) . Spearman 's rho indicated a significant positive correlation for the overall quality category comparisons of the two tools ( 0.52 ; p<0.001 ) . CONCLUSIONS The AACPDM rating system has acceptable interrater reliability . Evaluation of its study quality ratings demonstrated reasonable agreement when compared with a similar tool Parkinson 's disease ( PD ) and basal ganglia dysfunction impair movement timing , which leads to gait instability and falls . Parkinsonian gait consists of r and om , disconnected stride times — rather than the 1/f structure observed in healthy gait— and this r and omness of stride times ( low fractal scaling ) predicts falling . Walking with fixed-tempo Rhythmic Auditory Stimulation ( RAS ) can improve many aspects of gait timing ; however , it lowers fractal scaling ( away from healthy 1/f structure ) and requires attention . Here we show that interactive rhythmic auditory stimulation reestablishes healthy gait dynamics in PD patients . In the experiment , PD patients and healthy participants walked with a ) no auditory stimulation , b ) fixed-tempo RAS , and c ) interactive rhythmic auditory stimulation . The interactive system used foot sensors and nonlinear oscillators to track and mutually entrain with the human 's step timing . Patients consistently synchronized with the interactive system , their fractal scaling returned to levels of healthy participants , and their gait felt more stable to them . Patients and healthy participants rarely synchronized with fixed-tempo RAS , and when they did synchronize their fractal scaling declined from healthy 1/f levels . Five minutes after removing the interactive rhythmic stimulation , the PD patients ' gait retained high fractal scaling , suggesting that the interaction stabilized the internal rhythm generating system and reintegrated timing networks . The experiment demonstrates that complex interaction is important in the (re)emergence of 1/f structure in human behavior and that interactive rhythmic auditory stimulation is a promising therapeutic tool for improving gait of PD patients Patients with Parkinson 's disease ( PD ) walk with a shortened stride length and high stride-to-stride variability , a measure associated with fall risk . Rhythmic auditory stimulation ( RAS ) improves stride length but the effects on stride-to-stride variability , a marker of fall risk , are unknown . The effects of RAS on stride time variability , swing time variability and spatial-temporal measures were examined during 100-m walks with the RAS beat set to 100 and 110 % of each subject 's usual cadence in 29 patients with idiopathic PD and 26 healthy age-matched controls . Carryover effects were also evaluated . During usual walking , variability was significantly higher ( worse ) in the patients with PD compared with the controls ( P < 0.01 ) . For the patients with PD , RAS at 100 % improved gait speed , stride length and swing time ( P < 0.02 ) but did not significantly affect variability . With RAS at 110 % , reductions in variability were also observed ( P < 0.03 ) and these effects persisted 2 and 15 min later . In the control subjects , the positive effects of RAS were not observed . For example , RAS increased stride time variability at 100 and 110 % . These results demonstrate that RAS enables more automatic movement and reduces stride-to-stride variability in patients with PD . Further , these improvements are not simply a by-product of changes in speed or stride length . After walking with RAS , there also appears to be a carryover effect that supports the possibility of motor plasticity in the networks controlling rhythmicity in PD and the potential for using RAS as an intervention to improve mobility and reduce fall risk It is commonly agreed that a functional dissociation with respect to the internal vs external control of movements exists for several brain regions . This has , however , only been tested in relation to the timing and preparation of motor responses , but not to ongoing movement control . Using functional magnetic resonance imaging ( fMRI ) , the present study addressed the neuroanatomical substrate of the internal-external control hypothesis by comparing regional brain activation for cyclical bimanual movements performed in the presence or absence of augmented visual feedback .  Subjects performed a bimanual movement pattern , either with the help of on-line visual feedback of the movements ( externally guided coordination ) or with the eyes closed on the basis of an internal representation of the movement pattern ( internally generated coordination ) . Visual control and baseline rest conditions were also added . Results showed a clear functional dissociation within the network involved in movement coordination . The hMT/V5 + , the superior parietal cortex , the premotor cortex , the thalamus , and cerebellar lobule VI showed higher activation levels when movements were guided by visual feedback . Conversely , the basal ganglia , the supplementary motor area , cingulate motor cortex , the inferior parietal , frontal operculum , and cerebellar lobule IV-V/dentate nucleus showed higher involvement when movements were internally generated . Consequently , the present findings suggest the existence of distinct cortico-cortical and subcortico-cortical neural pathways for externally ( augmented feedback ) and internally guided cyclical bimanual movements . This provides a neurophysiological account for the beneficial effect of providing augmented visual feedback to optimize movements in normal and motor disordered patients The effects of rhythmic auditory stimulation ( RAS ) on gait in adolescents with acquired brain injury ( ABI ) were investigated . A total of 14 adolescents with ABI were initially recruited , and 12 were included in the final analysis ( n = 6 each ) . They were r and omly assigned to the experimental ( RAS ) or the control ( conventional gait training ) groups . The experimental group received gait training with RAS three times a week for 4 weeks . For both groups , spatiotemporal parameters and kinematic data , such as dynamic motions of joints on three-dimensional planes during a gait cycle and the range of motion in each joint , were collected . Significant group differences in pre-post changes were observed in cadence , walking velocity , and step time , indicating that there were greater improvements in those parameters in the RAS group compared with the control group . Significant increases in hip and knee motions in the sagittal plane were also observed in the RAS group . The changes in kinematic data significantly differed between groups , particularly from terminal stance to mid-swing phase . An increase of both spatiotemporal parameters and corresponding kinematic changes of hip and knee joints after RAS protocol indicates that the use of rhythmic cueing may change gait patterns in adolescents with ABI Rhythmic auditory stimulation ( RAS ) was used as a pacemaker during a 3-week home-based gait-training program for Parkinson 's disease ( PD ) patients ( n = 15 ) .  Electromyogram ( EMG ) patterns and stride parameters were assessed before and after the test without RAS to evaluate changes in gait patterns . Data were compared with those of two control groups ( n = 11 ) , who either did not participate in any gait training or who participated in an internally self-paced training program . RAS consisted of audiotapes with metronome-pulse patterns embedded into the on/off beat structure of rhythmically accentuated instrumental music . Patients who trained with RAS significantly ( p < 0.05 ) improved their gait velocity by 25 % , stride length by 12 % , and step cadence by 10 % more than self-paced subjects who improved their velocity by 7 % and no-training subjects whose velocity decreased by 7 % . In the RAS-group , timing of EMG patterns changed significantly ( p < 0.05 ) in the anterior tibialis and vastus lateralis muscles . Evidence for rhythmic entrainment of gait patterns was shown by the ability of the RAS group to reproduce the speed of the last training tape within a 2 % margin of error without RAS BACKGROUND Independence of certain gait characteristics from dopamine replacement therapies highlights its complex pathophysiology in Parkinson 's disease ( PD ) . We explored the effect of two different cue strategies on gait characteristics in relation to their response to dopaminergic medications . PATIENTS AND METHODS Fifty people with PD ( age 69.22 ± 6.6 years ) were studied . Participants walked with and without cues presented in a r and omized order . Cue strategies were : ( 1 ) internal cue ( attention to increase step length ) and ( 2 ) external cue ( auditory cue with instruction to take large step to the beat ) . Testing was carried out two times at home ( on and off medication ) . Gait was measured using a Stride Analyzer ( B&L Engineering ) . Gait outcomes were walking speed , stride length , step frequency , and coefficient of variation ( CV ) of stride time and double limb support duration ( DLS ) . RESULTS Walking speed , stride length , and stride time CV improved on dopaminergic medications , whereas step frequency and DLS CV did not . Internal and external cues  increased stride time and walking speed ( on and off dopaminergic medications ) . Only the external cue significantly improved stride time CV and DLS CV , whereas the internal cue had no effect ( on and off dopaminergic medications ) . CONCLUSIONS Internal and external cues selectively modify gait characteristics in relation to the type of gait disturbance and its dopa-responsiveness . Although internal ( attention ) and external cues target dopaminergic gait dysfunction ( stride length ) , only external cues target stride to stride fluctuations in gait . Despite an overlap with dopaminergic pathways , external cues may effectively address nondopaminergic gait dysfunction and potentially increase mobility and reduce gait instability and falls The purpose of this study was to use Rhythmic Auditory Stimulation ( RAS ) for children with spastic cerebral palsy ( CP ) in a clinical setting in order to determine its effectiveness in gait training for ambulation . RAS has been shown to improve gait performance in patients with significant gait deficits . All 25 participants ( 6 to 20 years old ) had spastic CP and were ambulatory , but needed to stabilize and gain more coordinated movement . Participants were placed in three groups : the control group , the therapist-guided training ( TGT ) group , and the self-guided training ( SGT ) group . The TGT group showed a statistically significant difference in stride length , velocity , and symmetry . The analysis of the results in SGT group suggests that the self-guided training might not be as effective as therapist-guided depending on motivation level . The results of this study support three conclusions : ( a ) RAS does influence gait performance of people with CP ; ( b ) individual characteristics , such as cognitive functioning , support of parents , and physical ability play an important role in design ing a training application , the effectiveness of RAS , and expected benefits from the training ; and ( c ) velocity and stride length can be improved by enhancing balance , trajectory , and kinematic stability without increasing cadence QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis Background . Neurologic music therapy has demonstrated improved walking performance in persons with neurologic disease ; however , little evidence supports the use of music with functional resistance exercise to improve motor capacity and daily functions for children with cerebral palsy . Objective . To investigate the effect of additional patterned sensory enhancement ( PSE ) music combined with exercise for children with spastic diplegia . Methods . An assessor-blind , r and omized controlled trial with 6- and 12-week follow-ups was carried out . Thirty-six children with spastic diplegia , aged 5 to 13 years , were assigned to a PSE group ( n = 18 ) or a no-music group ( n = 18 ) . Both groups received 6-week , home-based , loaded sit-to-st and exercise , but only the PSE group exercised with prerecorded PSE music . The primary outcome was Gross Motor Function Measure ( GMFM ) . Secondary outcomes included Pediatric Evaluation of Disability Inventory ( PEDI ) mobility and self-care domains , 1-repetition maximum of sit-to-st and , and walking speeds . Results . Three children did not complete the program . Intention-to-treat analysis showed both groups improved in GMFM D , E , and Goal dimensions ; Functional Skills Scales of PEDI mobility domain ; and 1-repetition maximum of sit-to-st and at posttest and follow-ups ( P ≤ .005 ) . The PSE group improved significantly greater than the no-music group in the GMFM D and Goal dimensions ( P < .005 ) after training , and the improvement persisted for at least 6 or 12 weeks ( P ≤ .013 ) . No significant improvements in the rest PEDI scales and walking speeds were found . Conclusions . Adding neurologic music therapy to functional resistance exercise could induce greater improvements in gross motor capacity for children with cerebral palsy The guidance hypothesis ( Schmidt , 1991 ) predicts that the guiding properties of augmented feedback are beneficial for motor learning when used to reduce error , but detrimental when relied upon . Therefore , a heavily guiding form of feedback might be detrimental for learning . In addition , the guidance hypothesis predicts that practice with a high relative frequency of augmented feedback would be detrimental for learning . An experiment is described that crossed two forms of feedback with two levels of relative frequency . Subjects practice d movements to a target with either physical guidance or knowledge of results , and with either a high or faded relative frequency . The high frequency physical guidance condition result ed in the poorest retention , and both high frequency feedback conditions result ed in the least accuracy in transfer . These results provide support for the guidance hypothesis and suggest consideration of the combined effects on learning of the type and relative frequency of augmented feedback and acquisition-test conditions BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVES To examine changes in balance , balance confidence , and health-related quality of life immediately and 6 months after  body weight-supported treadmill training ( BWSTT ) for persons with chronic stroke ( primary objective ) and to determine whether changes in gait speed after BWSTT were associated with changes in these dimensions of health ( secondary objective ) . DESIGN Prospect i ve pre-/posttest pilot study with 6 months retention . SETTING University research laboratory setting s. PARTICIPANTS A convenience sample of participants ( N=19 ; at least 6mo poststroke ; able to ambulate 0.4 - 0.8 m/s ) were recruited . INTERVENTION BWSTT was provided for 24 sessions over 8 weeks with 20 minutes of total walking each session . MAIN OUTCOME MEASURES Berg Balance Scale ( BBS ) , Activities-Specific Balance Confidence ( ABC ) Scale , Stroke Impact Scale ( SIS ) , comfortable 10-m walk test ( CWT ) , and fast 10-m walk test ( FWT ) . Proportions of participants who achieved minimal detectable changes ( MDCs ) were examined for all measures . RESULTS Statistically significant improvements were found from pre- to posttest for BBS , ABC , SIS mobility , SIS stroke recovery , and CWT scores ( P<.05 ) and from pretest to retention on BBS , ABC , CWT , and FWT scores ( P<.05 ) . For most participants , improvements did not exceed MDCs . Changes in gait speed and BBS , ABC , and SIS scores were not associated . CONCLUSIONS The findings of this study suggest that effects of BWSTT may transfer beyond gait to positively influence balance , balance confidence , and health-related quality of life . However , for most participants , BWSTT was not sufficient to induce improvements in balance and balance confidence beyond measurement error or long-term retention of enhanced perceptions of quality of life INTRODUCTION Rhythmic auditory cueing improves certain gait symptoms of Parkinson 's disease ( PD ) .  Cues are typically stimuli or beats with a fixed inter-beat interval . We show that isochronous cueing has an unwanted side-effect in that it exacerbates one of the motor symptoms characteristic of advanced PD . Whereas the parameters of the stride cycle of healthy walkers and early patients possess a persistent correlation in time , or long-range correlation ( LRC ) , isochronous cueing renders stride-to-stride variability r and om . R and om stride cycle variability is also associated with reduced gait stability and lack of flexibility . METHOD To investigate how to prevent patients from acquiring a r and om stride cycle pattern , we tested rhythmic cueing which mimics the properties of variability found in healthy gait ( biological variability ) . PD patients ( n=19 ) and age-matched healthy participants ( n=19 ) walked with three rhythmic cueing stimuli : isochronous , with r and om variability , and with biological variability ( LRC ) . Synchronization was not instructed . RESULTS The persistent correlation in gait was preserved only with stimuli with biological variability , equally for patients and controls ( p's<0.05 ) . In contrast , cueing with isochronous or r and omly varying inter-stimulus/beat intervals removed the LRC in the stride cycle . Notably , the individual 's tendency to synchronize steps with beats determined the amount of negative effects of isochronous and r and om cues ( p's<0.05 ) but not the positive effect of biological variability . CONCLUSION Stimulus variability and patients ' propensity to synchronize play a critical role in fostering healthier gait dynamics during cueing . The beneficial effects of biological variability provide useful guidelines for improving existing cueing treatments INTRODUCTION Interval exercise training can elicit physiological adaptations similar to those of traditional endurance training , but with reduced time . However , the intense nature of specific protocol s , particularly the " all-out " efforts characteristic of sprint interval training ( SIT ) , may be perceived as being aversive . The purpose of this study was to determine whether listening to self-selected music can reduce the potential aversiveness of an acute session of SIT by improving affect , motivation , and enjoyment , and to examine the effects of music on performance . METHODS Twenty moderately active adults ( 22 ± 4 yr ) unfamiliar with interval exercise  completed an acute session of SIT under two different conditions : music and no music . The exercise consisted of four 30-s " all-out " Wingate Anaerobic Test bouts on a cycle ergometer , separated by 4 min of rest . Peak and mean power output , RPE , affect , task motivation , and perceived enjoyment of the exercise were measured . Mixed-effects models were used to evaluate changes in dependent measures over time and between the two conditions . RESULTS Peak and mean power over the course of the exercise session were higher in the music condition ( coefficient = 49.72 [ SE = 13.55 ] and coefficient = 23.65 [ SE = 11.30 ] ; P < 0.05 ) . A significant time by condition effect emerged for peak power ( coefficient = -12.31 [ SE = 4.95 ] ; P < 0.05 ) . There were no between-condition differences in RPE , affect , or task motivation . Perceived enjoyment increased over time and was consistently higher in the music condition ( coefficient = 7.00 [ SE = 3.05 ] ; P < 0.05 ) . CONCLUSION Music enhances in-task performance and enjoyment of an acute bout of SIT . Listening to music during intense interval exercise may be an effective strategy for facilitating participation in , and adherence to , this form of training Abstract Purpose : The primary purpose of this pilot study was to evaluate the effectiveness of a14-week aquatic exercise program on gross motor function and walking endurance in children with cerebral palsy ( CP ) . The secondary purpose was to evaluate changes in functional strength , aerobic capacity and balance . Method : A prospect i ve time series group design consisting of four measurement sessions ( two baseline , one post intervention , and 1-month follow-up ) was used . Eight ambulatory children ages 6–15 years with CP and classified at Gross Motor Function Classification System Level I or Level III participated in an aquatic aerobic exercise program . Results : Significant improvements were observed for the primary outcomes of gross motor function and walking endurance . No significant differences between any of the secondary measures were observed , although all of the measures demonstrated trends of improvement after intervention . Conclusion : Ambulatory children with CP may improve their gross motor skills and walking endurance after an aquatic exercise program held twice per week for 14 weeks , utilizing moderate-to-vigorous exercise intensity and consisting of functional activities
Auditory entrainment can influence gait performance in movement disorders .
The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution .
However , a consensus as to its effects based on gait in people with cerebral palsy is still warranted .
A systematic review and meta- analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy .
This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention .