Strategies to Improve Functional Movement Using Music for the Gait Trainer 3

“The Clinical Advantage”™

Biodex Rehabilitative Performance Plan Authors: Hope Young, MT-BC Kristen Barta, DPT Rachel Throop, DPT Emily Morris, MT-BC Natalie Thompson, PT

This performance plan is designed to treat patients demonstrating gait disturbances as a result of various types of neurological processes or chemical changes in the brain – e.g., Parkinson’s disease, cerebral palsy, CVA and other movement disorders. The direction of this intervention is based on patient examination, evaluation, and the patient’s specific goals.

The desired end result for this performance plan is to assist patients in regaining their independence, as well as their ability to participate in activities that are important to them. This performance plan uses current concepts which link movement and music to help gain neuromuscular control. Strategies to Improve Functional Biodex Rehabilitative Performance Plan Movement Using Music for the Gait Trainer 3

Table of Contents

History of Music Therapy ��.4 Science of Music Therapy ��.4 The Brain Processes Music to Enhance Motor Skills ��.4 The Brain Processes Music for Sensory Skills ��.4 Definition of Terms �� 5 Gait Trainer/Music-Assisted Therapy Start Up �� 5 Gait Trainer/Music-Assisted Therapy – Step by Step �� 6 Pretraining and Gait Assessment �� 6 Initializing Sound Bar �� 6 Fitting Music to a Patient’s Cadence Using the Gait Trainer 3 (GT3) �� 6 Influencing Gait Patterns Using Music: Overview �� 8 Pitches or Octaves: Effect on Movement �� 8 Techniques to Facilitate Gait Components Using the Gait Trainer 3 ��.9 Pending Discharge ��10 Sending the Patient Home with an Exercise Program ��10 Selected Abstracts �� 11 About the Authors ��13 Hope Young, MT-BC ��13 Kristen Barta, DPT ��13 Rachel Throop, DPT ��13 Emily Morris, MT-BC ��14 Natalie Thompson, PT ��14 Bibliography �� 15

Biodex Medical Systems, Inc. 3 Strategies to Improve Functional Biodex Rehabilitative Performance Plan Movement Using Music for the Gait Trainer 3

History of Music Therapy

A relationship between music and healing has been acknowledged as far back as early civilizations. The 20th century music therapy discipline began after World War II. Doctors and nurses noticed the patients’ positive responses to musical performances and music programs. Then, facilities throughout the country began to set up music plans to help patients regain movement.

Over the last 50 years, music therapy has been gaining popularity in the medical field, schools, and recreational programs. Today many medical and rehabilitation facilities offer music therapy as one of their treatment modalities. There are many approaches to music therapy combined with clinical applications that assist in restoring movement in all populations.

Science of Music Therapy

Music therapy is a universal phenomenon. It connects science and sound as a means to facilitate functional movement and gait patterns. Some of the basic elements of music are rhythm, melody, pitch, tempo and timbre. These elements can positively affect gait. Rhythmic stimulation through music has been shown to improve motor deficits in a variety of disorders. The Brain Processes Music to Enhance Motor Skills

• Music is processed in all areas of the brain. This gives the patient the ability to access and stimulate areas of the brain that may not be accessible through other modalities.

• Research shows that music enhances and optimizes the brain, providing better, more efficient therapy and improved performance motor skills.

• While auditory stimuli ascend to the higher cognitive processing areas of the brain, signals simultaneously descend directly down the spinal column, causing an immediate reflex-like reaction in muscles of the body to produce more organized movement.

• Research supports parallels between rhythm and movement. Rhythm is used as an external timekeeper to organize, coordinate, and improve movement. In the music therapy world we call that entrainment.

• Therapists can use music to facilitate more functional, organized, coordinated, and higher quality movements. Motor planning, motor coordination, gait training, and body awareness can also be improved.

The Brain Processes Music for Sensory Skills

• Music provides concrete, multi-sensory stimulation to the brain and can affect the auditory and visual systems. The rhythmic component of music is very organizing for sensory input. As a result, auditory, visual, tactile, proprioceptive (input to muscles and joints), vestibular (input for balance), and self-regulation processing skills can be improved through music therapy.

4 MUSIC FOR THE GAIT TRAINER 3 Definition of Terms

• Walking speed – distance walked per unit of time

• Steps per minute (spm) – amount of steps taken in one minute; can be derived with a formula or counted

• Cadence time – number of steps per unit of time

• Stride length – distance covered between two successive ground contacts of the same foot

• Step time – time between two successive ground contacts of the opposite feet

• Step length – distance covered between two successive ground contacts of the opposite feet

• Coefficient of Variation (CV) – measures the consistency or variability of each step while walking. The more variability there is with stepping, the greater the percentage score; thirteen percent and under is considered normal.

• Entrainment – the process in which a person’s normal rhythm syncs with an external source. Entrainment cues can change one’s timing of movement.

• Rhythmic Auditory Cueing (RAC) – a neurological technique used to facilitate movements that are biologically rhythmical, as in gait. These physiological effects of auditory stimulus work on the motor system to improve control.

• Sensory Enhanced Movement (SEM) – specific musical compositions that provide spatial, temporal, and force cues to movements that are not rhythmical by nature. This technique facilitates non-rhythmical movements.

• Pitches – the degree of highness or lowness of a tone; also indicates direction in space

• Timbre – unique quality of musical sound independent of pitch and loudness

Gait Trainer/Music-Assisted Therapy Start Up

The Biodex Gait Trainer 3 with version 3.X software can be configured with an optional Music-Assisted Therapy Package. The sound bar on the Gait Trainer may be a different model from those displayed in the manual.

The Music-Assisted Therapy component will not be activated until the flash drive is inserted into the USB port at the bottom of the display. (The location of USB ports may vary depending on the display model.) The software will activate automatically once the flash drive is inserted. When the Music-Assisted Therapy software is activated, the Music Therapy button will be visible on the left side of the Gait Trainer screen.

If the Gait Trainer was ordered with the Music-Assisted Therapy Package, the flash drive is included in the packaging along with the manual, safety lanyard, etc. The starter library includes musical arrangements with various rhythmic beats and music therapy-informed compositions composed at a range of tempos.

If the Music-Assisted Therapy Package was purchased after the delivery of the Biodex Gait Trainer 3, the sound bar can easily be installed. Simply unscrew the lower two screws on the display mount, slide the sound bar bracket between the display and the display mount, and re-apply and tighten the screws. The sound bar has two cables: one for power and one for sound. Both plug into the display directly above it. Headphone and microphone jacks The sound bar also has standard jacks for headphones and a microphone.

Biodex Medical Systems, Inc. 5 Gait Trainer/Music-Assisted Therapy - Step by Step Pretraining and Gait Assessment

Explain the process to the patient. It is important to complete the majority of the music discussion prior to gait training. Typically, the patient will fatigue and the data will not be as accurate during walking when attempting to simultaneously establish preference/context and set up the music.

Perform complete gait assessment. The physical therapist will perform an initial evaluation with a complete gait assessment. Cadence time or steps per minute (spm) should be determined. A gait analysis should be performed.

• Various walk tests can be used depending on the patient’s functional ability and endurance; recommendations are 6- or 10-meter walk test.

• Select a specific walk test that applies to the patient’s ability and count the patient’s steps. Keep track of the time it took the patient to complete the test. To calculate the spm: 60/time (in seconds) X (#of steps)= cadence/spm.

• For lower level patients, have patient ambulate for 15 seconds, counting each heel strike and multiplying the total by 4 to calculate spm.

• Typically the gait assessment is performed over ground, although some therapists may prefer to analyze gait patterns and gait speed on the Gait Trainer 3. Variations in evaluative techniques are based on each therapist’s preference.

Gait training can begin once the patient’s gait speed and impairments have been determined. Initializing Sound Bar

Sound Bar Components

• Jack for headphones to assist with patient focus and an additional jack for microphone

• Thumb drive

• Volume control

Operating the Sound Bar

• Turn on using the power switch located on the right side of the sound bar.

• Adjust the volume. Some patients may benefit from use of the headset. The jack is located on upper right corner of the sound bar. There are two jacks available: one for the headphones and one for a microphone.

• Select a musical composition that best suits the needs of the patient. Typically, RAC is the initial technique to assist with a patient’s cadence and is the initial treatment for the majority of patients.

Fitting Music to a Patient’s Cadence Using the Gait Trainer 3 (GT3)

Fitting the music refers to determining the steps per minute (spm), allowing for the initiation of the entrainment process and selecting the appropriate music that will facilitate movements the patient is lacking. Fitting the music properly to the patient will help the patient perform at their optimal performance level. Have the patient sit and listen to the music, and have them tap their foot or feet to the beats per minute (bpm). This will be the first step in the entrainment process.

6 MUSIC FOR THE GAIT TRAINER 3 • Entrainment. Allow the patient to get comfortable with the Gait Trainer, and let them walk a few minutes at a speed slower than their natural cadence. Typically spm is dropped to 40-50 percent of their baseline walk test. Slowly increase the belt speed (spm) as per the patients tolerance. This will further assist with regulating their natural cadence time, completing the entrainment process. Entrainment will be observed when the person appears to walk naturally to the music in a more relaxed and natural pattern.

• Set initial speed/tempo. At this point the patient has completed their walk test, spm have been calculated and the patient has worked on entrainment in sitting and walking on the Gait Trainer 3 at their own particular cadence time. The next step is to gradually increase the belt speed based on the patient’s level of comfort and performance. With the patient on treadmill, adjust the walking speed until desired spm is reached.

• Begin gait training. When it is time to start gait training, begin working on one gait component: heel strike (HS). The goal is for the patient to walk step-over-step bilaterally at the established tempo.

• Adjust music and speed. Based on analysis of the person’s gait pattern, adjust the music (bpm) and speed (spm). NOTE: The therapist must become familiar with the music library in order to make distinctions in each composition to select the appropriate use of songs (e.g., those with cognitive and severe gait impairments may require “Animals Everywhere” exercise).

• Observe and watch for subtle functional corrections or exacerbation of movement issues. Discontinue music playback if exacerbation is observed and return to metronome option until the correct fit of music is determined.

• Change tempo. To progress the patient during the treatment phase, increase the tempo of the music gradually in 5-10% increments.

• Fading. RAC should be faded, while encouraging the patient to maintain their RAC frequency. The patient can work on mental imagery of the music during ambulation.

• Frequent Modulation. Based on observation of the individual’s gait pattern, frequent changes in tempo and musical selection should be made to fine-tune gait components.

IMPORTANT! Reassess the patient’s progress at the next follow-up session.

Biodex Medical Systems, Inc. 7 Influencing Gait Patterns Using Music: Overview Pitches or Octaves: Effect on Movement

Higher – Affects head, upper body alignment, head height

Lower – Affects mid trunk

Lowest – Affects lower legs and feet

Animals Functional Auditory Everywhere Movement Instrument Strategies Cue bpm Goal 45-108 bpm Initial contact Metronome/ RAC ࡟࡟ Constant music (heel strike) bass drum ࡟࡟ Facilitates heel strike 45-108 bpm Initial contact Bass guitar RAC ࡟࡟ A crisp sound with greater force assists with increasing stride length Metronome/ (heel strike) ࡟࡟ Tends to get people to stroll downbeat of ࡟ At slower movement ranges, it helps with continuity of songs ࡟ movement (helpful with Parkinson’s and FOG). ࡟࡟ (79, 89,108 bpm) Can use this beat for gait, but can take a person to half time. Helps with increasing stride length and decreasing walking speed. ࡟࡟ Cues the patient to slow down and take longer steps ࡟࡟ Helps to reset the patient’s automatic movement ability (once mastered, cue patient to step/walk and increase tempo again) With 89/108 Step length Piano/bass RAC ࡟࡟ Downbeat to facilitate heel strike and with more force to bpm piano/ encourage step height Weight shift bass together ࡟࡟ Two different alternating notes to facilitate weight shifting ࡟࡟ Useful for patients with neglect. Unilaterally, PT can cue lead foot to coincide with sensory cue to affected side.

BASS & KEYS created to help bilateral gait components – e.g. trunk rotation, arm swing & weight shifting

42-108 bpm Upper trunk Guitar RAC (SEM ࡟࡟ Facilitates: provides ••Trunk rotation and anterior trunk posture for those in extension Mid swing anticipatory ••Arm swing and initial swing phase of gait cycle pattern for ••More of a side-to-side movement (makes a person want to lift, mid swing side-to-side) swing) 45-108 bpm Mid trunk Saxophone SEM ࡟࡟ Created as a gentle wave – relaxing feeling ࡟࡟ Helps with movement initiation. Helpful for patients with FOG. Initial to mid ࡟ Pulling sensation at lower walking speeds; for trunk rotation swing ࡟ and upward trunk extension ࡟࡟ Forward movement and smooth UE swing (especially at slower tempos) 45-108 bpm Posture Clarinet SEM ࡟࡟ Higher-pitch octave for more trunk elevation elevation ࡟࡟ Pulling sensation ࡟࡟ More UE/spine/height extension than SAX since octave is higher 45-108 bpm Posterior WS Trombone SEM ࡟࡟ Facilitates hip/trunk rotation ࡟࡟ Forward smooth momentum with pulling through core and hips Lower legs ࡟࡟ Ground LE movements midstance

45-108 bpm Endurance Midway 2-3 ࡟࡟ Helps when person is not moving forward burst min cues built ࡟࡟ Helps provide extra boost when person is fatiguing in emotionally ࡟࡟ Only used in short bursts, not continuous sound followed and movement clarinet ࡟ Monitor patients prone to ambulating with a festinating quicken sound ࡟ gait pattern

8 MUSIC FOR THE GAIT TRAINER 3 Techniques to Facilitate Gait Components Using the Gait Trainer 3 Samples taken from compositions designed for use in the Biodex Gait Trainer 3

Animals Everywhere (gentle forward-pulling sensory experience throughout piece): BPM Time Activity Guitar pattern for leg lift, extension and drum playing downbeat for consistent heel strike from 0:00 - 2:08 beginning through end of song. Wind instruments added to provide sensory cue to smooth out movement and cue UE upward 2:08 postural alignment. 45 bpm 3:30 Medium enhancement of forward/progressive sensation to music for endurance boost. 4:15 Musical cue for UE and head floating upward, as well as cue for home stretch to end. Music builds stronger layers of instruments such as bass line for enhanced sense of forward movement, 5:09 with further smoothing out of movements and overall increase in quality of movement. Metronome begins for 15 seconds alone for heel strike. Guitar pattern again, for leg lift and extension. 0:00 - 0:26 Acoustic quality of a march to enhance upward and longer stride. 2:30 Mark bass line with texture of instrumentation with accent and texture to facilitate rotation. 57 bpm 3:40 Simple, lighter texture quality to music to relax, support endurance. 4:30 Bass line to support longer stride cue. 4:53 Music adds eighth notes towards end of song to support progressive feel when fatigue can become issue. Stronger layering of downbeat for heel strike and initiation of movement. Use bass line at 36 bpm to 0:00 - 0:26 open and elongate stride, then bring them back to drum/metronome at normal 72 bpm.

72/36 bpm 0:53 - 1:05 Use music cues to support increased postural alignment. 1:20 Sensory patterns to support weight shift and UE rotation. 4:12 Head floating, body well balance over mid foot. Bass again at 45 bpm to open stride and piano/bass combination to provide L/R weight shift cues. Can 0:00 - 0:21 exaggerate dystonia for patients with strong one-side dystonia, i.e. exaggerate a curled arm or upward leg curl. If this happens, use other Animals Everywhere tempo track or Street Walking either tempo range. 89/45 bpm 1:08 Music cues smoothing quality to movement. 3:20 Increased texturing of instruments to better integrate postural alignment and smoother quality in gait. Bass again at 45 bpm to open stride and piano/bass combination to provide L/R weight shift cues. Can 0:00 - 0:21 exaggerate dystonia for patients with strong one-side dystonia, i.e. exaggerate a curled arm or upward leg curl. If this happens, use other Animals Everywhere tempo track or Street Walking either tempo range. 108/54 bpm 1:08 Music cues smoothing quality to movement. 3:20 Increased texturing of instruments to better integrate postural alignment and smoother quality in gait. Street Walking 0:00 - 0:26 Heel strike first. Gentle pushing quality to sensory pattern, builds movement up then backs off and gives anticipatory 1:19 72 bpm cues for more complex UE/LE complex coordination. Integrate texture for full hip extension and UE rotation, arm swing. Throughout piece, more up/down as 2:13 well as sideways (rotate/weight shift) enhanced quality for more complex gait movements. 0:00 - 0:26 Heel strike first, with smooth progression of movements. 90 bpm 1:45 Coordination to integrate hip flexion, rotation and more open, relaxed natural arm swing. Silvery Moon Medley Simple (RAC) heel strike for functional improvements in stride length and symmetry. SEM swing pattern for All Tempos: 0:00 - end normalized gait. Only 3 simple instruments, no confusing extra sensory or over-stimulating patterns present.

All other songs preloaded in the GT3 system are meant for use with patients who have mild to moderate gait impairment with mild to no known cognitive or sensory sensitivity issues, such as the orthopedic population.

Biodex Medical Systems, Inc. 9 Pending Discharge Sending the Patient Home with an Exercise Program

For ongoing patients emerging to independent levels and/or preparing for an upcoming discharge, music selected by the therapist containing prescribed tempos for their unique movement goals can be transferred from the gait trainer sound bar via thumb drive. Music can be downloaded onto a mobile device for personal home use. The patient can gait train when discharged to home and still listen to specific musical and/or handpicked genres in the clinic. The goal is consistency of carryover and lack of decline following their release from therapy.

In addition, patients can perform sensory/motor driven exercises at home with preselected rhythms or music to encourage higher level movement patterns. Movements can include arm swing, reaching, squatting, single-leg stance, and toe tapping while utilizing instruments or household items for visual and auditory cueing. Appropriate musical instruments are selected based on therapeutic techniques which emphasize range of motion, endurance, strength, and coordination.

10 MUSIC FOR THE GAIT TRAINER 3 Selected Abstracts Turning and Unilateral Cueing in Parkinson’s Disease Patients with and without Freezing of Gait (2012)

Spildooren, J. Vercruysse, S., Meyns, P., Vandenbossche, J., Heremans, E., Desloovere, K.,Vandenberghe, W., Nieuwboer, A.,

BACKGROUND: Freezing of gait (FOG) is one of the most disabling symptoms in Parkinson’s disease (PD), and cueing has been reported to improve FOG during straight-line walking. Studies on how cueing affects FOG during turning are lacking. Given the asymmetrical nature of turning and the asymmetrical disease expression, we aimed to gain a new perspective on how unilateral cueing may alleviate FOG.

OBJECTIVE: To explore disease dominance and turning side as contributing factors to turning problems and FOG and to investigate the effect of unilateral cueing.

METHODS: In the first study, 13 PD patients with FOG (freezers) and 13 without FOG (nonfreezers) turned toward their disease-dominant and nondominant side (off medication). During the second study, 16 freezers and 14 nonfreezers turned with and without a unilateral auditory cue at -10% of preferred cadence. Total number of steps, turn duration, cadence, and FOG episodes were measured using VICON.

RESULTS: Cadence, but not FOG frequency, was higher when turning toward the disease-dominant side. FOG started more frequently (64.9%) on the inner side of the turning cycle. Unilateral cueing seemed to prevent FOG in most patients, irrespective of the side at which the cue was offered. A carryover effect was found for cadence during turning, but the effect on FOG disappeared when the cue was removed.

CONCLUSIONS: The occurrence of FOG is not influenced by turning toward the disease-dominant or nondominant side, which is confirmed by the fact that it does not make a difference at which side unilateral cueing is applied. Cueing reduces FOG during turning, but these effects disappear dramatically after cue removal. This raises further questions as to the influence of training on cue dependency and on the feasibility of either continuous application of cues or using cognitive strategies as an alternative.

Biodex Medical Systems, Inc. 11 The Effects of Therapeutic Instrumental Music Performance on Endurance Level, Self-Perceived Fatigue Level, and Self-Perceived Exertion of Inpatients in Physical Rehabilitation (2011)

Lim, Hayoung & Miller, Karen & Fabian, Chuck.

ABSTRACT: The present study investigated the effects of a Neurologic Music Therapy (NMT) sensory-motor rehabilitation technique, Therapeutic Instrumental Music Performance (TIMP) as compared to Traditional Occupational Therapy (TOT), on endurance, self-perceived fatigue, and self-perceived exertion of 35 hospitalized patients in physical rehabilitation. The present study attempted to examine whether an active musical experience such as TIMP with musical cueing (i.e., rhythmic auditory cueing) during physical exercises influences one’s perception of pain, fatigue, and exertion. All participants were diagnosed with a neurologic disorder or had recently undergone orthopedic surgery. Investigators measured the effects of TOT and TIMP during upper extremity exercise of the less affected or stronger upper extremity. Results showed no significant difference on endurance measures between the two treatment conditions (TIMP and TOT). Statistically significant differences were found between TIMP and TOT when measuring their effects on perceived exertion and perceived fatigue. TIMP resulted in significantly less perception of fatigue and exertion levels than TOT. TIMP can be used for an effective sensory-motor rehabilitation technique to decrease perceived exertion and fatigue level of inpatients in physical rehabilitation.

Gait Improvement in Patients with Cerebral Palsy by Visual and Auditory Feedback

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.

MATERIALS AND METHODS: Visual and auditory feedback cues were generated by a wearable device, driven by inertial sensors. Ten randomly selected patients with gait disorders due to cerebral palsy and seven age-matched healthy individuals trained with visual feedback cues, while ten patients and eight age-matched healthy individuals trained with auditory feedback cues. Baseline performance (walking speed and stride length along a 10-m straight track) was measured before device use. Following 20-min training with the device and a 20-min break, performance without the device was measured again and compared with the baseline performance.

RESULTS: For the patients who trained with visual feedback, the average improvement was 21.70% ± 36.06% in the walking speed and 8.72% ± 9.47% in the stride length. For the patients who trained with auditory feedback, the average improvement was 25.43% ± 28.65% in the walking speed and 13.58% ± 13.10% in the stride length. For the healthy individuals who trained with visual feedback, the average improvement was -2.41% ± 9.54% in the walking speed and -2.84% ± 10.11% in the stride length. For the healthy individuals who trained with auditory feedback, the average improvement was 0.01% ± 7.73% in the walking speed and -2.03% ± 6.15% in the stride length.

CONCLUSIONS: Training with visual and auditory feedback cues can improve gait parameters in patients with gait disorders due to cerebral palsy. This was contrasted by no improvement in age-matched healthy individuals.

12 MUSIC FOR THE GAIT TRAINER 3 About the Authors Hope Young, MT-BC, Founder/CEO, Center for Music Therapy, Inc. Austin, Texas Executive Producer, Movement Tracks Project

Hope Young is the founder and CEO of the Center for Music Therapy, Inc., the first and oldest for-profit music therapy facility in the world specifically designed to research and treat neurologic movement conditions and disorders through music. Ms. Young is a member of the National Academy of the Recording Arts and Sciences, the American Music Therapy Association (AMTA), Austin’s smart city consortium (ACUP), and the Healthcare Information & Management Systems Society (HIMSS). She is a leading global innovator and driving force behind the concept and development of merging music and biotechnologies as a health solution. Among other honors, she was a 2017 recipient of the Intelligent Health Award (IHA) for her research, patents, and the work of her Movement Tracks Project team in reducing the risk of falls and improving patients’ experience in treatment of movement disorders via the application of music. Kristen Barta, DPT, University of Augustine, Austin, TX Lead Researcher, Movement Tracks Project

Kristen Barta graduated from Texas, A&M University with a B.S. in Biomedical Science, and then completed her M.S. in Physical Therapy from Texas Woman’s University in 2002. Barta has worked in a variety of settings including outpatient, acute care, inpatient rehabilitation, and the ICU with a primary focus on the neurologically involved population and individuals with amputations. She completed her Doctor in Physical Therapy from Boston University in 2008, became board certified in Neurological Physical Therapy, and successfully completed her certification in Vestibular Rehabilitation through Emory University and the American Physical Therapy Association. In addition to teaching at the University of St. Augustine, Barta is researching the combination of gait training and music therapy for persons with Parkinson’s disease and cerebral palsy and assists in developing biotechnologies in these areas. Rachel Throop, DPT, Sr. Therapist, St. David’s Rehabilitation/Center for Music Therapy/Movement Tracks Project

Dr. Throop graduated from Washington University in St. Louis in 2006 with a Doctorate in Physical Therapy. She then returned to Austin, Texas to begin her career as a physical therapist. She is a Lead Physical Therapist at St. David’s Rehabilitation Hospital in Austin. Dr. Throop has worked in the inpatient department at St. David’s for 11 years, and assisted in development of their outpatient Parkinson’s Program. She also works with individuals with movement disorders in the home setting and facilitates individual and community-based exercise groups in conjunction with music therapists at the Center for Music Therapy. Dr. Throop is a certified LSVT BIG® therapist and a PWR!Moves® Therapist. Her current research includes investigating the impact of individualized therapist-selected music on the gait pattern of individuals with movement disorders at the Center for Music Therapy and University of St. Augustine.

Biodex Medical Systems, Inc. 13 Emily Morris, MT-BC, NMT/Clinical Team Leader, Center for Music Therapy/ Movement Tracks Project

Emily Morris is a board-certified music therapist who graduated in 2011 with a degree in Music Therapy from Florida State University in Tallahassee. After completing her internship in music therapy at Big Bend Hospice in Tallahassee, she moved to Austin, TX to join the clinical team at Center for Music Therapy, Inc. Ms. Morris specializes in Neurologic Music Therapy (NMT), researching, co-treating, and working closely with physical therapists in individual and group settings. She travels internationally to speak and train allied health partners in developing countries and isolated communities in the use of music in care delivery. Morris was a compositional contributor to the historic 2015 Movement Tracks Project recordings, and a key collaborator with Biodex Medical Systems, Inc. in development of the Gait Trainer 3 music option prototype. Ms. Morris is currently researching the impact of individualized therapist-selected music on the gait pattern of individuals with movement disorders, and collaborating on recordings for use with severe and profound movement related disorders. Natalie Thompson, PT/Education Administrative & Applied Clinician, Biodex Medical Systems, Certified in NMT

Natalie Thompson is a 1992 graduate of SUNY at Stony Brook with a dual degree in Biology and Physical Therapy. She has a background in clinical, managerial and educational settings. Natalie has practiced for ten years in orthopedics with specialized training from the McKenzie Institute and Institute of Physical Art. Since 2001, she has focused on working with neurologically impaired patients. Natalie was a hands on manager for United Cerebral Palsy for six years, after which she began treating young children up to five years of age. She was an adjunct teaching assistant for Stony Brook University in the Physical Therapy program. Currently, Natalie works for Biodex as a Clinical Administrator and Applied Clinician. She remains a part time treating clinician and consultant working with children up to three years of age.

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Biodex Medical Systems, Inc. 15 Biodex Medical Systems, Inc. 20 Ramsey Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9338, Email: [email protected], www.biodex.com

FN: 18-313 9/18