Table 2.
Studies analyzing the effects of RAC on gait
| Study | Research aim | Sample description, age (years), mean ± SD/range | PEDro score | Assessment tools | Research design | Auditory cueing | Conclusion |
|---|---|---|---|---|---|---|---|
| Efraimidou et al70 | Effects of RAC on gait in people with CP | Exp: 5M (35.2±13) Ct: 5M (38.8±12.2) |
5 | Timed up-and-go test, 10 m walk test, BBS, center-of-pressure sway, self-esteem scale, profile of mood states | Pretest, 50-minute session twice a week for 8 weeks with RAC at 70 bpm, and posttest at 90 bpm | Rhythmic music cueing (70–90 bpm), with 4/4 music meter | Significant enhancement in timed up-and-go test, normal and fast gait speed in a 10 m walking test in Exp compared to Ct Significant enhancement in BBS score in Exp compared to Ct Significant reduction in center-of-pressure sway and timing of right- and left-foot synchronization in Exp compared to Ct Significant enhancement in self-esteem score and overall scoring of profile and mood states in Exp compared to Ct |
| Shin et al38 | Effects of RAC on gait in people with hemiplegia (stroke/CP) | CP: 4F, 3M (30.1±4.1) Stroke: 4F, 7M (44.27) |
4 | Cadence, gait speed, stride length, stride time, step time, single/double-support time, stance/swing phase (temporospatial deviation and side-to-side comparison), pelvis, hip, knee, ankle, foot kinematics, gait-deviation index | Pretest, gait training with RAC for 30 minutes/session, and three sessions/week for 4 weeks, posttest | RAC by four-chord progression with metronome beat on keyboard at preferred cadence | Significantly reduced ankle plantar flexion at initial contact and push-off Reduced anterior pelvic tilt in sagittal plane after training with auditory cueing Significantly enhanced kinematic improvements in stroke patients compared to CP Significant enhancement in gait-deviation index and kinematics for people with subacute compared to chronic stroke No effect on gait parameters after training from auditory cueing Enhanced side-to-side symmetry after training from auditory cueing Significant enhancement in gait-deviation index, hip adduction in mid-stance, maximal knee flexion in mid-swing, ankle dorsiflexion in terminal stance after training from RAC |
| Wang et al73 | Effect of auditory feedback on motor capacity, strength, mobility, and gait in people with CP (spastic diplegia) | Exp: 6F, 12M (9±1.9) Ct: 3F, 15M (8.9±2.6) |
7 | Gross motor-function measure (dimensions D and E), goal-dimension score, gait speed, PEDI, functional skill scale of PEDI, caregiver-assistance scale, one-repetition-maximum load of a loaded sit-to-stand test, gait speed and gait duration for 10 m walking test | Pretest, sit-to-stand exercise at home three times/week for 6 weeks, posttest at 6, 12 weeks Training load progressed 2 weeks upon evaluation of one-repetition-maximum sit-to-stand test, auditory feedback adjusted every 2 weeks upon reassessment |
Auditory feedback as patterned sensory enhancement (spatial, temporal, and force cueing) Pitch variations: ascending and descending melodies indicate directions (range of motion cueing) Tempo, meter, and rhythmic pattern (speed and timing of movement) Loudness: strength of muscular contraction |
Significant enhancement in goal-dimension score during posttest at 6- and 12-week follow-up in Exp compared to Ct Significant enhancement in dimension D score in first posttest and 6-week follow-up posttest in Exp compared to Ct Enhancement in dimension E, dimension D (12 weeks posttest) scores during 6 and 12-week follow-up posttest in Exp compared to Ct Significant reduction in PEDI for caregiver assistance at 12-week posttest Exp compared to Ct Enhancement in gait speed (posttest and 12-week posttest), and one repetition maximum of sit to stand in posttest and 6- and 12-week posttests in Exp compared to Ct |
| Jiang75 | Effect of RAC on gait performance in people with CP | 5F, 4M (5–12) | 7 | Gait velocity, cadence, and stride length | Gait training with/without RAC at 0 and +5% of preferred cadence (randomly) for one 30-minute session/week for 3 weeks | RAC by piano, guitar, bass, and percussion, with music in 4/4 beat accented by metronome. Piano superimposed on beat to emphasize rhythm at preferred cadence | Significant enhancement in cadence and gait velocity with training from auditory cueing Enhancement in stride length with auditory cueing Significant enhancement in cadence and gait velocity for people with higher level of gross motor functioning compared to lower levels of gross motor functioning |
| Varsamis et al77 | Effect of RAC on gait performance in people with CP with mental disabilities | 7F, 11M (18.2±3.8) | 4 | Duration for gait performance, number of steps, steps/minute, pulse/minute, and steps and pulse (intraindividual Standard deviation) | Pretest, gait performance with/without RAC and instruction “do your best” | Rhythmic metronome cueing at preferred cadence | Significant enhancement in duration, number of steps with auditory cueing Significant reduction in steps/minute, pulse/minute, steps and pulse (intraindividual SD) with auditory cueing |
| Baram and Lenger41 | Effect of real-time auditory feedback on gait performance in people with CP | Visual cueing: 7F, 3M (13.3±6.2) Auditory cueing: 6F, 4M (11.1±6.5) Ct, visual cueing: 3F, 4M (12.4±0.5) Auditory cueing: 4F, 4M (12.6±7.4) |
4 | Pre- and posttest gait analysis; training performed between tests with visual or auditory cueing | Walking speed, stride length, and cadence | Real-time auditory cueing at preferred cadence | Significant enhancement in walking speed and stride length compared to Ct condition and visual condition alone No effect of auditory feedback on healthy Ct |
| Kim et al39 | Effect of RAC on gait for people with CP | Exp: 5F, 10M (27.3±2.4) Ct: 6F, 7M (27.3±2.5) |
7 | Cadence, gait velocity, stride length, step length, stride time, step time, stance phase, swing phase, gait-deviation index, kinematic data for pelvis, hip sagittal plane (anterior tilt/flexion at initial contact, maximal–minimal angle of anterior tilt/flexion), coronal plane (abduction–adduction at initial contact, maximal adduction–abduction angle), transverse plane (internal–external rotation at initial contact, maximal–minimal internal–external rotation), knee sagittal plane (flexion at initial contact, maximal flexion at swing, minimal flexion at stance), ankle sagittal plane (flexion at initial contact, maximal dorsiflexion at stance, minimal plantar flexion at preswing), foot transverse plane (internal–external rotation at initial contact, maximal–minimal internal–external rotation) | Pretest, gait training with RAC (Exp), neurodevelopmental therapy/Bobath therapy (Ct) at preferred cadence for 30-minute session three times/week for 3 weeks posttest | Rhythmic metronome cueing at preferred cadence | Significant enhancement in cadence, gait velocity, stride length, step length, swing phase, gait-deviation index in Exp after training with RAC compared to Ct Significant reduction in stride time, step time, stance phase in Exp as compared to Ct Significant reduction in pelvis: sagittal plane (anterior tilt initial contact, maximal angle of anterior tilt) in Exp as compared to Ct Significant enhancement in pelvis: sagittal plane (minimal angle of anterior tilt) and hip joint: transverse plane (maximal internal rotation) in Exp as compared to Ct Significant reduction in hip joint: sagittal plane (minimal flexion angle) and coronal plane (abduction–adduction at initial contact, maximal adduction–abduction angle) in Exp as compared to Ct |
| Kim et al76 | Effect of RAC on gait in children with CP | Exp I (community ambulators): 3F, 5M (25.1±8.1) Exp II (household ambulators): 2F, 4M (26.3±6.6) Ct: 15F, 15M (21.5±1.7) |
4 | Cadence, gait velocity, stride length, step length, stride time, step time, stance phase, swing phase, gait-deviation index, kinematic data for pelvis, hip sagittal plane (anterior tilt/flexion at initial contact, maximal–minimal angle of anterior tilt/flexion), coronal plane (abduction–adduction at initial contact, maximal adduction–abduction angle), transverse plane (internal–external rotation at initial contact, maximal–minimal internal–external rotation), knee sagittal plane (flexion at initial contact, maximal flexion at swing, minimal flexion at stance), ankle sagittal plane (flexion at initial contact, maximal dorsiflexion at stance, minimal plantar flexion at preswing), foot transverse plane (internal–external rotation at initial contact, maximal–minimal internal–external rotation) | Gait performance with/without rhythmic metronome cueing at preferred cadence | Rhythmic metronome cueing at preferred cadence | Significant reduction in pelvis: sagittal plane (anterior tilt initial contact, maximal, minimal angle of anterior tilt) and hip: sagittal plane (maximal, minimal flexion angle) and transverse plane (maximal internal–external rotation) in Exp after training with RAC (Exp I > Exp II) Significant enhancement in gait-deviation index with RAC in Exp (Exp I > Exp II) Significant reduction in step length for household-ambulator group with RAC |
| Kwak74 | Effect of RAC on gait performance in people with CP | 30 (6–20) Exp I: 10 patients Exp II: 10 patients Ct: 10 patients |
4 | Cadence, stride length, gait velocity, gait cycle, gait symmetry, and foot-contact pattern | Pretest, (Exp I and II) gait training at +5%, +10%, and +15% of preferred cadence in first, second, and third weeks, respectively, training for 30 minutes/session for 5 days/week for 3 weeks posttest Exp I: therapist-guided gait training with RAC (with drum/clap cueing, pattern sensory enhancement, and therapeutic instrument music playing for muscle strengthening) Exp II: therapist-guided gait training, but self-guided training with RAC Ct: conventional training by a therapist without auditory cueing |
RAC at +5%, +10%, and +15% of preferred cadence by music, steady-beat pattern with 4/4 meter, ie, 80–120 bpm Input by drum or clap sound in closed and open tone to differentiate acoustics for right and left foot |
Significant enhancement in stride length, gait velocity, and gait symmetry for Exp I Enhancement in stride length, gait symmetry, and gait velocity for Exp II compared to Ct Enhancement in cadence for EXP I and II and reduction in cadence for Ct |
Abbreviations: BBS, Berg Balance Scale; bpm, beats per minute; CP, cerebral palsy; Ct, control group; Exp, experimental group; F, female; M, male; PEDI, Pediatric Evaluation of Disability Inventory; RAC, rhythmic auditory cueing