Parkinson disease (PD) is a progressive movement disorder characterized by substantial walking-related disability. Loss of dopaminergic neurons in the basal ganglia results in reduced gait automaticity, for which persons with PD appear to compensate by reallocating attention to the task of walking. The re-allocation of attention contributes to walking disability by increasing stride time variability and hindering distribution of attentional resources to real-world walking.
Rhythmic Auditory Stimulation (RAS) is a rehabilitation intervention which shows promise for improving walking in PD. RAS is an external cueing medium utilizing repetitive auditory beats to prime neurons in the motor cortex by way of direct connections between auditory and motor brain regions. RAS hypothetically enhances gait automaticity through a process of auditory-motor entrainment, in which the motor signal frequency locks to the frequency of the auditory stimulus, reducing attention directed towards walking. RAS has demonstrated immediate and potent effects on walking, as reflected clinically by improvements in speed, stride length, and step frequency.
Although promising, most RAS studies have been conducted in controlled clinic settings using fixed-tempo auditory cues to which a person must entrain. This open loop approach fails to account for the vast heterogeneity in PD gait impairments, varying entrainment abilities, and real-world environments that demand adaptive walking behavior. Moreover, the impact of RAS on gait automaticity and cognitive load is poorly understood.
To overcome these limitations and advance this field, the following studies seek to examine the effects of our autonomous closed-loop, music-based intervention designed to individualize a progressive RAS gait training program for use in real-world environments in persons with PD. Study 1 of my dissertation evaluates the feasibility of deploying this music-based device over a four-week period in an unsupervised, naturalistic environment in individuals with PD. Concurrently, this study aims to demonstrate proof-of-concept of this autonomous closed-loop music intervention through examining its impact on daily steps, daily minutes of moderate intensity walking, and walking quality (spatiotemporal gait characteristics). Complementing this, Study 2 of my dissertation is a mechanistic study exploring how persons with PD respond in real-time to the autonomous closed-loop, music-based intervention in terms of stride-to-stride entrainment stability, key spatiotemporal gait parameters, and gait automaticity. Stride time variability has been a surrogate measure recognized to capture gait automaticity and will be used to better understand whether this intervention may increase gait automaticity and reduce attention directed towards walking. Together, my dissertation will provide insight into the potential effects of gait training using RAS in real-world environments and assist in advancing gait rehabilitation interventions in persons with PD. / 2026-05-13T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/48751 |
| Date | 13 May 2024 |
| Creators | Zajac, Jenna Ann |
| Contributors | Ellis, Terry D. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial-NoDerivatives 4.0 International, http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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